Sideline preparedness for the team physician: consensus statement

The objective of the Sideline Preparedness Statement is to provide physicians who are responsible for making decisions regarding the medical care of athletes with guidelines for identifying and planning for medical care and services at the site of practice or competition. It is not intended as a standard of care and should not be interpreted as such. The Sideline Preparedness Statement is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the health care professional. Individual treatment will turn on the specific facts and circumstances presented to the physician at the event. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. The Sideline Preparedness Statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues; they have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.     

Team physician consensus statement

The objective of the Team Physician Consensus Statement is to provide physicians, school administrators, team owners, the general public, and individuals who are responsible for making decisions regarding the medical care of athletes and teams with guidelines for choosing a qualified team physician and an outline of the duties expected of a team physician. Ultimately, by educating decision makers about the need for a qualified team physician, the goal is to ensure that athletes and teams are provided the very best medical care. The Consensus Statement was developed by the collaboration of six major professional associations concerned about clinical sports medicine issues: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine. These organizations have committed to forming an ongoing project-based alliance to "bring together sports medicine organizations to best serve active people and athletes."     

The handicapped in sports

The first U.S.O.C. workshop on sports medicine for the handicaPped athlete led to several conclusions. First and foremost, the disabled athlete as an amateur athlete with a desire to participate must ever be uppermost in our minds, hearts, and planning. It appears that one of our chief objectives within the U.S.O.C. should be a central unifying force operating with joint support of the Sports Medicine Council and the Handicapped in Sports Committee, under the Sports Medicine Division. This arrangement will serve as an information and clearing center for the better understanding of each other and each organization of sports for the disabled athletes. We need to identify and classify for attention the common problems inherent among these groups and coordinate our various efforts. Fundamental to improvement in the application of sports medicine concepts is development of a definite plan for the education of voluntary coaches and trained or professionally prepared coaches, athletic trainers, physical therapists, and physicians. A variety of concurrent approaches are feasible with initiative and sharing of resources. An additional venture must be to begin pooling and computerizing our present and future information in this regard (professional articles and medical records) within the U.S.O.C. information retrieval system. This must be systematized so the pertinent information can then the disseminated and furnished nationwide to anyone or any group dealing with the disabled athlete in sports. Ultimately, our objective is to make this information available to all handicapped people.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ethics in sports medicine

Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.     

Sport and medicine in ancient Greece

Sport and medicine in ancient Greece were the result of a widespread tradition of liberty, which was at the heart of one of the most brilliant civilizations in history. Whereas war encouraged the development of surgical knowledge springing out of medical experience on the battlefield, peace promoted the burgeoning of sport as an integral part of Greek upbringing, allowing the channeling of young people's aggressiveness into physical competition. Medicine was magical and mythological, especially in the time of Homer (9th century BC); Aesculapius, the mythical god of healing, was its reference point. With Hippocrates (5th century BC), the body of medical experience was to be codified and built up, and was to undergo a novel evolution based on the theory of the balance of the four humors. The athlete's mentality, faced with trauma in the sports ground, underwent a change; injury was no longer considered a punishment by the gods. At the same time, temple offerings tendered in the hope of victory gave way to the athlete's personal preparation based on a specifically modified lifestyle, diet, and training. The resulting progress in medicine and public health, especially from the 5th century BC onward, was not only to favor athletic performances of high quality but also surgical techniques that were very advanced for their time. Thus it can be seen that the medical knowledge associated with the practice of sport progressed during antiquity because of its obligation to follow the warrior and then the athlete.     

Sports medicine in New Zealand.

Sports medicine in New Zealand is characterized by a team approach. Experienced professionals work together to the benefit of athletes, be they elite performers or those in sport for purely recreational purposes. A no-fault accident compensation scheme is used to provide speedy access to treatment services for those injured in sport and also for advice on accident prevention. Recent initiatives include a task force on drugs in sport and the creation of regional sports foundations. Sports medical education is a prominent part of the New Zealand scene.     

