Q: Mike Healy, can you tell us a little about your roles and responsibilities at The FA?
MH: As Head of FA Medical Education, I have the responsibility for the delivery of a high quality medical education programme for the whole game that is appropriately resourced and delivered by tutors with strong FA Learning values.
That involves managing the development and delivery of FA Emergency and First Aid for Sport courses.
These have been specifically designed for healthcare professionals such as doctors and physiotherapists in the professional game and for non-medical professionals, such as coaches, teachers and parents in both the professional and grassroots game.
To facilitate the latter, I manage a small team of FA Regional Medical Coordinators (FARMC) who in turn work directly with The FA Licensed Medical Tutor workforce in their respective regions.
One of the primary areas of work last year has been the development of a ‘fit for purpose’ MSc in Exercise and Sports Medicine for the football industry. This we have achieved in collaboration with the University of Birmingham.
Q: Can you tell us a bit about your background?
MH: I qualified as a Chartered Physiotherapist in 1985 and have extensive experience working across sport as well as time spent serving in the military.
I spent 22 years with the armed forces, which included 15 years with the Royal Navy and five with the Army. I experienced active tours in both the Falklands and in Bosnia.
I was Head Physiotherapist in seven military units, including the Commando Training Centre Royal Marines and Headley Court Joint Services Physiotherapy Department.
I joined The FA 12 years ago where I worked as Head of Medical Services to England Development Teams (U16-U20s) for five years before becoming Head of Medical Education in 2010.
Q: Can you give us an insight into the scope of medical education provided by The FA for coaches?
MH: Every player at any level of football should be able to participate in a safe environment with the reassurance that their medical interests have not been overlooked.
The FA Medical Department therefore strongly recommends that whenever football activity, be it competition or training, is taking place, an individual who has completed an appropriate first aid course is in attendance.
A coach's primary role is clearly to coach. However, in many instances it is the coach who has to undertake the role of first-aider. As such, they must be able to respond quickly to the needs of a casualty on the field of play in order to identify injury or illness, recognise specific signs and symptoms to provide appropriate treatment.
The Medical Department has therefore developed a fit for purpose, football-specific first aid programme to address coaches’ needs.
Q: What are the current requirements for coaches with regards to their medical education?
MH: Currently, the mandated requirement is that the coach must have The FA Emergency Aid (EA) qualification or an equivalent qualification as a minimum.
Unfortunately, the EA programme only educates participants in basic life support, the recovery position, and how to treat choking, major bleeding and shock.
Thankfully, many coaches have recognised that their needs are greater and have undertaken the FA Basic First Aid for Sport course, which is the minimum recommended qualification for anyone undertaking the pitchside first aider role.
Q: What does the Basic First Aid for Sport (BFAS) course involve?
MH: The BFAS course is a foundation sports first aid course for individuals who, in the absence of professional first aiders, have the responsibility for the provision of pitchside and on-field first aid when supporting football activities.
The course is designed to provide participants with an understanding of the common football and sports injuries and the general duties and responsibilities of a sports first aider.
It also provides the basic knowledge, skills and attitude necessary to recognise and differentiate a major injury from a minor one, as well as the ability to administer basic first aid to a casualty engaged in sports activity or who is in a sports environment.
Q: Has there been a greater focus on medical education for coaches at all levels since the Fabrice Muamba scare and what has the game learned from the incident?
MH: It had been my long held view, one which I have vocalised on many FA emergency/first aid courses, that it would take a high profile incident to alert many individuals to their duty of care responsibility for players.
The Fabrice Muamba case was that such incident. It generated a significant and immediate response from many areas.
In many respects it led to an almost knee-jerk reaction for the widespread distribution of defibrillators. However, what needs to be disseminated was that Fabrice had several shocks from a defibrillator, before and after arrival at hospital, all to no avail.
What kept Fabrice alive was the cardio-pulmonary resuscitation (CPR), in effect, the chest compressions. His survival was also facilitated by being taken to an appropriate facility where his condition could be best managed.
Therefore, having the CPR basic skills has demonstrated most vividly its importance in saving a life.
One further important element in managing any incident is having an Emergency Action Plan (EAP) for each and every environment. It needs to be a plan that is simple, functions with a minimum number of personnel and is robust so that it will work in time of crisis.
Q: How much importance is given to dispelling popular misunderstandings about on-field medical care?
MH: There is a widespread misunderstanding that an injured player who is unconscious may have ‘swallowed their tongue’ and subsequently requires the tongue to be pulled forward manually, followed by immediate positioning of the player into the recovery position (on their side with their head back).
These misconceptions need to be dispelled. Players do not swallow their tongues. In reality it is the relaxed tongue that simply falls back and obstructs the airway.
In the first instance, an airway obstructed by the tongue needs to be managed by appropriate head positioning (head tilt and chin lift), followed by confirmation that the player is breathing normally.
Rolling a player into the recovery position does not mean a player will recover and should certainly not be attempted until normal breathing has been restored.