The Doctor's Sports
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SPORTS BAG THE DOCTOR’S SPORTS BAG A well-prepared sports bag can make all the difference to the outcome of an injury at a sporting event. The sports physician and medical support personnel providing cover at a sports event must be prepared for any form of emergency. Preparation makes the unex- pected less catastrophic and allows immediate, efficient medical care. Procedures and equipment relevent to the event, and possibly extra personnel, must be included in the planning. POINTS TO CONSIDER •Type of sport covered • Age of participants and probable emergencies • Infrastructure of the country in which the sports event will be held •Type of medical bag • Contents of the bag — equipment, paperwork, communication devices, and PHILDA DE JAGER drugs MB ChB, DIP PNS, DASA Diving Medicine, • Easy emergency access, avoid accidental use of banned substances BLS ACLS, BSc Med Hons Sport Med, • How to obtain supplies at the venue, and consider foreign registration of Hyperbaric and Aviation Medicine your qualifications •Product liability across borders — be in possession of the required customs Private Sports Medicine Practitioner documentation Pretoria • Controlled drugs — obey rules of country of sports event • Insure the sports bag and keep it secure at all times. Philda de Jager has been practising gener- al, sports and rehabilitation medicine in Type of sport Pretoria for the past 13 years. She quali- You have to consider the type of sport and type of injury you will most likely be confronted with. Travelling with a swimming team or Tae-Kwando team will cer- fied in sports medicine at UCT, and trav- tainly determine the content and amount of trauma treatment equipment needed. elled as South African team physician to Covering an endurance event involves getting to check points, and preparing for the Atlanta as well as the Sydney Olympic thermal injuries or dehydration. Is it a single-code tour or a multicode tour, such Games. She was a team member of the as the Olympic Games you have to cover? Each sport has its own injury profile Kuala Lumpur Commonwealth Games and with which the travelling physician will have to familiarise him/herself, as well as Moscow Youth Games. She was also a medical procedures determined by the sport. For example, in boxing the com- petitors are pre-examined and an international hockey competition will not start member of the NOCSA Medical before a doctor and the emergency personnel are available on the bench. Commission and of the Ministerial Task Force on South African Sport, and headed Participants’ age and emergencies the Sports Commission’s Medical One should know the average age, gender and physical ability of the partici- Commission. Philda lectures part-time to pants and accompanying officials. One may have to handle a threatened abor- MSc Sports Medicine students at the tion, myocardial contusion, myocardial infarction, kidney stones, a dislocated ankle or a spinal injury. Participants in veteran games may present with medical University of Pretoria, is an external exam- pathology, more chronic medication use and a specificl injury profile. These are iner for the University of the North, and is true scenarios from two previous Olympic Games. active in aviation and diving medicine. She is a Past President of the South African Country Sports Medicine Association. To which country is the team travelling? Whether one travels to Nigeria for the All African Games as opposed to Kuala Lumpur for the Commonwealth Games will influence the type of bag packed. What is the local medical support like? Will well-equipped ambulance and paramedical support be available? Remember that you have to be able to carry everything you pack! Consider the weight of your own luggage, as there is often little help. March 2004 Vol.22 No.3 CME 117 SPORTS BAG How is the team travelling to the sport- Emergency drugs Quick Guide to Drug-Free Sport). ing event — by boat, by train or on a • Atropine sulphate 1 mg pre-filled • Book on emergencies/resuscitation 16-hour flight from Johannesburg to syringe, or 0.6 mg/ml. Give 1 mg algorithms: Guide to the Manage- Atlanta? Consider medically catering intravenous injection, maximum ment of Common Medical Emergen- for 86 athletes, team officials and 0.04 mg/kg. Repeat every 5 min- cies in Adults. 