Boxing doctor: get involved
Authors: Michael Kipling, Gillian Hodgson
Publication date: 02 Dec 2009
Boxing elicits a varied response from the medical profession, but medical officers Michael Kipling and Gillian Hodgson, from the British Boxing Board of Control, are asking doctors to get involved
Boxing has always been an emotive sport. Some people reading this article will be astounded that doctors choose to be involved in this aggressive competition, with risks of injury and death. The relative merits and ills of boxing have been debated in many forums and will continue to be debated as long as the sport continues.
In our younger days we both watched many bouts of boxing at the ringside; MK accompanying his late father, a general practitioner and former area chief medical officer for the British Boxing Board of Control. This early exposure resulted in a lifelong love of boxing and led to the authors becoming involved in the sport.
Boxing allows some who might otherwise end up in the ghetto trap that has befallen so many generations to escape into a world of financial and professional independence. It teaches discipline and control as well as avoidance of vices, and it has been a life changing influence for many people.
We believe that no other sport provides such a contest of will, physical prowess, and skill as boxing, and although there are reports of serious injury within the sport (most topically brain injury, both acute and chronic), it has been shown that there are more major brain injuries each year caused by golf and horse riding than by boxing. Great battles have been fought over the years, with reputations being built and broken and world fame at stake; fortunes have been made and lost in the ring; and the spectacle is electrifying.
Range of competition
Boxing takes place at a wide range of levels. At one extreme there are the elite professionals, competing for national and international titles. Then there are the jobbing professionals, the majority of boxers, who provide a learning environment for the up and coming young stars as well as a competitive undercard for the bigger fights. Beyond this there is the popular Amateur Boxing Association, in which the home nations have had considerable success in recent years in world and Olympic events. Again, there is stratification of this tier, with most registered boxers being “enthusiastic amateurs” who engage in local events and will never achieve more than self confidence and regular exercise (as with most sportsmen and women worldwide).
A recent addition to the sport is the phenomenon of “white collar” boxing competitions among businessmen, although often the standard is poor. Female boxers are becoming more prominent within the sport, raising further debates regarding ethics and medical risk. Recent examples of female boxers include five times world champion Jane Crouch. The “Fleetwood assassin,” who retired last year, had to sue the British Boxing Board of Control to be granted a licence to box in 1998.
Ms Crouch has been quoted as saying that boxing saved her “from a life of booze, drugs, and street fighting,” after being expelled from school as a youngster. This ruling opened the gates for female boxing to become mainstream in the United Kingdom. Another famous female boxer is Laila Ali (daughter of the world’s most famous pugilist, Mohammed Ali). Medical research into the risks to female boxers is on the rise owing to their differing anatomy and physiology compared with their male counterparts; there is considerable interest from sports medics worldwide.
Set-up in the UK
The British Boxing Board of Control is the governing body for professional boxing in the UK, with the Amateur Boxing Association regulating the amateur scene. Current regulations state that all professional contests must have an anaesthetist (or doctor with airways and anaesthetic training for whom anaesthesia is a regular part of their work) and at least one other doctor present at the ringside. An ambulance and paramedic crew must also be on site, with the local emergency department and neurosurgical centre being alerted by letter before the event. The amateur set-up requires only one doctor, who does not need to be an anaesthetist, as well as the paramedics.
The board currently has councils for Scotland, Northern Ireland, and Wales, and then northern, southern, midland, and central regions of England. Each of these has a chief medical officer, who is responsible for attending board meetings and then informing the medical officers in their region of upcoming bouts and arranging medical cover. Current guidelines suggest the chief medical officer should be present at all major bouts.
Role of a medical officer
Being a medical officer for the British Boxing Board of Control is not a profession in its own right. Reimbursement of expenses and occasional “pay days” from televised bouts are the only reward over and above enjoyment of the shows. The medical officer must provide the necessary equipment and drugs for the contest, bought at their own expense. It is beyond the remit of this piece to detail the contents of the medical bag that the authors use, but most will match the relevant skill set of the clinician using them and can be sourced at a reasonable cost after an initial outlay.
We see three distinct roles for the medical officer: anaesthetist; general medical care; and surgical care.
