Competition Medical Guidelines forWorld Athletics Series Events
A Practical Guide
October 2020 – Second Edition1World Athletics
Health and Science Department
Authors:
Paolo Emilio Adami
Stéphane Bermon
Frédéric Garrandes
Gaia Guadagnini
Reviewers:
Pedro Branco
Fumihiro Yamasawa

Table of Contents

Chapter 1.............................................................................. 7
General principle for medical organisation........ 7
Chapter 2........................................................................... 18
Medical management for In-Stadium
athletics events.................................................................18
Chapter 3........................................................................... 23
Medical management for Out-of-Stadium
events and elite race competitions (including
Race Walk, Marathon, Half Marathon and
Cross Country).................................................................23
Chapter 4........................................................................... 35
Most frequent medical conditions inendurance events............................................................35
Chapter 5........................................................................... 37
MCM algorithms..............................................................37

Appendices....................................................................... 54
Appendix A....................................................................... 55
Medical encounter forms............................................55
Appendix B....................................................................... 60
Recommended staff and equipment for
WAS events.........................................................................60
Recommended numbers of medical andparamedical personnel Out-of-Stadium
athletics events.................................................................62
Recommended medical equipment andsupply for In-Stadium athletics events.............63
Recommended medical equipment andsupply for Out-of-Stadium athletics events.64
Recommended numbers of medical andparamedical personnel in World Athletics
Cross Country Championships..............................65
Recommended medical equipment andsupply for World Athletics Cross Country
Championships.................................................................66
Appendix C....................................................................... 67
Recommended medication and medical
supplies for WAS events ...........................................67
Medical supplies and equipment .........................69

Foreword
The health and safety of our athletes is paramount. At World
Athletics we want everyone who participates in our sport to enjoy
the competition and feel a sense of achievement, but this is only
possible in a safe environment.
For this reason, I am pleased to introduce the second edition of
the Competition Medical Guidelines for World Athletics Series
Events, which offers expert guidance to athletics event organisers
on how to prepare and implement an appropriate medical plan forWorld Athletics Series events.
Much has changed in our world since the first edition was issued in January 2013. This updated
guide contains the latest scientific advice on topics including infection control and heat stress andhas been compiled by medical practitioners who have extensive experience working with athletics
competition, both inside and outside the stadium.
It is an essential reference for the medical specialists working with our Local Organising Committees
and I commend it to you.

Sebastian Coe,

President, World Athletics

4Preface
This document aims at supporting Local Organising Committee (LOC) Medical Teams of World
Athletics In-Stadium and Out-of-Stadium events, in the preparation of the medical services for the
event. This guideline alongside the other documents provided by the Health and Science department,
should guide the LOC through every phase of the preparation. The work should be done in close
connection and constant communication with the Medical Delegate and the Health and Science
department. The LOC is in any case financially responsible for all provisions detailed hereunder.

5

6

Chapter 1
General principle for medical organisation
1.

Medical TeamThe Medical Team is only one of the many components of athletics event organisation which isnecessary to conduct a successful competition. The missions of the Medical Team are:•to provide primary and emergency care to athletes, staff, officials, judges, volunteers, World
Athletics family members and spectators at all competitions, training, and other event sites;•

to provide other medical support services needed to ensure the safety and health of the above
described categories;•

to arrange for referrals, where necessary, to a higher level of health care.

The composition and scope of the Medical Team may vary with the size of the competition; numberof people involved (athletes, officials, judges, volunteers, media, etc.), and responsibilities assigned toother departments of the Local Organising Committee (LOC).
The members of the Medical Team must integrate all aspects of their operation into the functions of
the other departments, if their mission is to be carried out successfully.

2.

The Medical Director

The LOC should appoint a certified physician as the Medical Director. The Medical Director should
lead the Medical Team and is ultimately responsible for all health care services provided at all official
sites, venues, and accommodation areas. The Medical Director oversees the overall coordinationof medical organisation and represents the Medical Team of the Organising Committee. He/sheshould preferably be a member of the local medical community, to ease cooperation with community
resources. The Medical Director reports to, and co-operates with, World Athletics – mainly World
Athletics Medical Delegate – and the LOC President/CEO.
The Medical Director’s responsibilities include a number of significant tasks and duties. Due to theburden of work, it is strongly recommended to appoint assistants to the Medical Director. Amongthem a Deputy Medical Director and venue managers who can help the Medical Director in thefollowing duties:a)Ensure recruitment and supervision of the various medical personnel that should have basic
knowledge of the nature of Athletics as a sport, and should have sports medicine skills;
7b)

Design a comprehensive health care system, making sure that adequate facilities, supplies andequipment are available for medical care at all official sites, venues and accommodation areas;c)

Recruitment and co-ordination of community medical resources, including emergency transport
services, emergency room(s) and hospital admissions;d)Ensure the correct accreditation and formal licensing of medical staff and of teams’ official
medical personnel;e)Assist the LOC in obtaining liability insurance for medical staff (doctors, nurses, physiotherapists,
volunteers etc.) and negotiate, if any, an insurance contract to cover care and consultative
services for all accredited personnel;f)Support the LOC in developing a medical budget, according to the necessary and planned
medical services;g)

