Competition Medical Guidelines forWorld Athletics Series Events
Appendix A
Medical encounter forms
October 2020 – Second Edition

1Illness-Related Race Medical Encounter Data (R-MED) Form
Endurance Sport Events –1.

Race Details: <Pre-populate before the event>Race name:
2.

Date:

Course Q2

Course Q3

Course Q4

At finish

Sweeper bus

Hospital

Other

Athlete Demographic Details: Race Number:
Male

4.

Official finish time:

Location Of The Medical Facility:
Course Q1

3.

Official start time:

Female Race finisher:Yes

No Arrival time at medical facility (hh/mm):

Athlete Illness-Related Medical History:

4a. Pre-Race History:
Did the athlete suffer from any pre-race acute illness/symptoms (gastro/acute illness or infective illness?
Details of pre-race illness or injury (Type):
LRT symptoms

URT symptoms with no systemic symptoms

Nausea/vomiting and diarrhoea

Yes

No

URT symptoms with systemic symptoms

Nausea only

Nausea and vomiting

2-7 days before

8-14 days before

Diarrhoea

Other infective illness

Other pre-race illness
Onset of pre-race illness:

Race day

1 day before

Analgesics/NSAIDs use 0-24 hours before the race?

Yes

Analgesics/NSAIDs use during the race?

Yes

No

Prescription medication use (list please):

Yes

No> 15days beforeNo

Reason for medication use:
4b. Presenting Complaint:
Collapse (pre-finish)

Collapse (post-finish)

Fatigue/exhaustion

Muscle cramps (systemic)

HeadacheHot (suspected hyperthermia)

Skin (chafing/blisters)

Skin (cut/laceration)

Musculoskeletal (upper limb)

Confused

Muscle cramps (localized)

Abdominal cramps/pain

Chest pain

Diarrhoea

Cold (suspected hypothermia)

Palpitations

Nausea/vomiting

Difficulty breathing

WheezeSeizure
Coughing

Skin (other)

Musculoskeletal (head/neck)Musculoskeletal (chest/trunk)Musculoskeletal (spine/back)Musculoskeletal (hip/pelvis)

Musculoskeletal (lower limb)

Deep Chest/Abdominal trauma

Other:

Additional clinical notes:

5.

Clinical Examination:

5.1. Mental status (APVU):

Alert

5.2. Glasgow Coma Scale:/15 Eye:5.3. Hydration:

Normal (clinically)

Fluid intake during race (ml):Responds to voice/4 Verbal:

Responds to pain
/5 Motor:

Unresponsive/6

Dry mouth (mucosa)

Oedema (swollen periphery)Pre-race weight (kg):Post-race weight (kg):Poor skin turgor% Weight change:

5.4. Vital signs
Time of measurement
Admission

5.5. Other clinical findings:

Pulse

BP Systolic/diastolic)Core Temp% SatsGlucoseOther%

6.

7.

8.

Orders/Investigations:
Admit to ICU/resuscitation (medical tent or hospital)

Admit medical tent for treatment

Fluids (IV)

Other:

CoolingWarming

Wound care

Lab tests (glucose)

Lab tests (sodium)

Lab tests (Hct/Hb)

Lab tests (ECG)

Lab tests (potassium)

Elevate legs

Lab tests (urea/creat)

Lab tests (Ultrasound)

Fluids (Oral)Lab tests (blood gas)

Lab tests (Other):Laboratory/Investigation Results (Attach):
Lab tests (glucose)

Lab tests (sodium)

Lab tests (Hct/Hb)

Lab tests (ECG)

Lab tests (potassium)

Lab tests (urea/creat)

Lab tests (Ultrasound)Lab tests (blood gas)

Lab tests (Other)

Treatment:

8.1. Fluids
Oral Fluid (volume ml):

Type:

IV Fluid (volume ml):

Water

Sports drink

Type:

Hypertonic salineRate:

ml over

Other:min Start time:

End time:

8.2. Medication
Type:

Dosage:Route (po/IM/IV):Time (given):

Type:

Dosage:Route (po/IM/IV):Time (given):

8.3. Other treatment:

9.

Pre-Discharge Assessment:

Conscious/orientatedYes

No

Asymptomatic

No

N/A

Yes

N/AAmbulatory

Yes

No

N/A

Passed urine:

Yes

No

N/A

10. Final Diagnosis Of Illness-Related Medical Encounter:
Main organ system:

Multiple organs

Cardiovascular system

Respiratory/ENT system

Rheumatological system

Gastrointestinal system

Genitourinary system

Dermatological system

Ophthalmological system

Dental illness

Drug use/Overdose

Central nervous system

Haematology/Nutrition

Psychological/PsychiatricEndocrine/Metabolic

Tumour/malignancy

Other medical illness

Final diagnosis/illness type (Enter code from Table):
11. Illness-Related Medical Encounter Severity:
Minor encounter

Moderate encounter

Serious/life threatening encounter

Sudden cardiac arrest (SCA)

Sudden cardiac death (SCD)

Non-cardiac sudden death

12. Discharge Information:
Discharged

Hospital transfer

Follow-up care needed

Follow up call by race medical team needed

Yes

No

Refusal of care
Other special instruction:

13. Transport Information:
Authorized by: Dr

Hospital name:

Transported by:

Receiving doctor:

Receiving doctor’s contact details:
Family/Next of Kin notified:

Yes

No Who was notified?

