Risk Management in Sport

Original Editor - Wanda van Niekerk based on the course by James Laskin

Top Contributors - Wanda van Niekerk and Jess Bell  

Introduction[edit | edit source]

The benefits of participation in sport, exercise and physical activity are widely broadcasted, but there remains a risk that participation in any of these activities may result in injury. There are different levels of risk associated with different sports. The risk levels relate to the characteristics of the sport, the rules of the sport and respect for fellow team mates and competitors. Sports governing bodies, sports medicine professionals and all parties involved have a responsibility towards the athletes and spectators to manage the risks involved. These can include aspects such as the identification and characterisation of risks that are involved in specific sports and to provide guidance on mitigating and managing these risks.[1]

Key Definitions[edit | edit source]

Table 1. Key Definitions in Risk Management in Sport.[2]
Terminology Definition
Risk factor A condition or situation that may possibly / potentially cause harm
Risk The chance or probability of something happening; it is measured in terms of likelihood and consequences
Risk management The process of measuring or assessing risk and developing strategies to mitigate the identified risks
Risk assessment Identification, estimation and evaluation of risks
Risk estimation Identifying possible consequences from a risk factor and an estimation of the magnitude and probability of these consequences occurring
Risk mitigation Identifying and applying measures to control the level of risk or the consequences from risk factors

The Process of Risk Management[edit | edit source]

  • Risk management is a medicolegal issue.
  • Good and safe practice implies that there has been reasonable forethought at a suitable, sufficient and appropriate level.
  • The objectives of risk management include[3]:
    • making sure that potential safety problems are understood
    • determining that existing precautions are adequate and relevant
    • implementing any further precautions and actions as necessary
  • Different levels of risk management exist. Firstly, there are generic and written protocols covering the overall risks. Secondly, there are the risks and written protocols specifically compiled for a specific event or facility. The final tier of risk management is dealing with the ongoing and dynamic levels of risk assessment. The unexpected incidents need to be dealt with in real-time.[3]

Models of Risk Assessment[edit | edit source]

  • Classic workplace risk matrix:
    • A risk assessment matrix is a tool that can be used to assess and prioritise risks as part of risk management. The higher the severity and likelihood of an event, the greater the risk. The consequences of the event also determine the risk of an event. If the consequences are minor, it will be considered a low-ranking risk and with severe consequences, it will be considered a high-ranking risk.
    • Read more on Risk Assessment Matrix: Definition, Examples, and Templates


  • Athlete-specific risk matrix[5]:
    • Making use of a pre-season evaluation and creating a risk matrix for an athlete or athletes
    • Considerations will be:[5]
      • internal risk factors such as age, sex, health, body composition, fitness levels, anatomy, and skill level that predisposes an athlete to an injury
      • exposure to external risk factors such as human factors (teammates, opponents), protective equipment, sports equipment and the environment which will make the athlete susceptible to injury
      • the occurrence of an inciting event that causes an injury such as joint motion, playing situations, training programme and the match schedule
      • read more:
  • Staged sport risk model[6]:
    • This model guides clinicians in managing injury risk in athletes[6]
    • Stage 1: injury trends (when, where, and how)
    • Stage 2: injury risk factors (what factors increase or mitigate the risk of injury?)
    • Stage 3: sport demands (what should the athlete be prepared for?)
    • Stage 4: athlete profile (does the athlete present with characteristics of at-risk athletes?)
    • Stage 5: athlete management (short- and long-term management and interventions)
    • Stage 6: athlete monitoring (response of athlete to management over time)
    • Read the article here: A six stage operational framework for individualising injury risk management in sport[6]
  • Injury risk management model:
    • Flowchart model
    • Assessment of intrinsic and extrinsic risk factors, which is then followed by the estimation and evaluation of the level of risk
    • Risk mitigation through therapeutic and preventative interventions
    • Risk communication
      • This is an important step in risk management
      • Effective communication is necessary and information should be presented in appropriate formats so that all stakeholders have a clear understanding
    • Read how FIFA approaches risk management in the protection of the health of football players[7] here.

Read about the legal aspects of the emergency response plan: Emergency response plan.[8]

Emergency Response and Planning[edit | edit source]

Emergency Action Plan Components[edit | edit source]

Components of an emergency action plan include the following[9]:

  • Documentation
    • Written emergency action plan that includes logistics, staff involved and a map of the facility
  • Identification of the appropriate personnel to render care
    • Key personnel
    • Specific roles and responsibilities of each person
  • Specification and maintenance of emergency equipment needed
    • Includes detail about necessary equipment, the location of equipment and the training required to use equipment
  • Communication
    • Contact information
    • Communication methods to use when an emergency occurs
  • Mode of transportation for the injured or sick athlete from the site of injury to the sideline, training facility or medical facility
    • Location of ambulance services
    • Location of exit and entry points
  • Emergency procedures outlined and specified for each sport and practice venues
    • Appropriate medical care facilities should be identified
    • Location should be provided
    • Proper routes for transportation should be included

Emergency Action Plan[edit | edit source]

A pre-arranged emergency action plan is vital at any sport event. The following should be considered when developing an emergency action plan[10]:

