M R Carmont*, R Daynes+, D M Sedgwick,
The Belford Hospital, Fort William, Highland Acute Hospitals NHS Trust; *University Hospital of North Staffordshire, Stoke-on-Trent; +Sheffield Vocational Training Scheme, Institute of General Practice & Primary Care, Northern General Hospital, Herries Road, Sheffield
Correspondence to:
Mr MR Carmont, C/o Mr Sedgwick’s Secretary, The Belford Hospital, Belford Road, Fort William, PH33 6BS Email: mcarmont@hotmail.com
SMJ 2005 50(3): 106-108
Abstract
Background: Extreme sports events are increasing in popularity, particularly in mountainous areas throughout Great Britain. Emergency medical care for these events is usually provided by voluntary organisations, providing event side first aid and referring patients to nearby District General Hospitals. The Fort William Mountain Bike Race is part of the UCI World Cup Series: 173 competitors racing in cross country, downhill and 4X events. The Belford Hospital provides year round medical care for the Lochaber community, which frequently swells during the tourist season. The hospital has 8300 new attendances per annum, 35 patient reviews per 24 hrs. Methods and Results: We have reviewed the impact of the event on the local hospital. In total 52 riders reported 61 injuries. The hospital treated 24 (14%) riders. Retrospective analysis of attendances has revealed 19 riders attended on race days, increasing attendees by up to 28%. 46% of injured riders were seen at the A&E department, 1 rider requiring admission for observation and 1 rider required inter-hospital transfer. Injury patterns (knee 20%, hand/wrist 18% & shoulder 18%) were similar to other reported series. Conclusions: We believe that extreme sports events can have considerable impact on small district general hospitals. Additional triage and staffing resources should be utilised and event organisers should anticipate the additional problems they present to the local community. District General Hospitals continue to provide a substantial contribution to the provision of health care for extreme sports within the UK.
Key words: Extreme sports, mountain biking, impact, hospital.
Introduction
Mountain bike racing has been increasing in popularity since its development in the 1970’s in the western United States. The disciplines of cross country and downhill have attained Olympic status the first full medals being awarded in 2000. On downhill courses, lasting only a few minutes, racers may reach speeds of 45mph and many wear body armour to prevent injury. On cross country events, races last several hours duration so competitors ride as lightly as possible. In both events helmets are compulsory.
Several studies concerning injury sustained during competitive and recreational off road cycling have been published, principally questionnaire surveys1-7 and observational reports of injuries sustained during the National Off Road Biking Association Series in North America.8,9 Injury rates of 0.4% have been noted from these series. Review articles have also been written concerning the mechanisms of injury.10,11 Jeys et al have commented on the resource implications for rural hospitals regarding mountain biking injuries during a study of the injuries sustained during mountain biking in rural Shropshire.12 Several studies report the impact of mass gathering events on hospitals13-18 however there is little literature on the impact of sporting events on small district general hospitals within the United Kingdom. We reviewed the impact of an extreme sports event, with 173 competitors and 15000 anticipated spectators on the Belford Hospital, a small 51 bed district general hospital.
Methods
All Accident & Emergency department attendances from the weekend of the event 2003, were compared to those from preceding and following control weekends. The overall numbers of attenders, those injured and those subsequently admitted were noted. Details of the accident, riders’ management and injuries were noted in the department attendance register. Race participation was confirmed by comparison to the event start list provided by the organisers, Rare Management.
A questionnaire was presented to all patients attending the A&E department over the race weekend to provide insight into patient awareness of the race, the numbers of people accompanying injured riders to the hospital and the study itself. Retrospective data on the injuries sustained by riders was collected from attendance register together with injury information from event-side first aid providers (St Andrews First Aid Volunteers and Nevis Range Ski Patrollers). This permitted the numbers of injuries managed solely at the event to be identified together with those that subsequently received treatment at the A&E department.
Results
Attendance data is represented in Table I. In addition to the above data for the race weekend, five riders attended during the preceding practice three days. During the event the hospital treated 24 riders (14% of the 173 competitors). Retrospective analysis of attendances has revealed 19 riders attended on race days, increasing new attendees by 28%. Injury regions were similar to other reported series on off road biking these are represented in Table II. In total 52 riders reported 61 injuries.
