Can you hear me coach? A communication model for field sport games

By Garrett Fintan Coughlan @garrett_physio, Andy Friend @andyfriend2011, Brian Green @briangreen36 and Jonathan Hanson @sportsdocskye

In the high pressure environment of professional field sports games, growing numbers of medical personnel are required to provide care. The interprofessional environment has created a higher demand on non-technical skills called ‘human factors’ which include situational awareness, decision making, communication, teamwork and leadership. These skills should be learnt to ensure good clinical outcomes and optimal patient care. Communication strategies commonly exist in disaster relief [1], military and aviation settings [2], however, there is a paucity in the sports medicine literature. Standardised, accurate and unambiguous exchange of information between medical personnel, facilitate informed medical decision making–the highest possible standards of player care and reduced time wasted with non-essential information. In this editorial, we propose a practical medical communication model for field sport games.

PRE-GAME

Pre-game meeting

The pre-game meeting with on and off-field medical personnel (Table 1) from both teams outlines individual and key leadership roles in addition to medical room and pitch protocols (e.g., catastrophic emergency, extrication plan, equipment available, video review). A clearly identifiable leader with clear and concise instructions are two of the most important factors that may differentiate between success and failure of a critical incident [3]. We recommend that all medical personnel agree on the communication protocols outlining the use of verbal (see below In-game) and non-verbal strategies (e.g., hand signals for injurious events / resuscitation team / blood / head injury assessments (HIA)) to manage potentially injurious on-field events. Coaching and medical staff not present at the meeting, should be made aware of any local variations to protocols to ensure clarity pre-game.

Table 1: Sample on-field and off-field medical personnel in professional club rugby

On-field Home Team On-field Visiting Team Off-field Medical Team
On-field Team Doctor On-field Team Doctor Match Day Doctor
On-field Physiotherapist On-field Physiotherapist Immediate Care Lead
Support Physiotherapist Support Physiotherapist Advanced Paramedic
Soft-t issue Therapist Ambulance Team
Video Review Technician
Medical Room Video Reviewer

 

Radio check

Professional teams typically use a secure radio system for in-game communication, allowing for tactical and medical information to be relayed between coaching and medical staff.  We recommend that the off-field medical team have an independent radio system to facilitate communication given their potentially different locations in game.  Teams should ensure that a pre-game radio check is completed.

IN GAME

Pre-field entry

Identifying and communicating potentially injurious on-field events by players, coaching and medical staff may expedite the initiation of a care plan (e.g. medical staff video review / off-field medical staff activation), and/or coaching staff to prepare a substitution. Informing the refereeing officials of a significant injury may allow for the game to be stopped for appropriate medical care in a safe environment.

Have I got your attention?

With large staff numbers on the radio system, clarity on the source and destination of the message are critical to ensure information is transferred between the relevant personnel.  At the start of each message the source should state their name/role and the destination of the message, e.g. ‘Doctor to Coaches….’ , followed by the message with verbal acknowledgement of the receipt of information using the same strategy.  Additionally, the use of the aforementioned hand signals may provide immediate feedback to those pitch side regarding on-field events.

The 3 Ps: Player – Problem – Plan

Medical staff should be timely and consistent with their verbal communication. We propose using the ‘3 Ps: Player – Problem – Plan’, when relaying injury information (Figure 1).  This strategy can give clarity for those listening and standardises the information flow for each potential injury event, particularly given the differing professions and potentially different medical staff members rotating game cover in-season.

Player: Identifying the player involved by their full name minimizes ambiguity arising from using a player’s nickname or one with the same or similar name.

Problem: Outlining the issue with clinical language relevant to the addressee is essential. For example, a coaching staff message may be the type and site of injury (‘calf muscle strain’), whereas an off-field medical personnel message may require more specific clinical terminology (e.g. ‘appeared ataxic following the collision’).

Plan: A definitive and concise plan should be communicated following each stage of the on-field assessment. For example, following the initial assessment the plan may be that further assessment is required to determine the extent of the injury or that the player may need to be removed immediately.

POST GAME

A post game debrief should be undertaken by medical personnel to review medical events, as well as the efficacy of protocols and the communication process. Finally, the plan of care for injured players should be shared with the medical personnel.

In this editorial, we outlined a potential communication model for medical staff involved with field sport games and conclude that to ensure effective working relationships and optimal player care, the consistency and clarity of information pre, in and post game is essential.

***

Garrett Coughlan @garrett_physio has over 10 years experience working as a sports physiotherapist in elite rugby. Currently, he is the Lead Physiotherapist with Connacht Rugby in Galway, Ireland. He completed his undergraduate and postgraduate studies at University College Dublin and went on to work with the Irish Rugby Football Union for five years prior to his current role. He has combined his clinical work with research over the past 15 years, primarily in the areas of lower limb rehabilitation and assessment, athlete profiling and concussion. Email: Garrett.coughlan@connachtrugby.ie
Andy Friend @andyfriend2011 is the current Head Coach of Connacht Rugby in Ireland. Andy has been a professional rugby coach for the past 25 years and has extensive experience coaching around the world in countries like Japan, Australia, UK and now Ireland. His passions include his family, the outdoors and anything competitive.
Brian Green’s @briangreen36 sports physiotherapy and high-performance experience spans over 20-years. He is the Lead Physiotherapist and Performance Manager for the USA Rugby Men’s 7’s Program. Recently, he was critical in implementing several high-performance initiatives that focused on coaching development and off-field player mentorship. In 2004, Brian joined the IRFU Senior Men’s 15’s team management. During this time he expanded his rugby depth and breadth by engaging in several academic and clinical research projects in injury prevention, performance profiling, and analysis of high-performance structures. Brian has a Ph.D. from the University College Dublin. He was part of Team USA Rio 2016 and is looking forward to Tokyo 2021!
Jonathan Hanson @sportsdocskye is a Consultant in Sport and Emergency medicine in NHS Fife in Scotland.  He was involved in the development of elite and grassroots pitch-side emergency medical courses for World Rugby and the FA Premier League amongst others for over a decade, before moving on to look at human factors, pitch-side risk and error minimisation in elite sport.  He is an active team physician working in professional rugby and Olympic games with Team GB and worked at the 2018 FIFA World Cup in Russia with England with a specific focus on team work, risk management and decision accuracy around on field head injury and immediate care incidents.

Competing interests

None declared

References

1 Shittu E, Parker G, Mock N. Improving communication resilience for effective disaster relief operations. Env Sys Dec 2018;38:379-397. doi.org/10.1007/s10669-018-9694-5

2 Burke CS, Salas E, Wilson-Donnelly K, et al. How to turn a team of experts into an expert medical team: guidance from the aviation and military communities. Qual Saf Health Care 2004;13:96–104. doi.org/10.1136/qshc.2004.009829

3 Jan Ekstrand J, Lundqvist D, Davison M, et al. Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs. BJSM 2019;53:304-308. doi.org/10.1136/bjsports-2018-099411

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