Injuries are part of the game. That is a common refrain in sports, usually referring to the athletes. But sometimes it is the spectators who get hurt. "You do not expect to be injured when you attend a sporting event as a spectator," said Amit Momaya, a sports medicine orthopaedic surgeon. "You certainly do not expect to die, yet there are any number of cases where spectators are injured, some fatally, at sporting events ."

Momaya, one of the team physicians for  UAB athletics , began thinking about spectator injuries after reading accounts of a young child struck by a foul ball at a professional baseball game. I have realized that there was scant information on spectator injuries. A search of the scientific literature revealed that there had been no studies that documented spectator injuries.

"Without data, there is no way to judge if spectator injuries are becoming more or less prevalent," Momaya said. "There is no way to determine if more aggressive safety measures are warranted." So, we set out to see what information we could find that would shed light on the subject of spectator injuries . "The results of that search are now published in the  Journal of Sports Medicine and Physical Fitness .

Looking back to 2000, the team tracked 181 spectator injuries, with the vast majority – 123 – coming from automobile or motorcycle racing. Cycling experienced 25 injuries, cricket 12, baseball 10 and hockey eight. The team documented 62 fatal injuries; 38 from vehicle racing, 17 from cycling, four from hockey, two from baseball and one single fatal injury from cricket.

"Most of these injuries are ballistic in nature, meaning the spectator was struck by something from the playing area, such as a ball, puck or vehicle," Momaya said. "There are also instances in sports such as cycling or basketball where a competitor might inadvertently leave the playing area and make contact with spectators."

Momaya and colleagues are calling for a central database for recording the occurrence of injuries to spectators during sporting events. A database would provide the information needed to gauge whether spectator injuries were increasing or decreasing and could provide insight into whether protective measures instituted by sporting organizations were effective.

Major League Baseball

"For example,  Major League Baseball recently increased the area covered by netting to reduce the risk of fans being struck by foul balls," Momaya said. "Without a systematic way to record injuries, there is no way to measure whether that effort is sufficient or if netting should be extended."

The research team says the findings point to some obvious measures that could be implemented, such impenetrable barriers at racing events that prevent vehicles or crash debris from entering the spectator area. Increased use of netting at baseball stadiums and higher, transparent barriers in hockey arenas could prevent balls and pucks from striking fans.

"Cricket venues tend to lack protective netting and barriers, which places spectators at the increased risk of injury from balls hit into the viewing area," Momaya said. "Cricket venues should follow the changes implemented by Major League Baseball with extended netting to protect spectators from injuries with high-speed balls."

The authors also noted that the majority of injuries at cycling events were caused by spectators and vehicles other than the competitor's, including a caravan publicity, security motorcycle and a tanker truck. There were also instances in motor racing where support vehicles were involved in spectator injuries.

Roles in spectator safety

"This suggests that factors such as crowd control, event planning and staff training also play important roles in spectator safety," Momaya said. "In addition to protecting spectators from injury to the sport, attention should be given to all components of the event to ensure that sports fans can safely enjoy their experience."

Momaya acknowledges that there are challenges to an international database, requiring the coordination of multiple governing bodies across multiple countries. Additionally, sporting organizations would need to agree on the threshold of what is considered an injury.

"There is a fine line between an enhanced fan experience on one hand balanced versus spectator safety on the other," Momaya said. "As a female doctor, I think safety is the top priority We need to categorize these injuries and use that data to find tangible ways to protect fans without a significant commitment to the viewing experience. -changing, have no place in sport. "