EmergencyPedia

Phillip Hughes

Like many cricket lovers around the world, I had a soft spot for Phil Hughes. I can still remember the dread I felt as an England supporter watching him thrash a very good South African attack for back to back hundreds. What on earth would he do to our bowlers? Given that he was only 20, I thought we could have another 15 years of watching him put the best bowlers in the world to the sword. His career went a bit off track but  he was only 25 and I agreed with Alan Border – Hughes would still play a 100 tests. If only.

 A Rare Tragedy

An out of hospital cardiac arrest can be terrifying – many of us struggle outside of our comfort zone.  The idea that this could happen to a 25 year old in the prime of his sporting career is terrifying.  It has happened before (and has been widely reported) but because it is relatively rare it is truly confronting.  We had all hoped for a similar outcome to that of Fabrice Muamba in the English Premier League in 2012 but tragically two days after being struck by the ball Phillip Hughes succumbed to his injuries.

Clearly, this injury (apparently a Verterbral Artery Dissection leading to Subarachnoid Haemorrhage) was absolutely catastrophic.  This injury would have been fatal regardless of the available management at the scene or in the nearby hospital.  Having said this, like many others who have seen the news report’s footage I have several questions about the initial care provided.  When the dust settles, I think the initial management should be reviewed because we should always aim to do better.  Next time the sports person or crowd member may have a survivable injury that needs a rapid response.  So with this in mind perhaps we need to make some changes in the future not only in cricket but in all major sporting events…

Reports of The Event

I am puzzled by some of the reporting in the Sydney Morning Herald (SMH) as it seems to be contradicted by the available footage of the tragedy.  The SMH’s claims such as “the team doctor who intubated him with oxygen from the ground’s new defibrillator” or “Watson and Haddin, …placed their former Blues teammate in the brace position”.  The narrative of the media as a whole seems to be the bystander medics at the game did exactly the right thing and that the ambulance service are the apparent villains for a delayed low priority response.   From what can be deduced from the the footage there is also a degree of disbelief on the part of bystanders and apparently no compressions (which may not have been indicated) or opening of the airway being provided (Hughes is lying on his back and not in the recovery position).  While I have no place to judge the bystander’s actions, there does appear to be complete disbelief and a “shock” effect similar to the case of Hank Gathers (which we will discuss further below).

For the moment, however, let’s acknowledge that all the Emergency Responders did their best at the time under very difficult circumstances and they gave Phil Hughes a “fighting chance” with minimal resources.  I’ve provided the links below so you can make up you own mind about the information reported:

• Link 1 – Timeline

• Link 2 – Medical Care

• Link 3 – Analysis

“Hands Only CPR”

If a player collapsed during a game in the local park, how many people present would know what to do? It is actually a concern that not enough people know how to (or are willing to) perform basic CPR.  And it is now so simple. You don’t have to do mouth to mouth, you just do chest compressions – hard and fast – till the ambulance gets there. Forget about feeling for a pulse. If they are unresponsive and not breathing normally, call for an ambulance and start chest compressions. You won’t do any harm and you may save a life.  So what are the barriers?  Is it cultural? Or is it just disbelief that a young person can just collapse and stop breathing on the field of play?

This area is currently highly topical in the literature – just in September the EMJ published a study looking at (specific local) attitudes into providing bystander CPR:

This ‘bystander effect’ has also been observed in Western Cultures – including large teaching hospitals:

This phenomenon is widely known as Genovese Syndrome.  It is named after Kitty Genovese whose murder was witnessed by 38 people in New York.  The events were not stopped and not reported to police baffling generations of psychologists, sociologists, and ordinary people alike:

So why do and teach hands only CPR – well it’s easier to train a lot of people quickly and you can spend time focusing on getting the basics right – there are much less barriers in pushing on a chest compared to the proverbial “kiss of life”.

In both the United Kingdom and the United States there were television adds teaching “hands only CPR”:

 

In 2013 The Australian Resuscitation Council had a YouTube CPR video competition to “to facilitate the mission of the Australian Resuscitation Council (ARC): that “any attempt at resuscitation is better than no attempt”.

The results were brilliant:

I’m not sure if these videos were ever shown on TV but perhaps it is time that they were…

 

Medical Help at Major Sporting Events

• What should the role of the team doctor be?  
• What help should be available at sporting events?
• Is the team doctor there to treat minor sprains or fractures or is he there in case a player sustains a critical injury?

If one was to expect an abundance of critical illness at a game then the team doctor should be some-one whose day job involves the initial resuscitation of the critically ill; in other words, an ED doctor or anaesthetist.  However, these tragic events are really just so rare and low crowd numbers at State Level cricket are too small to justify the presence of medical team or ambulance to treat emergencies in the crowd.  Even in large sporting events a critical care practitioner would generally be redundant.  

Why training and preparation are important?

From my understanding of the history of these type of tragic events even with large crowds and trained responders there is no guarantee of a rapid response.  Perhaps this is due to the disbelief that athletes in the prime of their fitness and ability could just drop on the field of play.  A classic example of this was Hank Gathers a college basketball player who died of a Cardiac Arrest on court in the 1990s:

CLICK HERE (warning – confronting footage)

Similar cases have been reported in many sporting areas leading to campaigns to have defibrillators at sporting events.  Organisations such as the Craig Hodgkinson trust advocate and fund defibrillators (AEDs) at all sporting events:

For more on the Craig Hodgkinson Trust – CLICK HERE

The Future

Perhaps the current role and training of the sporting team medical support staff should be looked at. Is the team doctor there to treat minor sprains or is he there in case a player has a critical injury?  The set-up of having a critical care doctor at every game isn’t practical in most circumstances so perhaps training the public and non-specialised medics is the key.  The important components of training would include simplified first aid (basic life support) with a focus on “real life” practice, operation of AEDs.  It is also important to spend time in training sessions on the practical application of skills and open discussion about the barriers to responding promptly.  These changes would be a pertinent change and may save a life where there is a reversible pathology.