Racecourse Medical Officers – a jockey’s first line of defence

NECESSARY evil or first line of defence for jockeys’ welfare after an on-track fall? Racecourse medical personnel have always had to tread a fine balance but, says Sue Smith, it’s all a matter of trust.

Smith, a racecourse medical officer for 23 years at Cheltenham and latterly at Chelmsford, explains: “Jockeys need to get the next ride and they don’t want to be stood down, therefore they can tend to find excuses to hide. But if they know and trust you, they come and see you.”

Colleague James Burton, senior racecourse medical officer at Leicester, agrees. “When I started in the job about 12 years ago, I heard stories that jockeys would run away from the RMO, but I don’t think that’s the case nowadays. You build up a doctor-patient relationship and foster trust.

“Jockeys are very resilient. They know their limits, and if they come to see me, I take that very seriously. And often, if they don’t come to see me, I still take it very seriously. But I do trust them, although we have to retain a sense of clinical suspicion.”

“The relationship with jockeys has definitely improved.”

Smith reiterates: “The relationship with jockeys has definitely improved.” And that goes for medical provision on racecourses generally, which took another step forward in late-2015 with changes to the BHA’s guidelines.

She adds: “When I started, there was variability between the racecourses as to organisation and the skill sets involved among medical personnel. It’s become much more uniform and much more professional. We try very hard to provide consistent care, whatever the race meeting.

“Among sports in Britain, racing has a great reputation for medical services and my experience of the Olympics, the Commonwealth Games and such as motor sports and eventing tells me that a lot of those sports look at us to see where they need to be. That’s come from BHA medical advisers wanting minimum standards for racing over the last 25 years, so that a better structure has come from the centre and our duties are much more organised.”

 

James Burton believes there has been a change of not attitude but the environment over the period he has been involved in racecourse work. “Some of the changes that have come in recently have involved more time for doctors,” he says. “We’re more vigilant about registration, and more aware of personal development and ongoing training. Everyone has embraced the change, which is really good.”

“A racecourse is one of the safest places on which to have a life-threatening episode.”

Evidence came at a one-day conference for RMOs organised by the RCA at Warwick racecourse in late-April, when attendance was 50 per cent up and the breadth of skills much wider, and which was followed by a special training day.

Burton explains: “It probably mirrors the status that pre-hospital care now has within the medical field. It’s become almost a speciality in its own right, so with more professional provision of general pre-hospital care and a better structure in terms of training and governance, that has spilled over into areas where pre-hospital care is important, such as in racing.”

The BHA’s latest changes to medical facilities on racecourses prefaced the introduction of new guidelines by the National Institute for Health and Care Excellence (NICE) earlier this year.

Sue Smith explains: “The establishment of trauma networks within each area of the country has rationalised and massively improved trauma outcomes by streamlining the service. We’ve followed those networks and the NICE recommendations and the guidelines as far as racecourses are concerned, as closely as we can.”

Burton adds: “What’s important is that a much greater emphasis has been placed on local variations and risk assessments. It took time, but Jerry Hill, the BHA’s medical adviser, sent out information on all the fallers we had had, the fall rates for each racecourse, and being able to think about local risk assessments has been really valuable.”

While by virtue of the jockeys’ chosen profession they are the highest profile patients encountered by racecourse medical officers on a daily basis, it can often be overlooked that the RMO’s responsibility covers the entire on-track attendance, and surveys into the survival of people attending sporting and leisure events consistently reveal that a racecourse is one of the safest places on which to have a life-threatening episode.

James Burton explains: “It’s important to remember that we’re doctors first and medical officers second. We obviously have a professional responsibility to the jockeys on a raceday, which is why we’re there, but we have a duty of care to anybody on the racecourse who comes forward with a significant medical problem.

“The diverse background of doctors involved on racecourses, from GPs to hospital specialists, reflects that point.

“There’s an accepted model of care called the chain of survival, and we know that each of the parts are the key to good outcomes, and each of those links is about early access to help, whether it’s cardiopulmonary resuscitation (CPR) or treatment such as defibrillation. With professionals in attendance – the medical team, paramedics, doctors and nurses – you’ve got very early access to that expert treatment on a racecourse.”

Sue Smith has practical knowledge of dealing with medical issues among racegoers from her experience at Cheltenham.

“Medical provision, especially at the Festival, is designed to look after a very large crowd, among whom there will be people who suffer illnesses because they are on site for long periods over four days,” she says. “Every year we look at the figures of what we’ve seen and update the skills for the following year. This year the number of accidents to jockeys was secondary to those in the crowd; last year it was less so, and three years ago we had very bad jockey accidents.

“Festival crowds are generally becoming older; they have more complex medical conditions, they cover long distances and don’t want to miss the racing because it’s a high visibility event. The result is that they bring their ailments with them, knowing that medical services are on site, so they make a beeline for us if they’ve forgot their prescriptions, for example.”

James Burton is used to dealing with smaller crowds, but attention to detail is nonetheless important, he says, adding: “Of course there is a higher crowd density at such as the Cheltenham Festival or the Grand National, but ultimately you could have a crowd of ten people and one of them could become unwell. The key is to be prepared for all eventualities. There’s always the possibility of an accident, and that goes for racegoers as well as jockeys.”