Sports medicine and the law

Legal problems occur in sports medicine as well as in other fields. To whom do sports doctors owe their duty - to the club, to the team or to its members? Doping has become a part of competitive sport. What is the doctor's responsibility in relation to this? Medical "treatments" given sometimes on demand, in order to enable athletes to continue the game or competition despite the high risk of future severe irreparable damage, may constitute gross negligence. Consent given by athletes in such circumstances may be considered invalid. The club is obliged to insure its members against personal injuries. However, insurance companies may refuse to cover cases where a priori negligent medical treatment was demanded, or will sue the doctor for reimbursement. Medical confidentiality should be kept even regarding athletes, and disclosing any information is unlawful without the athletes' consent. Doctors' professional duty to the athletes should override any duty to the club that hired them, and professional medical opinion should override any caprice of the athlete.     

Society of Apothecaries diploma in sports medicine.

The Society of Apothecaries examination in Sports Medicine consists of four parts: a multiple-choice question paper; a written paper; a clinical section; and an oral section. The candidates must have experience in sports medicine and have to submit a dissertation and a case history book. The importance of an examination in sports medicine is discussed.     

Defining the sports medicine specialist in the United Kingdom: a Delphi study

OBJECTIVE: To define the role and responsibilities of the sports medicine specialist using a recognised research technique. METHODS: A Delphi technique was employed using anonymous postal questionnaires sent to a random sample of 300 members of the British Association of Sport and Exercise Medicine. The questionnaire of 300 putative attributes was developed in a pilot study and the Delphi technique used allowed participants to modify their responses according to the responses of other participants. RESULTS: There was a 53% response to both rounds of the study with 75.6% of the respondents being male, 39% having a higher qualification in sports medicine, and 45.6% being general practitioners. Some 86.3% strongly agreed that sport and exercise medicine should be a recognised speciality and 90% strongly agreed that it should be available on the National Health Service (NHS). The most important specialist attributes were orthopaedic and soft tissue medicine (83.6% strongly agreed) and emergency medical management (79.7% strongly agreed). More than 75% of respondents did not agree that either research or personal playing experience were relevant. CONCLUSION: Sports and exercise medicine is an evolving speciality in the United Kingdom. We believe this is the first systematic attempt to define the role and responsibilities of the sports medicine specialist and the findings are of relevance to the future development of a career pathway.     

Wheelchair sports medicine

Wheelchair sports medicine involves the assessment of recreational and competitive sport capacities of physically disabled individuals, medical classification to allow fair competition among athletes with various types and degrees of disability, the prevention, diagnosis, and treatment of athletic injuries, and research into the biomechanics and physiology of wheelchair athletics. Involvement in wheelchair sports medicine activities increases professional awareness and provides a valuable referral source for organized sports activities.     

Proceedings of the First Scandinavian Congress in Sports Medicine, Oslo, Norway, November 5–8, 1992

The First Scandinavian Congress in Sports Medicine was arranged by the Norwegian Society of Sports Medicine, the Norwegian Society of Sports Physiotherapy and the Scandinavian Foundation for Medicine & Science in Sports, to increase the exchange of science in sports medicine in Scandinavia. The Congress assembled almost 600 participants, who were offered a series of guest lectures from distinguished researchers, several symposia, instructional courses and free paper sessions. The second Scandinavian Congress in Sports Medicine will be held in Copenhagen in 1994.     

The female athlete

Over time, women have become more extensively involved in athletic programs. The female athlete presents a unique challenge to sports medicine in general. Although specific types of injuries are the same as in the male athlete, the female athlete is at higher risk for some of these injuries. Injuries may be sport specific, but gender-related injuries are also related to morphologic and physiologic differences between the male and female athlete. This article reviews some of the differences between the male and female athlete and focuses on a few prominent injuries or risks related specifically to the woman athlete.     

Musculoskeletal ultrasound education for sports medicine fellows: a suggested/potential curriculum by the American Medical Society for Sports Medicine

The following musculoskeletal ultrasound (MSK US) curriculum was developed by the American Medical Society for Sports Medicine (AMSSM) to provide a pathway by which a sports medicine fellow can obtain adequate MSK US training during their fellowship to meet the requirements of competency outlined by the American Institute of Ultrasound in Medicine (AIUM) Training Guidelines for the Performance of MSK US Examination. Many fellowship programmes may not be able to follow all of the recommendations outlined by this document owing to their available resources. However, this curriculum can be used as a suggested/potential guideline for MSK US training within a sports medicine fellowship, and may assist programmes in developing or modifying their own internal training methods.     

Optimizing the collegiate preparticipation physical evaluation.