Twenty-four(46%) of injured riders were seen at the A&E department and one rider required admission for observation. Only one rider was transferred to another hospital for further investigation. Regarding event-side first aid, 43(83%) injured riders were seen by event side providers, with 56% of injured riders receiving treatment solely at the event side. It is noted that three of these were referred to A&E but did not attend. Twenty-six questionnaires were collected from A&E attendants, 15 from competitors, five from travelling spectators and seven from members of the local community not related to the event. All respondents were aware of the event. A total of 73% respondents were accompanied by one or two people, whereas only 66% of injured riders were accompanied.
Discussion
Over the last few years adventure racing and extreme sports have increased in popularity throughout the UK. The mountainous area around Fort William is an ideal location for these events, hosting ski, trials bike, rafting and many running races. All of these adventurous activities lead to a significant increase in the local population during these events and the summer holiday period. The Fort William Mountain Bike race has been held since 2001 and has formed part of the World Cup Series for the last three years. The event had been awarded the Best Mountain Bike Event of the 2002 Series and so the popularity of the event would draw some 170 competitors and an anticipated 15,000 spectators to the area.
The Belford Hospital is a small district general hospital with 51 in-patient beds. The A&E department receives 8,300 new attendances per annum, on average 35 patient reviews per day during the summer. The department is normally staffed by three nurses and two junior doctors with a consultant surgeon, physician and anaesthetist on call. The hospital is geographically isolated, with the nearest specialist neurosurgical, cardiothoracic and orthopaedic centres being in Glasgow and Inverness. Road transfer times to these centres are 2.5 and two hours respectively. There is a full-time operating theatre available at the Belford. Ultrasound and CT scanning is available on site during office hours and out of hours when appropriately trained radiography staff are on-call. There is an ISDN2 line linking the Belford to the radiology and orthopaedic departments in Inverness.
The hospital staff are used to the weekend influx of recreational sportsmen however extreme sports events such as the mountain bike race are thought to place significant demands on the A&E department. Event organisers, Rare Management kept the hospital well informed of the event and likely numbers of spectators, which allowed the organisation of extra staffing, one extra nurse, and preordering of extra dressings etc. However given the reported North American injury rate of 0.4%, the 173 competitors should have been unlikely to place increased demands even on such small departments.
Although only 24 riders attended A&E during the course of the event, most (14) attended on the main racing day of the competition which increased the numbers of new attendants by 28% when compared to control weekends before and after the race. This represents a significant increase in workload. Due to prior preparation by the event organisers an extra nurse had been rostered, increasing staffing by 33%. It was noted however that many riders arrived over a relatively short time period, thus requiring triage. Unfortunately the department was so busy that staff were unable to distribute and collect questionnaires to all attendants however 15 riders completed questionnaires out of 26 collected.
Several riders presented during the three practice days preceding the race weekend and they did not appear to increase the department workload. Although 56% of riders received medical treatment from event side providers alone, three of these had been referred to A&E but did not attend. This suggests that the majority of riders had minor injuries e.g. bruises and abrasions, which could be dealt with adequately at the event and that the riders were satisfied with the care received. This is consistent with reported superficial injury rate of 60% in recreational riders treated at Mammoth Mountain Ski Area.19 The fact that 46% of riders did receive medical assessment and treatment at the Belford emphasises the importance of the hospital for the event, particularly in view of the long distances to travel to other hospitals.
The injury rate of the event 52/173(30%) is higher than previously reported figures of 0.4% as all injuries treated were noted rather than those which resulted in significant injury i.e. injury sustained by the rider, which prevented him from completing the event.9 The majority of injuries were simple bruises and many bikers will remount following a fall and complete the race even in the presence of such an injury. The regional distribution of injuries was similar to previous studies with knee injuries (20%), with hand /wrist (18%) and shoulder/upper arm injuries (15%) occurring commonly. The vast majority of injuries were soft tissue contusions, lacerations and sprains. Only one patient required admission for observation and analgesia and another had to be transferred to Inverness for an urgent ultrasound scan. One rider reported a chain ring injury associated with clipless pedals.20
Nurses working in the department reported increased numbers of alcohol related injuries over the weekend and increased mountain bike related injuries to local children from the area, however we were unable to confirm this with the data reviewed. Injuries may have been sustained in attempts to emulate riders in the weeks after the event.
