and information posters displayed in common areas
are several examples.- Common medical conditions and their prevention,
location of medical aid stations on the course and
available services at these areas assist the participants
in their planning and preparation for a safe event. - Medical presentations to the athletes and interest
groups are often well received. - Race-day information regarding weather conditions
and health warnings has been used with success at
numerous events (Cianca et al, 2001).
STAFFING
MEDICAL AND NONMEDICAL SUPPORT
- The appropriate staffing of medical treatment areas
with both medical and nonmedical staff is important
in the safe conduct of the medical aid station. The
composition and number of this staff will vary
depending on the location and nature of the event. - The number of staff can be best derived from previous
experience or through comparison with similar events in
similar conditions. A helpful guide from the American
College of Sports Medicine (Armstrong et al, 1996) is to
provide the following medical personnel per 1000 run-
ners: 1 or 2 physicians, 4–6 podiatrists, 1–4 emergency
medical technicians, 2–4 nurses, 3–6 physical thera-
pists, 3–6 athletic trainers, and 1–3 assistants.
Approximately 75% of these personnel should be sta-
tioned at the finish area. - Nonmedical staff can assist with the transport of
injured athletes, documentation, medical tracking,
and provide information within the medical aid station
and to event staff.
STAFF FEEDBACK
•After the event it is most important to elicit feedback
from both medical and nonmedical staff. This often
identifies areas that had not been considered in the ini-
tial planning and execution phases of the event.
- The follow-up of these comments in a written after-
action report is highly recommended as it allows the
documentation of areas of concern, develops solu-
tions, and prepares for subsequent events.
TRIAGE AND TREATMENT GUIDELINES
- The majority of the medical conditions presenting at a
given event can be predicted well in advance.
Preparing, training, and practicing for these conditions
are important in the evaluation, treatment, and disposi-
tion of injured participants.SEVERE VS. NONSEVERE- The initial evaluation of an athlete in the medical aid
station should focus on the severity of their injury
(Holtzhausen and Noakes, 1997). Fortunately most
complaints are nonsevere in nature and can be quickly
treated and released.
•Severe medical conditions include cardiac events,
hypothermia, hyperthermia, hyponatremia, near-
drowning, and head and neck trauma. These can be
quickly differentiated from nonsevere conditions by
the evaluation of mental status, rectal temperature
(Roberts, 2000), blood pressure, and pulse. Serum glu-
cose and sodium levels may also aid in the diagnosis. - Depending on the medical care plan of the event,
some of these severe conditions may be treated at the
medical aid station or transported via EMS to the most
appropriate medical treatment facility.
MEDICAL VS. MUSCULOSKELETAL- Medical conditions, such as exercise associated col-
lapse, heat stroke, chest pain and hyponatremia can be
triaged from muscle cramps, blisters, and extremity
pain in the treatment areas. - This separation of care allows the assignment and
preparation of support staff in the area of care for
which they are most experienced. This also allows
those with more severe conditions to be treated in the
same area where they can be more closely moni-
tored. - The establishment of a medical holding area has
proven successful (O’Connor et al, 2003). This area is
reserved for athletes who are waiting for transporta-
tion for nonsevere conditions or who are not prepared
to leave the medical area, but do not require further
care. This group is continuously observed and encour-
aged to make their way back to the after event areas.
EVALUATION OF EXERCISE ASSOCIATED
COLLAPSE- The majority of cases of exercise associated collapse
are the result of predictable physiologic events associ-
ated with exertion and respond rapidly to positioning
with the head down and legs and pelvis elevated posi-
tion (Holtzhausen and Noakes, 1997). These athletes
generally have normal mental status.
22 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE