The Pitchside Medical Bag

Three things decide the contents, and none of them is a list you found online.

The first is not the course you attended. It is your competence. The Faculty of Pre-Hospital Care endorses immediate care in sport courses, and endorsement is a mark of curriculum content and educational quality: it confirms that a course teaches to a standard, not that you may go and do what it taught. What actually authorises a procedure is your current competence, your professional scope, your governance and indemnity arrangements, and the local protocols you work under. A certificate is evidence towards that. It is not the thing itself.

The higher-level courses do add procedures, venous cannulation, chest decompression and a surgical airway among them, and that is where a bag changes. But the question is never whether you did the course. It is whether you are currently competent, covered and permitted to do this, here, today. Your bag should stop where that stops.

The second is the setting. A community club with a defibrillator on the wall needs a different bag from a squad at a remote venue with a long extraction. The question is what you will have to do yourself before help arrives and for how long, and it is answered by your risk assessment and your emergency action plan rather than by an assumption about response times.

The third is the sport. Water, motorsport, combat sports and equestrian each bring problems the others do not, and a generic bag serves none of them well.

None of that makes a heavier bag a better bag. Every item you carry is one more thing to check, to replace, to find under pressure and to justify afterwards.

The bag is organised by the survey, because the survey is how you will think when it matters. Catastrophic haemorrhage, airway, breathing, circulation, disability, exposure. Lay it out that way and you reach for the right pocket without having to decide to.

Catastrophic haemorrhage goes at the top, because it is the only thing that comes before the airway: dressings that work, and a tourniquet if you are trained in one. Then airway, holding the adjuncts you actually use, in the sizes you might meet, including paediatric sizes wherever children play. Then breathing, meaning oxygen where you can carry it and something to deliver it with. Then circulation, which for most people is dressings and a blood pressure cuff rather than a cannula. Then disability, where a glucometer earns its place because hypoglycaemia takes seconds to find and is easy to miss. Then exposure: shears, and something to keep the athlete warm.

If you carry sharps, carry a sharps container and personal protective equipment, and think in advance about where a used needle goes on a wet pitch with a crowd around you. It is not a detail.

Then the grab bag question, which most people never settle. What you run onto the pitch with is not the whole bag. The first is what you need in the first two minutes and can carry at a sprint; the second is everything else. Deciding that split in advance is the difference between arriving with what you need and arriving with everything. Where the rest lives has constraints of its own: medicines are not left in a car boot through a summer afternoon, and oxygen has its own requirements for secure transport and storage.

Restock after use, before the next fixture, rather than waiting for the next scheduled check. And pack documentation, which nobody does and everybody needs.

Drugs are where governance bites. Prescription-only medicines carry rules about who may supply them, who may administer them and under what authority, and being a doctor does not settle all of it, particularly where somebody else will be administering.

The exception worth knowing is adrenaline, and it is narrower than it is usually quoted. UK medicines legislation exempts the administration of adrenaline 1 in 1000 by intramuscular injection for the purpose of saving a life, by anyone, and no Patient Group Direction is needed for that. What the exemption does not do is authorise you to obtain or hold the stock in the first place, or to act beyond your competence. Procurement, storage and governance are separate questions with separate answers, and they get answered before the day rather than during it.

What has left the bag is instructive too. Resuscitation Council UK's position is that chlorphenamine and hydrocortisone are not first-line treatments and need not be included in an anaphylaxis pack, and many club packs still carry them because nobody revisited them. That is a statement about the anaphylaxis pack specifically rather than an instruction to strip them from every bag, but it is a fair prompt to ask whether your bag reflects the guidance now or the guidance you were taught.

Checking is unglamorous and it is where bags quietly fail. Somebody owns it, it happens on a schedule, and it is recorded. Drugs expire, dressings expire, batteries die, and none of it announces itself.

And the bag is not the plan. A perfect bag at a venue where nobody knows where the defibrillator is has solved the wrong problem.

• •The Faculty of Pre-Hospital Care endorses immediate care in sport courses. Endorsement confirms curriculum content and educational quality; it does not confer competence or a licence to practise, and what a practitioner may do is governed by their competence, professional scope, governance and indemnity.
• •The Faculty's pre-hospital emergency medicine skills framework describes levels of practitioner competence, designed to help agencies understand who can do what on scene rather than to record educational attainment.
• •UK medicines legislation exempts the administration of adrenaline 1 in 1000 by intramuscular injection for the purpose of saving a life, without a Patient Group Direction. It does not address procurement or supply.
• •Resuscitation Council UK sets the contents of the anaphylaxis pack, and states that chlorphenamine and hydrocortisone need not be included in it.

• •The bag is a claim about your competence; carry nothing you are not competent and covered to use.
• •Course endorsement confirms educational quality; it does not authorise a procedure.
• •Contents follow your competence, the setting and the sport, guided by the risk assessment.
• •Organise it by the survey, so that you find things without having to decide to.
• •Adrenaline may be given to save a life without a Patient Group Direction; that covers giving it, not obtaining it.
• •An unchecked, unrestocked bag is a decoration.