  • Develop separate emergency action plans for each sports field, court or facility.
  • Determine who from the medical team will be on duty at practices and competitions and clearly define each member's role and responsibility in the case of an emergency. Clinicians should be aware of their limits of practice. Those responsible for sports team or athletes should engage in further training in emergency care.
  • The sports medicine team should be familiar with and practise using and operating emergency equipment such as stretchers and automated external defibrillators.
  • Decide what emergency equipment should be available for each sport as this may vary between sports.
  • Removal of protective equipment - specific procedures and policies should be established[11]
  • All sports medicine team members should be familiar with the community-based emergency health care delivery plan, including communication and transportation policies. Especially when a team is travelling.
  • Familiarise all team members with the emergency care facility administration and treatment policies, especially when a minor needs emergency care.
  • The designated person to make the emergency call should provide the following information:
    • type of emergency situation
    • type of suspected injury
    • present condition of the athlete
    • current assistance being provided
    • location of the caller and exact location of emergency.
  • Access to keys to gates and padlocks should be provided to medical team members or staff members in case of emergencies.
  • All staff members, maintenance team and sports medicine team members should be informed of the emergency plan annually or whenever there are any changes to the plan. Each person should know their role and responsibility in the case of an emergency.
  • Assign a person to accompany the athlete to the hospital.
  • Clinicians should have contact information for athletes and team members at all times, especially when travelling with a team. The parents or guardians of minors should complete and provide consent forms for medical treatment when a minor is travelling with a team.
  • Meet with all emergency responders before the event to discuss the management of situations. Maintain a professional relationship between all parties providing emergency care at an event. The most important consideration is what is best for the injured athlete.
  • Procedures and guidelines on how to handle an emergency should be established and practised before the event.
  • Minors
    • Consent to treat an injured minor should be obtained from the parent.

Athletic Injury Management Checklist[edit | edit source]

Things that sports clinicians can do to minimise the chance of injury include:

  • arrange for physical examinations and preparticipation screenings[13]
  • ensure appropriate training and conditioning of the athlete[14]
  • monitor environmental[15] and field conditions to ensure safe participation
  • select and maintain properly fitting protective equipment[16]
  • education of parents, coaches and athletes about the risks inherent to sports participation
  • teach proper techniques
  • be certified in cardiopulmonary resuscitation (CPR) and the use of AEDs (Automated External Defibrillator)
  • be certified in first aid

Resources[edit | edit source]

References[edit | edit source]

  1. Fuller CW, Junge A, Dvorak J. Risk management: FIFA's approach for protecting the health of football players. British journal of sports medicine. 2012 Jan 1;46(1):11-7.
  2. Fuller C, Drawer S. The application of risk management in sport. Sports medicine. 2004 May;34:349-56.
  3. 3.0 3.1 Laskin, J. Pre-Competition Management Course. Plus. 2023
  4. Let's Learn Public Health. Risk and How to use a Risk Matrix. Available from: https://www.youtube.com/watch?v=-E-jfcoR2W0[last accessed 01/03/2023]
  5. 5.0 5.1 Bahr R, Holme I. Risk factors for sports injuries—a methodological approach. British journal of sports medicine. 2003 Oct 1;37(5):384-92.
  6. 6.0 6.1 6.2 Roe M, Malone S, Blake C, Collins K, Gissane C, Büttner F, Murphy JC, Delahunt E. A six stage operational framework for individualising injury risk management in sport. Injury epidemiology. 2017 Dec;4:1-6.
  7. Fuller CW, Junge A, Dvorak J. Risk management: FIFA's approach for protecting the health of football players. British journal of sports medicine. 2012 Jan 1;46(1):11-7.
  8. Abbott AA. Emergency response plan. ACSM's Health & Fitness Journal. 2012 Sep 1;16(5):33-6.
  9. McDermott ER, Tennent DJ, Patzkowski JC. On-field Emergencies and Emergency Action Plans. Sports Medicine and Arthroscopy Review. 2021 Dec 3;29(4):e51-6.
  10. Handling Emergency Situations and Injury Assessment. In: Prentice, W. Essentials of Athletic Injury Management. 11th Edition. McGraw-Hill Education. 2020.
  11. 11.0 11.1 11.2 11.3 Courson R, Ellis J, Herring SA, Boden BP, Henry G, Conway D, McNamara L, Neal TL, Putukian M, Sills AK, Walpert KP. Best practices and current care concepts in prehospital care of the spine-injured athlete in American Tackle Football March 2–3, 2019; Atlanta, GA. Journal of athletic training. 2020 Jun;55(6):545-62.
  12. Mills BM, Conrick KM, Anderson S, Bailes J, Boden BP, Conway D, Ellis J, Feld F, Grant M, Hainline B, Henry G. Consensus recommendations on the prehospital care of the injured athlete with a suspected catastrophic cervical spine injury. Journal of Athletic Training. 2020 Jun;55(6):563-72.
  13. MacDonald J, Schaefer M, Stumph J. The Preparticipation physical evaluation. American family physician. 2021 May 1;103(9):539-46.
  14. Miranda-Comas G, Zaman N, Ramin J, Gluck A. The role of workload management in injury prevention, athletic, and academic performance in the student-athlete. Current sports medicine reports. 2022 Jun 1;21(6):186-91.
  15. Racinais S, Hosokawa Y, Akama T, Bermon S, Bigard X, Casa DJ, Grundstein A, Jay O, Massey A, Migliorini S, Mountjoy M. IOC consensus statement on recommendations and regulations for sport events in the heat. British Journal of Sports Medicine. 2023 Jan 1;57(1):8-25.
  16. Jin H, Lee H. Risk factors based on analysis of injury mechanism and protective equipment for ice hockey amateur players. International journal of environmental research and public health. 2022 Apr 1;19(7):4232.
  17. Finnoff J. Sports event planning considerations post-COVID-19. United States Olympic & Paralympic Committee. United States Olympic & Paralympic Committee. April 28, 2020-v0. 12.