David Wales is a senior chartered physiotherapist. He completed his graduate degree in physiotherapy at the University of Manchester and later earned a Master of Science degree in Sports Medicine and Rehabilitation from the University of the West of England. After working at Charlton Athletic FC, he has spent the last few seasons working with Arsenal FC. We caught up with him to find out more about pitch side physiotherapy care.
Judging by the rapid recovery made by most players when the physio runs onto the pitch you must have something special in your pitch side bag?
"Not really, it's all standard emergency aid and wound care stuff. Unless there is a head injury or an injury to a goalkeeper, the referee directs the player off the pitch as soon as possible. This means we normally have about 30 seconds to make an assessment on whether the player is fit to continue. As you can't do a lot on the pitch it's pointless carrying too much on. We do have paramedics standing by and all the paramedic equipment, including a defibrillator (emergency machine to restore normal heart rhythm using an electric shock), oxygen and fracture kit is kept by the side of the pitch, just in case there is a serious injury. This means you only take the essential stuff onto the pitch in your bag.
So what is the essential stuff in your bag and what is it used for?
"Well, for serious injuries the most important things are the airway management aids. I have a plastic 'Airway' (device to help air enter the lungs) which can be inserted into the Trachea (windpipe). This is used in an unconscious patient to keep the airway patent, and allows a tube to be inserted which gets air into the lungs. Obviously, this is of primary importance in someone who has a severe injury.
"If a person suffers a head injury they may lose their nervous system's drive to breath and actually stop breathing, so we may have to assist their ventilation using an 'Ambu' bag and face mask (a self inflating bag used to get air into the lungs).
"The other important thing with head injury is the potential damage to the Cervical spine (neck). Sometimes the force to the head can damage the neck, so all head injuries have to be treated as potential 'C spine' fractures which will require immobilisation. For this reason, I always have a hard collar in my bag.
"Fortunately, that equipment is very rarely required. The most common things I have to deal with on the pitch are direct blows, which most often require an ice pack. Occasionally, a player sustains a laceration and the bleeding has to be stopped rapidly. For this reason I have sterile gauze pads, sterile solution to clean the wound and 'butterfly' stitches in my bag. If it's a nasty wound it will have to be thoroughly cleaned before it can be stitched by the doctor. If the cut is on the face then the first aid job is always followed by a consultation with a Maxillofacial surgeon, in order to improve the cosmetic appearance."
So, you don't have a 'magic sponge' in your bag?
"No, sorry. The magic sponge is not so prevalent these days. Some people still use them, but they can only be used once, then they have to be thrown away to avoid the risk of cross infection.
Do you have extra first aid training?
"Yes, the Football Association state that we have to undertake a 'First Aid at Work' course every three years, but this is a minimum requirement. In addition, I've attended an Advanced Trauma and Life Support Course and every month we have London Ambulance Paramedics come in to do emergency aid training to a certified standard. This covers a range of emergency scenarios that hopefully we never have to put into practice."
What is the worst injury you have had to deal with on the pitch?
"Tibia and Fibula fractures are always quite nasty.
However, I find head injuries the most frightening scenario to deal with because
of the potential consequences and the fact that the player can seem fine, then
deteriorate rapidly. "