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.

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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.

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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 not be

Table I. Checklists of equipment needed

Diagnostic equipment Wound closure strips, wound closure material Stethoscope Tube of Superglue for superficial cuts Blood pressure meter — 2 cuff sizes Syringes — 3 ml/10 ml/20 ml — with needles Oto/ophthalmoscope Butterfly Torch and blue filter Razors Tongue depressor Bandages — crepe, triangular Peak flow meter Foley’s catheter (also used as under-water drain) Reflex hammer Pocket knife Advanced cardiac life support equipment Trauma shears Laerdal face mask Tape measure Ambubag — valve, mask, reservoir (varied masks) Speculum Laryngoscope blades and batteries Tourniquet Intubation tubes (nos 6.5/7.5/9) and inducer Adjustable solid neck brace Portable suction Glucometer Drip set, IV catheters, dextrose vaculiter (5%) 15 Haemoglobin meter drops/min set. Normal saline or Ringer’s lactate ECG ruler Military anti-shock trousers (nice to have) ‘Sharps’ box Oxygen tank, tubing, masks (if ambulance is not Magnifying glass available) Ear syringe Instruments — needle holder, artery forceps, scalpel, Fantastic optional extras blades, scissors, dental syringe, kidney bowl AED (automated external defibrillator)/pulse oximeter ECG/lung function Disposables Scale (wrestling, boxing, judo) Absorbent sponges Portable sonar equipment Oral airway Examination gloves Neuro/orthopaedic equipment Pen and paper Neck brace — solid and soft, various sizes. Spinal Resuscitation shield board Lubricating jelly Cast padding Fluorescein eye strips and eye anaesthetic Crutches Urine dipsticks (specific gravity is handy for hydra- Elastic bandages tion status) Finger-sized aluminium foam splints Urine bottles Knee/ankle immobiliser Lignocaine 1% with and without adrenaline Plaster/fibreglass splinting Stitching material — nylon 4/0 and 5/0, non- Sling shoulder/wrist brace absorbable/absorbable Tape Alcohol swabs Thermal blankets

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tempted to use a diuretic for Record-keeping Olympic Games as citizens of an swollen lower extremities after trav- • Registers for schedule drugs (e.g. African country. Some contact sports, elling. Pack them separately pethidine) such as boxing, require a clearance • Anti-inflammatory/anti-gout treat- • Acquisition supply record certificate, but other contact sports ment. Athletes often use high-pro- • Date on which transaction occurred carry risks. The social aspect of sport tein drinks and gout can be found • Name and address of person/firm also exposes athletes as well as offi- in a young population, in veterans that supplied the drug(s) cials to possible infection. Carry the and in officials. • Quantity supplied 3-day Retrovir/3TC Post-HIV Exposure •Total stock on hand. pack and start treatment within 2 Prescription forms hours after exposure, if possible. These are very valuable, and often get Insure your sports bag and its con- Vaccines stolen to obtain extra medication for tents. It can be covered in travel insur- family and friends. Protect them well ance or alternatively as part of the All athletes who travel regularly must and control their authenticity. travelling team’s equipment. Also con- have their immunisation schedule with them, and update their tetanus and Controlled drugs sider temporary medical insurance for your own or visiting athletes. An event hepatitis B vaccinations. Take care Remember that you will be held such as the Olympic Games will have with adolescents. Not everyone will responsible for the misuse of con- event insurance that can include all adhere to the instruction to immunise trolled drugs. In some countries, such participants and officials. At the him/herself. Some countries require as Singapore, even the carrying of opening ceremony of the 1996 yellow fever and diphtheria immunisa- illegal, addictive substances is punish- Olympics in Atlanta an official died of tions. Pneumococal immunisation can able by the death penalty. Govern- a heart attack. The hosting country be done. Diphtheria and tetanus (2 ments regulate medication supply, was liable. With proper cover your types) vaccines must be carried; the therefore possession, prescription, stor- team will have easy access to special latter should be stored in a refrigerator age, record-keeping and disposal must investigations. or cool space. be in line with local regulations. For References available on request. example, a combination of paraceta- mol, caffeine, codeine phosphate and AIDS exposure pack meprobamate is illegal in Australia AIDS is a reality in sport, with expo- and one should declare and clear it sure very possible, especially when with customs. athletes have to qualify for the

IN A NUTSHELL

Prepare your emergency bag according to the specific type of sport covered, the age of participants, probable emergen- cies and country in which the sports event will be held.

Choose the type of bag according to conditions of the field of play.

Consider what to pack — equipment, paperwork, communication devices and drugs.

Pack for easy emergency access and to avoid the accidental use of banned substances.

Know how to obtain supplies at the competition venue and make sure of your foreign registration.

Product liability across borders — prepare to clear customs with necessary documentation.

Controlled drugs — know the rules of the specific country where the event will take place.

Insure the sports bag and keep it secure.

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