14. Additional Clinical Notes:

15: Doctor/Clinician Details:
Doctor/Clinician name:
Date:

Signature:Time:Injury-Related Race Medical Encounter Data (R-MED) Form
Endurance Sport Events –1.

Race Details: <Pre-populate before the event>Race name:
2.

Date:

Course Q2

Course Q3

Course Q4

At finish

Sweeper bus

Hospital

Other

Athlete Demographic Details: Race Number:
Male

4.

Official finish time:

Location Of The Medical Facility:
Course Q1

3.

Official start time:

Female Race finisher:Yes

No Arrival time at medical facility (hh/mm):

Athlete Medical History:

4a. Injury History:
Onset of Injury:

Acute

Mechanism of Injury:

Chronic (pre-existing)Acute exacerbation of chronic injury

Traumatic – contact with another athlete

Traumatic – contact with moving object

Traumatic – contact with immobile object
Traumatic non-contact
Overuse injury
OtherFactors Contributing to the mechanism of injury: Violation of rules
Weather conditions
Equipment failure
Course/field of play conditions

Fatigue

Psychological

Other:

4b. Presenting Complaint:
Pain

Loss of function

Upper limb injury

SwellingConfusion

Spine/back injuryUnresponsive (coma)

Hip/pelvis injury

Head/neck injury

Lower limb injury

Chest injury

Trunk injury

Abdominal injury

Injury multiple anatomical areas:
Other injury:
Additional clinical notes:

5.

Clinical Examination:

5.1. Mental status (APVU):

Alert

5.2. Glasgow Coma Scale:/15 Eye:5.3. Hydration:

Normal (clinically)

Fluid intake during race (ml):Responds to voice/4 Verbal:

Responds to pain
/5 Motor:

Unresponsive/6

Dry mouth (mucosa)

Oedema (swollen periphery)Pre-race weight (kg):Post-race weight (kg):Poor skin turgor% Weight change:

5.4. Vital signs
Time of measurement

Pulse

BP Systolic/diastolic)Core Temp% SatsGlucoseOtherAdmission

5.5. Other clinical findings:

6.

Orders/Recommended Investigations:
Admit to ICU/resuscitation (medical tent or hospital)
Wound care

Admit medical tent for treatment

Splint/brace

Other:

Lab tests (Ultrasound)Lab tests (Radiology – X Rays)

Lab tests (MRI scan)

Lab tests (CT scan)

Warming%7.

Laboratory Results:

Clinical notes:

8.

Treatment:

8.1. Wound Care:
Wound dressing

Suture laceration

Other:

Type:

Water

8.2. Fluids:
Oral Fluid (volume ml):
IV Fluid (volume ml):

Sports drink

Type:

Hypertonic salineRate:

ml over

Other:min Start time:

End time:

8.3. Medication
Type:

Dosage:Route (po/IM/IV):Time (given):

Type:

Dosage:Route (po/IM/IV):Time (given):

8.4. Other treatment:

9.

Pre-Discharge Assessment:

Conscious/orientated

Yes

No

Asymptomatic

No

N/A

Yes

N/A

Ambulatory

Yes

No

N/A

Passed urine:

Yes

No

N/A

10. Final Diagnosis Of Illness-Related Medical Encounter:
Main organ system:
Head injury

Neck injury

Trunk/abdominal injury
Lower leg injury

Shoulder injury

Lumbar spine injury

Ankle injury

Upper arm injury

Elbow injury

Pelvis/buttock injury

Forearm injury

Hip/groin injury

Thigh injury

Foot injury

Injury location unspecified or crossing anatomical boundaries:
Final diagnosis/illness type (Enter code from Table):
11. Illness-Related Medical Encounter Severity:
Minor encounter

Moderate encounter

Serious/life threatening

Non-cardiac sudden death

12. Discharge Information:
Discharged

Hospital transfer

Follow-up care needed

Follow up call by race medical team neededYes

NoRefusal of care
Other special instruction:

13. Transport Information:
Authorized by: Dr

Hospital name:

Transported by:

Receiving doctor:

Receiving doctor’s contact details:
Family/Next of Kin notified:

Yes

No Who was notified?

14. Additional Clinical Notes:

15: Doctor/Clinician Details:
Doctor/Clinician name:Date:
6

Signature:
Time:

Chest injury
Knee injury

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