The anaesthetist is crucial to the bout, as the contest cannot take place without one. They must be present at the ringside at all times and so tend to be less involved with the general care given during the course of a show (a number of bouts). They must have passed the fellowship exam and be practising and intubating regularly. Should a boxer receive a knock-out blow, their role is to liaise with the paramedics, who carry oxygen and intubation equipment.
General medical care
This is an ideal role for a general practitioner as they are perfectly set up to do the yearly medical examination for a professional boxer required by the British Boxing Board of Control. This requires examination, blood sampling, and magnetic resonance imaging of the brain (with an initial magnetic resonance angiography of the cerebral circulation and screening for aneurysms on first application for a licence to box).
Other general medical roles at each bout are to be present at the weigh-in (usually the day before a bout), and to perform a precontest medical either at the weigh-in or on the day of the contest. After the bout, the boxers must be briefly examined to assess their fitness to leave the ring and do interviews (bouts are often televised) and then given a full postcontest medical. Any injuries should be noted, documented, and then treated, or the boxer should be referred to an emergency department or specialist unit (such as neurosurgery or ophthalmology).
The most common injury sustained during a professional boxing contest is a laceration to the face. This leaves a role for those trained in and regularly practising suturing of skin. Surgeons and emergency medics are therefore ideal for this role, although certain lacerations (such as those affecting the tarsal plate or corneal injuries) are best referred for specialist care. As part of the contest team, the precontest medical examinations also fall within their remit. It must be remembered that suturing is not just a surgical skill and that other clinicians may have this skill.
After a bout, certain British Boxing Board of Control regulations must be applied. In the case of some results or injuries, the boxer’s licence will be suspended (as guided by the board officials), preventing them from competing or sparring. During bouts, the medical officers may be called on by the referee at any point to assess a boxer’s fitness to continue, although ultimately it will be the referee’s decision about whether to heed that advice (all sensible, experienced referees will do so).
Currently, the British Boxing Board of Control looks at each applicant’s curriculum vitae on merit and assesses them for suitability for a role as a medical officer. There are no set requirements, and a wide range of clinicians hold roles within the board. At present general practitioners, surgeons, emergency medics, and sports medicine specialists make up the bulk of the cohort, though psychiatrists and junior doctors with no fixed specialty also work as medical officers.
An important guiding principle should be that to hold medical indemnity, although no extra fee is needed, the protection organisations require that the clinician “has the required skills to deal with the problems encountered in the sport in question, and is maintaining competency in those skills.” The ideal candidate has emergency medicine exposure, is skilled in advanced trauma life support, and can suture to a skilled level, having knowledge of both field and regional nerve block local anaesthesia for the purposes of suturing.
With the London 2012 Olympics looming there will be a greater need for British Boxing Board of Control and Amateur Boxing Association medical officers in the UK. The expected increased uptake of the sport among the general population will lead to a requirement for more doctors to come forward. Although the sport has been on the downturn for some years because of negative press reports and public perception, there is optimism regarding a resurgence of the sport at grassroots level, particularly in the face of the childhood obesity epidemic.
In terms of professional development, the European Boxing Union, in conjunction with the British Boxing Board of Control, held its first annual medical officers symposium in Cardiff last July. This international symposium attracted many interesting speakers and opinions from around the world. A great deal of topical discussion was generated and it was a welcome opportunity to meet counterparts from other countries.
Some skilled clinicians based in the UK have the skill set required to become a medical officer for the British Boxing Board of Control or the Amateur Boxing Association, or both. Anaesthetists, because of their crucial role, are prized assets, as are emergency medics. Given that there is little or no financial reward and the bouts are usually outside normal working hours, potential medical officers must have a love of the sport and a passion for caring for these dedicated, generally delightful, and hardworking sportsmen and women.
Boxers deserve the highest standard of medical care, and as such there is a niche market for doctors to enjoy watching the contests and to fulfil this role. We feel there is much to be positive about in the future of the “sweet science” and look forward to encountering like minded individuals and hopefully future colleagues.
Competing interests: MK and GH both hold positions with the British Boxing Board of Control.
Michael Kipling British Boxing Board of Control medical officer
Seaham, County Durham
Gillian Hodgson British Boxing Board of Control chief medical officer, northern area council Cardiff