BACKGROUND: Today's collegiate student athlete is a highly diverse individual and as such is at higher risk for many health problems both on and off the field. OBJECTIVE: To determine if a preparticipation evaluation (PPE) can be optimized to help the collegiate team physician and athletic trainer assess both current and past health issues of student athletes. DATA SOURCES: Utilizing MEDLINE and other medical literature database search engines, the authors conducted detailed literature searches on this subject. Key words used in these searches included preparticipation physical evaluation, collegiate, athlete, cardiovascular, preventive healthcare, high risk, alcohol, tobacco, sexually transmitted disease, motor vehicle accident, adolescent, and female. METHODS: Approximately 35 articles were selected for review for this report. Authors reviewed articles within their particular area of content responsibility. Personal communications with several sports medicine experts were also conducted. RESULTS: Twenty-three articles were selected for inclusion, in addition to information obtained from the American College of Sports Medicine and National Collegiate Athletic Association (NCAA) Web sites. Utilizing these sources, as well as guidance and suggestions from other sports medicine physicians, the authors determined that the NCAA-mandated PPE should deliver an overview of the athlete's entire health status. CONCLUSIONS: As detailed in this report, it is recommended that the NCAA PPE serve as a tool in tracking and assessing both current and past health issues of student athletes. These health issues would include (1) on-field health concerns such as cardiac and musculoskeletal conditions, (2) off-field health concerns (that may adversely impact on-field performance) such as sexual activity and substance abuse, and (3) health issues unique to the female student athlete, such as eating habits, nutritional record, and menstrual history. Primary care physicians should be involved in all PPEs as they have the necessary expertise to recognize potential problems in these areas.     

Nutrition on the Run

Abstract

Approximately 7.6 million high school students in the United States participate in sports. Although most sport-related injuries in adolescents are considered minor emergencies, life-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus and exercise-induced asthma, catastrophic brain injuries, cervical spine injuries, heat- and cold-related illness, blunt chest/abdominal injuries, and extremity fractures resulting in compartment syndrome. Emergency preparedness in athletics involves the identification of and planning for medical services to promote the safety of the athlete, to limit injury, and to provide medical care at the site of practice or competition. Several national organizations have published guidelines for emergency preparedness in school-based athletics. Our article reviews guidelines for emergency preparedness put forth by the Sideline Preparedness collaboration (comprised of 6 major professional associations, including the American Academy of Family Physicians, American Academy of Orthopedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine), the National Athletic Trainers' Association, the American Academy of Pediatrics' Committee on School Health, and the American Heart Association. Additionally, we review published data examining compliance of US high schools with these recommendations for emergency preparedness in school-based athletics, determine deficiencies, and provide recommendations for improvement based on these deficiencies.     

Preparation and medical management of events in mountain and high-altitude environments

Athletic pursuits in mountain and high-altitude environments continue to increase in popularity for the recreational and professional athlete. Accordingly, the sports medicine practitioner will have an increasing opportunity and responsibility to serve the unique needs of the mountain sport athlete. Many medical conditions occurring in the mountain and high-altitude environments will be unique to the Western medicine practitioner. This article discusses the medical care unique to athletes participating in these environments.     

Building a sports medicine team

There have been a growing number of participants in high school and collegiate athletics in recent years, placing ever-increasing demands on the sports medicine team. Building a winning sports medicine team is equally as important to the success of an athletic organization as fielding talented athletes. Acquisition of highly qualified, motivated, and hard-working individuals is essential in providing high quality and efficient health care to the athlete. Maintaining open paths of communication between all members of the team is the biggest key to success and an optimal way to avoid confusion and pitfalls.     

HIV and the athlete

HIV/AIDS is considered a worldwide pandemic, with continued increases in the number of newly diagnosed cases and persons living long-term with the disease. Athletes may be at risk of infection based on behaviors associated with participation in their sport and away from competition. The sports medicine physician must be aware of the risk of HIV/AIDS in the athlete, diagnosis and treatment options, the effect of HIV/AIDS on exercise, and strategies for prevention of HIV/AIDS in athletic competition.     

Interviewing principles for the psychiatrically aware sports medicine physician

This article describes how sports medicine physicians can best approach the diagnoses of mental illness in athletes. Examples of psychiatric problems common to athletes, their incidences in the population, and diagnostic tips to ferret them out are given. Vignettes of well-known athletes who have had these problems are included. Each highlights how the lack of diagnostic awareness of mental health issues in the athletic community and the stigma of "mental illness" prevented the athlete from getting treatment sooner.