Sports Medicine: Just the Facts

CHAPTER 99 • SPECIAL OLYMPICS ATHLETES 585

(ATLS) and ACLS, though rarely needed, should only

be provided if resources and trained providers are

available. Most situations will involve initial stabiliza-

tion only with rapid transport of those who require

more than basic first aid.

• Personnel: Medical practitioners may include a
  diverse group of providers ranging from physicians
  to EMTs. All must work within their level of train-
  ing and scope of practice.
  •Malpractice/liability: Good Samaritan laws will
  apply in some states. Medical practitioners should
  discuss coverage with event providers and their indi-
  vidual insurance company to determine the need for
  additional event coverage.


• Insurance: Most athletes are covered by individual
  insurance plans. SOI maintains an umbrella insur-
  ance plan that covers medical cost of emergency
  care required at games.


• Pre-event medical briefs
  
  
  1. Participant education: Competitors and volun-
     teers should be educated on the available medical
     services, the identification of providers and the
     location of aid station locations. Eating a low fat,
     complex carbohydrate diet to reduce the inci-
     dence of abdominal pains is recommended.
     Further, reminders should be given for athletes to
     take their chronic medications and consume
     appropriate fluids.
  
  
  2. Medical volunteers: A briefing should occur
     before the event and prior to each shift. Points to
     review include—incidence and types of injuries
     anticipated, scope of care, documentation, sched-
     ules, communication, and site layout.
  
  
  
  

ILLNESS AND INJURY PREVENTION

•Training: Coaching promotes proper technique and
appropriate assignment to ability groups. The use of
protective equipment is no different than use by able-
bodied athletes; however, the use of mouth guards and
protective eyewear is often lacking by Special
Olympics athletes.

• Safety precautions
  
  
  • Sport-specific medical and safety requirements are
    contained in the Official Special Olympics Sports
    Rules.
  
  
  • Protective eyewear is required for monocular ath-
    letes participating in dynamic reactive sorts (such as
    basketball, volleyball, and softball) and strongly
    recommended for athletes who wear street glasses
    and participate in these activities.
  
  
  • Protective headgear must be worn by athletes par-
    ticipating in cycling, equestrian, floor hockey,
  
  
  
  

softball (for batters and base runners), speed skat-

ing, and alpine skiing (for giant slalom and down-

hill events).

• Seizure precautions
  •Well-controlled seizure disorder: Risk for seizure
  during participation is minimal. Full participation in
  activities is generally allowed. Athletes are permit-
  ted to swim under direct one-on-one visual supervi-
  sion of a qualified lifeguard who is trained in
  cardiopulmonary resuscitation(CPR) and who is
  aware of the individual’s condition.
  
  
  • Poorly controlled seizure disorder: Even when
    seizures are not completely controlled, sports partic-
    ipation is permitted; however, the following sports
    should be avoided: swimming, power lifting, and
    sports involving heights such as gymnastics, diving,
    or horseback riding.
  
  
  • Supervision: Athletes with seizure disorders should
    be chaperoned at all times, reminded to take chronic
    medication at events and stay well hydrated.
  
  
  • Management of the seizing athlete: Most seizures
    will be short, self-limited, and followed by a postic-
    tal state. With status epilepticus, pharmacologic
    intervention may be indicated. After protecting the
    athlete from further injury and stabilizing the airway,
    antiepileptic benzodiazepines such as lorazepam
    (initial dose: 0.05–0.1 mg/kg up to 3–4 mg IV) or
    diazepam (initial dose: 0.2–0.5 mg/kg up to 5–10 mg
    IV or 0.2–0.3 mg/kg/dose rectal gel) may be admin-
    istered. The athlete with status epilepticus should be
    transported immediately for further evaluation and
    management. In addition, any athlete with new onset
    seizure needs to be transported and evaluated.
  
  
  • Return to play: If a self-limited seizure occurs
    during an event, the athlete should not participate
    further that day. If there is no recurrence overnight,
    the athlete may safely return to competition the next
    day. Individuals with petit mal (absence) seizures
    may be considered as exceptions to this rule and
    may be considered for return to play on the same
    day.
  
  
  
  


• Injury surveillance: Ongoing surveillance is a key to
  identifying sports that may result in injury or factors
  that may predispose Special Olympics athletes to
  injury or illness.


• Immunizations: Recommended immunizations
  include: hepatitis A, hepatitis B, measles-mumps-
  rubella(MMR), tetanus, and influenza. Immunization
  status should be closely reviewed for those participat-
  ing in regional, national, and international games.
  •Healthy athletes initiative:
  
  
  1. Established in 1996 to improve each athlete’s abil-
     ity to train and compete through better fitness and
     health.