6th ed. University of members of the press from your hand utes the Witwatersrand 2002. luggage. • Adrenaline 1 mg/ml subcutaneously • List of telephone numbers (team offi- or intramuscular injection. Adults cials/local medical support) Type of medical bag 0.2 - 0.5 ml, children 0.1 - 0.3 ml •Prescription pads The traditional briefcase-type medical • Epinephrine (1:10 000) pre-filled •Medical certificates bag is too small. One cannot carry it syringe, 1 mg/ml diluted to 10 ml • Letterheads and envelopes over one’s shoulder and walk 4 - 5 km intravenous injection, maximum 0.2 • Map of area/emergency network in a large stadium or during an mg/kg. Epipen 0.3 ml intramuscular plan and contact numbers endurance event. The case should injection > 45 kg • Dictating machine and tape have ‘cut-outs’ to protect glass medi- • Glucagon 1 mg and solvent, 1mg • Local pathology and X-ray forms cine vials and small separate compart- subcutaneous/intravenous/intra- • Cellular phone model acceptable in ments to facilitate finding things in a muscular the specific country with local sim hurry. ‘See-through’ compartments are •Lignocaine 20 mg/ml, 20 mg vials card. Two-way radio system. recommended, as well as loose remov- • Sodium bicarbonate 1 mg eq/kg What else to include able packets with zips. A ‘tool-box’ bolus, 50 ml type suitcase or paramedic bag with • Naloxone hydrochloride Additional drugs shoulder straps is ideal, and must 0.4 mg/1 ml, dose 0.4 - 2 mg Check for expired drugs every 6 have a lock. It’s not easy being • Nitroglycerin spray — lasts longer months. Store drugs at the correct stranded in a foreign country with no than tablets, 1 second spray every temperature (4 - 25°C). Sufficient sup- medical supplies and to have to try to 5 minutes plies or access to additional supplies replace sophisticated medical stock. •Water for injections 10 × 10 ml is essential. Pack at least one medica- • Corticosteroids: dexamethasone tion from each pharmacological classi- shock pack 20 mg/ml, methylpred- fication so that you are prepared for nisolone 40 mg/ml any medical problem. Find out if any • Aminophylline 250 mg/10 ml of the team members are on chronic •Inhalers: salbutamol and steroid medication and ensure that they carry • Buccal prochlorperazine their own supplies. Athletes can also • Painkillers: pethidine compile their own medical travel kit 50 - 100 mg/1ml, morphine containing basic medication, braces 15 mg/1ml and strapping. This will lighten the •Diazepam 10 mg/2 ml load on the stock carried by medical personnel, especially multi-coded Fig. 1. A typical sports bag. • Chlorpromazine/haloperidol • Furosemide/bumetamide ampoules sports teams. Ensure that they do not carry banned substances, and review What equipment? (banned) 20 mg/2 ml • Dopamine 400 mg in 250 ml their medical report forms where they Checklists of equipment needed are saline: 1 - 5 mg/kg/min have to declare all drugs they carry. given in Table I. • Mannitol 10 mg vial They could pack the following medica- tion: an antinauseant and antidiar- On-person panic kit • Magnesium sulphate 1 mg/1 ml, dose 2 - 4 mg intravenous injection rrhoeal, a simple painkiller, an anti- This separate grab pack, money-belt • Aspirin 160 mg/300 mg chew histamine, an antacid, a nasal spray, style, should include the following: tablets throat lozenges, brompheniramine or •oropharyngeal airway • Beta-blocker: atenolol 5 mg slow ephedrine tablets, a non-steroidal anti- •Laerdal pocket mask intravenous injection inflammatory drug, one course of a • absorbent sponges/gauze • Adenosine 0.1 mg/kg - 6 mg, then broad-spectrum antibiotic, a topical • examination gloves 12 mg intravenously after 2 min or antiseptic, and wound cover. • bandage/trauma scissors verapamil. (multi-purpose tool) Some notes and tips on • penlight What to put in the bag additional medication • pen and paper • Paperwork and cellular phone • Antacid; H2 blocker: Acute situa- • resuscitation shield • Book on banned substances tions are common in competition. • stethoscope. (obtainable from the South African An injectable form of an H2 antag- Institute of Drug-Free Sport — onist is useful. 118 CME March 2004 Vol.22 No.3 SPORTS BAG Travelling with a swimming • Antihistamine — sublingual (zanamivir) early in an infection team or Tae-Kwando team prochlorperazine can prevent progress of the disease will certainly determine the • Oral rehydration powders and and is of great importance to the intravenous rehydration solutions competitor. Less training time will content and amount of trau- •Vitamins — intravenous vitamins be lost and the risks of complica- ma treatment equipment and iron can be very useful as tions are reduced. At the Sydney needed. legal performance enhancers Olympics the medical team used a •Wound covers — blisters/abra- similar product, with great success sions/open wounds, especially in • Steroid tablets (equivalent to a total • Analgesia — soluble paracetamol, the case of cyclists and hockey of at least 100 mg prednisolone) consider sublingual preparations. players • Sleeping tablets for use during trav- • Antibiotics — include at least one • Salbutamol/steroid inhalers el and before competitions antibiotic other than penicillin •Influenza A and B treatment • Diuretics (banned). Do