Conclusion
We believe that extreme sports events can have substantial impact on small district general hospitals. As in this case additional triage and staffing resources should be utilised and event organisers should anticipate the additional problems they present to the local community. District general hospitals continue to provide a substantial contribution to the provision of health care for extreme sports within the UK.
ACKNOWLEDGEMENTS: We would like to thank the staff of the Belford Hospital, Fort William, The Nevis Range and Rare Management for their assistance with this project. We would also like to thank the staff of the North Staffordshire Medical Institute at North Staffordshire Royal Infirmary for their assistance with this research.
REFERENCES
1 Chow TK , Bracker MD & Patrick K. Acute Injuries from Mountain Biking. West J Med 1993; 159(2): 145-8.
2 Pfeiffer RP. Injuries in NORBA Pro/Elite category Off Road Bicycle Competitors. Cycling Sci 1993; 5: 21-4.
3 Pfeiffer RP. Off Road Bicycle racing injuries-The NORBA Pro/Elite Category. Clin Sports Med 1994; 13(1): 207-218.
4 Kronisch RL & Rubin AL. Traumatic Injuries in Off Road Bicycling. Clin Journal Sport Medicine 1994; 4: 240-4.
5 Rivara FP, Thompson DC, Thompson RS et al. Injuries involving Off Road Cycling. J Fam Prac 1997; 44(5): 481-485.
6 Grooten WJA, Genberg S, Jonasson L et al. Injuries among Swedish mountainbike cyclists at an elite level. J Sports Traumatol. Rel. res. 1999; 2 1(4): 196-205.
7 Gaulrapp H, Weber A & Rosemeyer B. Injuries in mountain biking. Knee Surg, Sports Traumatol, Arthrosc 2001; 9: 48-53.
8 Kronisch RL & Chow TK. Acute Injuries in Off Road Bicycle Racing. Am J Sports Med 1996; 24(1): 88-94.
9 Kronisch RL, Pfeiffer RP & Chow TK. Acute injuries in cross country and downhill off road cycle racing. Med Sci Sports Exerc 1996; 28(11): 1351- 1355.
10 Chow TK & Kronisch RL. Mechanisms of Injury in Competitive Off Road Bicycling. Wilderness and Environmental Medicine 2002; 13:27-30.
11 Kronisch RL & Pfieffer RP. Mountain Biking Injuries: An Update. Sports Med 2002; 32(8): 523-37.
12 Jeys LM, Cribb G, Toms AD et al. Mountain biking injuries in rural England. Br J Sports Med 2001; 35: 197-199.
13 Galvin GM & Jelinek GA. The impact of the America’s Cup on Fremantle Hospital. Arch Emer Med 1989; 6: 262-5.
14 Boyce SH, Stevenson J, Jamieson IS et al. Impact of a newly opened prison on an accident and emergency department. Emerg Med J 2003; 20: 48-51.
15 Bernstein SL, Rennie WP & Alagappan K. Impact of Yankee Stadium Bat Day on Blunt Trauma in Northern New York City. Ann Emer Med 1994; 23(3): 5559.
16 Michael JA & Barbera JA. Mass gathering Medical Care: A Twenty Five Year Review. Prehospital and Disaster Medicine. 1997; 12(4): 72-9.
17 Cooke MW, Allan TF & Wilson S. A major sporting event does not necessarily mean an increased workload for accident and emergency departments. Br J Sports Med 1999; 33: 333-5.
18 O’Donnell J, Mattick AP & Mehta R. The Football World Cup 2002- Analysis of related attendances to an Irish Emergency Department. Ir Med J 2003;96(3).
19 Pfieffer RP & Kronisch RL. Off Road Cycling Injuries: An Overview. Sports Med 1995; 19(5): 311-25.
20 Patel ND. Mountain bike injuries and clipless pedals: a review of three cases. Br J Sports Med 2004; 38: 340-41.