Sports governing bodies and tournaments will typically implement minimum standards for medical staff, facilities, medications, and emergency equipment for competitions (1, 2).  However, there is a paucity of information to guide medical teams with respect to their individual supply needs for games. The provision of medical equipment to facilitate both player performance and injury/ illness management forms an essential part of a team’s service delivery in a professional field-based team sport setting. This blog, using examples mainly from Rugby Union, aims to outline these medical equipment requirements that can be extrapolated to other sports.

Preparation:

The medical equipment listing should be agreed by the medical team at the beginning of the season and updated in-season as required.  Medical teams should also review guidance from governing bodies to ensure they are in line with the latest minimum operating standards. Teams may stock supplies at their stadium for home games or transfer them from their training base for both home and away games. Cases or bags can be packed in the days preceding the game to allow adequate time for any additional orders to be made with equipment suppliers, and for bags to potentially travel with the kit manager in advance for away games.  When travelling abroad, reviewing the information from Customs for each country is essential to ensure you only travel with medication/equipment that can be safely taken into the country.  It is also essential to have these documented to present to Customs if requested on arrival/departure.  The types of bags that should be considered by teams are listed below (Table 1). The use of a checklist system ensures that the appropriate type and quantity of equipment available for each game (Appendix 1 – Itemised Bags Listing). Consistency in the packing of bags assists different members of the medical team to have clarity on the location of the contents, as well as facilitating prompt access when required.

Off-field	On-field	Pitch-side
Physiotherapist Supplies Bag	Physiotherapist Pitch Bag	Splints Bag
Doctor Supplies Bag (including suture box, primary care supplies and sport-specific equipment)	Doctor Pitch Bag	Emergency Bag (including defibrillator, analgesia and oxygen supplies)
Medications Case		Vacuum Mattress
Recovery Devices		Split and/or Spinal Board and blocks
Medical folder		Collar

Table 1: Off-field, on-field and pitch-side bags from professional teams.

Off-field bags

These bags will typically be used pre and post-game by the medical team to carry both physiotherapy and medical equipment.

Physiotherapist Supplies Bag

This bag contains all of the squad strapping requirements including tape, sprays and protective items. Therapists should consider laying tape out on a table for players to utilise pre-game (e.g. line-out strapping), whilst items to be such as dressings and compression bandages should be laid out separately to provide easy access to same for immediate post game packaging of players.

Recovery Devices

Teams may utilise different recovery devices that are used post game as part of a player’s injury management and generic recovery (e.g. cold and active compression devices).

Doctor Supplies Bag

Doctors may wish to have supplies present in the medical room at games to deal with several common situations. Many doctors will have a suture box or area set-up pre-game should this be needed during a game. Similarly, a range of primary care diagnostic equipment (such as otoscopes, stethoscopes, thermometers etc) is often useful, especially for the travelling physician. Medical teams should also ensure that sport-specific equipment is also ready for match-days, such as ‘tablets’ to facilitate the Head Injury Assessment (HIA) process in rugby union. The doctor should also work with the medical team to ensure that a folder is available which is filled with pertinent medical information for each player (allergies, medications etc), as these can be invaluable in emergencies, as well as any baseline information that may be needed.

Medications Cases

Alongside the critical emergency medications, doctors may wish to have a supply of commonly prescribed medications on hand, especially if the team is touring and access to pharmacies is limited. Commonly prescribed and useful medications for games (or the surrounding period of time) would include oral analgesic medication, anti-inflammatories, anti-histamines, anti-emetics, topical creams (such as Fucidin and chloramphenicol ointment), and gastro-intestinal medications (including loperamide and buscopan). Other medications such as glyceryl trinitrate and aspirin will often be stocked, as well as oral contraceptives and medications to deal with symptoms associated with the menstrual cycle (such as tranexamic and mefenamic acid). Doctors should ensure that storage of these medications complies with local governance regulations, and that medication boxes are locked.

On-field bags

These bags will be carried by the on-field medical team on to the pitch from their touch line positions (3). In the case of inclement weather, some of these supplies can be protected inside a plastic bag to keep them dry and adhesive if required. On-field medical staff should wear gloves that are changed and disposed of accordingly in-game. It is useful to place some gauze and nose plugs under the glove on the dorsal aspect of the thenar eminence of the non-dominant hand to facilitate access when addressing blood injuries along with some saline pods for removing dirt.  If multiple players wear contact lens that are being held by the medical team during the game, the players initials can be written using a marker on the packaging to avoid confusion in sizings etc.  A small pocket mirror may be useful to facilitate the player putting the contact lens in. Rnergy gels for fatiguing players may also be useful as well as hair bands for players with long hair. Additionally, items such as a pocket mask, methoxyflurane inhalers and oropharyngeal airways for acute emergency care can also be included in external pockets of the bag for rapid access.

Physiotherapist Pitch Bag

This bag should contain the primary tape and blood management supplies that may be required in-game by the on-field physiotherapist. Minimal quantities of tape should be kept in this bag to allow for easy access to all items with another small bag kept pitch side for any top ups.

Doctor Pitch Bag

This bag should contain a wide number of items, to deal with a variety of on-field situations. Blood management supplies should be easily accessible, as well as player-specific medications and supplies (including contact lenses and inhalers etc). Dependent on the proximity of the more formal emergency bags, this bag could also contain useful and easily-transportable emergency equipment as per the physiotherapist pitch bag above.

Pitch-side bags

These bags will be kept pitch-side during the game with easy access for off-field medical team members (e.g. match day doctor, ambulance team). The use of radio communications and hand signals may indicate the requirement for these types of devices to be brought onto the field of play (4). The sizes of immobilising devices should account for anthropometric differences in players. 

Post-game

Post-game a checklist of any equipment used should be made with a note of any items that need to be replaced or repaired ahead of the next game.

Authors and Affiliations:

Garrett Coughlan, Dr Steffan Griffin and Dr Katy Hornby

Garrett Coughlan @garrett_physio has over 10 years experience working as a sports physiotherapist in professional club and international 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@icloud.com

Dr Steffan Griffin @steffangriffin is a Sports Medicine Training Fellow at the Rugby Football Union, and works clinically with London Irish RFC.

Dr Katy Hornby @HornbyKaty is a Sport and Exercise Medicine consultant, and the team doctor for England’s Red Roses team. She also works with Harlequins.

References

1. https://www.rugby-league.com/uploads/docs/Medical%20Standards%202021.pdf/
2. https://www.uefa.com/MultimediaFiles/Download/uefaorg/Medical/02/61/67/19/2616719_DOWNLOAD.pdf)
3. https://blogs.bmj.com/bjsm/2021/04/29/where-do-i-stand-a-game-positioning-model-for-medical-teams-in-professional-rugby-union/
4. https://blogs.bmj.com/bjsm/2020/05/14/can-you-hear-me-coach-a-medical-communication-model-for-field-sport-games/