Develop medical information for the Team Manual including detailed facts of medical careprovided by the Organising Committee to visiting teams, VIP’s, World Athletics Family and media.
The medical information should also be available on the Organising Committee website;h)

Maintain administrative liaison with World Athletics Medical Delegate. At major championships,
the Medical Director should work with World Athletics Medical Delegate to ensure that all World
Athletics Rules and Regulations are complied with. If necessary, appoint a Medical Team member
to serve as a liaison to World Athletics Medical Delegate;i)

Promote and/or invite teams to check the external validity of insurance policies of their
participants (for possible mutual recognition of health assistance between different states), and/or to cover their travel and accommodation periods by temporary insurance contracts;j)Develop policies and procedures for all departments of the medical organisation, for final
approval by the World Athletics Medical Delegate and if needed the LOC CEO;k)

Inform National Teams’ medical staff of all government regulations required for the importation of
medication and medical supplies, and provide necessary forms to meet these requirements;l)Work with venue coordinators and department heads to develop supply and equipment needs.
Determine whether these materials must be obtained by purchase, by loan or donation from local
medical sources;m) Deal with the Food Services Department and the Support Services Chair to assure that meals
and beverages are available for food safety control personnel.
n)Ensure that meal services are adapted to the early and late work schedules of staff members.

o)Guarantee that inadvertent food contamination with prohibited substances (e.g. clenbuterol or
nandrolone in meat; morphine poppy-seeds, stimulants in soft drinks, etc.) is avoided;8p)Work with local health authorities to implement control and prevention of contagious diseases.
Pay specific attention to epidemic outbreaks of infectious diseases (COVID-19, A type influenza,
dengue fever, norovirus etc.). Medical Director should also ensure water and air sanitation as
well as control of vectors. Implement monitoring programmes of environmental conditions, local
pollution, radiation, or any environmental disturbance that can create concern and alarm for thevisiting teams;q)Work with the local meteorological agency to ensure the WBGT measurement in competition
field, warm-up tracks and training venues;r)Work with the Housing Office to provide for the housing needs of Medical team members,
especially Medical staff who are scheduled for on-call emergency care during night-shifts;s)Ensure that convenient medical records are kept for all medical encounters from all relevant
medical centres in various sites (medical encounter form is available in “Appendix A”);t)

Make the necessary arrangements to compile daily and final statistical data from medical records.
It is suggested that a Daily Medical Report be prepared for review by the Medical Director andother officials on a ‘need to know’ basis;u)Work with World Athletics Medical Delegate to enable the implementation of data collection forathletes’ injuries and illnesses epidemiology study; andv)

During the actual period of the event, appoint a Medical Team member with adequate language
skills to serve as a liaison with visiting teams’ medical staff.

w)

Take necessary measures to collect biological waste from teams.

3.

The scope of the health care services

Provide health care and sports medicine services to athletes, team officials, VIPs, media, spectators,
local workers and volunteers, through the organisation of local personnel and facilities, and byworking with accredited national teams’ medical personnel.
The scope may vary with the size of the competition and the responsibilities assigned to otherdepartments in the organisation. The goal is to provide health care and sports medicine services
through an organisation of local personnel and facilities. The extent of services depends on thelocation, duration and type of competition, as well as the type and number of patients expected,
and the nature of the injuries or illnesses which are predictable. Patient groups may include not only
athletes, but also health care staff, team officials, LOC workers/volunteers, judges/referees, World
Athletics Family and VIP’s, media, and spectators. The services shall be available at all training sites
and competition venues, including all accommodation areas.

9Health Care Services include, but are not limited to the following:a)Adequate facilities available for medical services to cover all accredited people and allcompetition, training and accommodation sites;b)

Provision of primary and emergency care to all above mentioned categories at the various
venues and areas of the event, at no charge to all eligible individuals;c)Provision of other medical support services needed to ensure the safety and health of theaforementioned, and of the spectators;d)Maintenance of a data-recording system for all medical and physiotherapy encounters (acuteincidents, injuries, illnesses assistances and treatments provided);e)Supervision of pharmacy services, medication and medical equipment supplies;f)

Establishment of liaison for specialty services and consultations: such as imaging studies (i.e.
X-ray, ultra-sound, computerized tomography (CT), magnetic resonance imaging (MRI), etc.);
laboratory services; dental; ENT; ophthalmology; gynaecology; and orthopaedic care etc. (X-ray,Musculo-Skeletal –MSK-ultra-sound and orthopaedic services may be on-site at major events);g)

Coordinating service with the hospital network and emergency services; including thedevelopment of a liaison system with admitting hospitals to ensure timely reports of hospital
admissions, daily progress reports and hospital discharges;h)Supervision of environmental and meteorological parameters at all official sites, venues andaccommodation areas;i)

Public health and safety surveillance;j)Administration of official emergency treatments (including any kind of injection or intravenous
infusions) for athletes at World Athletics competitions only by LOC medical personnel in LOC
medical care sites by licensed professionals;k)Organise training sessions for the various medical care teams; including those in charge ofroad race events. Topics should include: information on Athletics and its rules; basic sports
medicine skills; evacuation; transfers and refer medical criteria on competing, on training andaccommodation areas; medical guidelines for common conditions in athletes, etc.

l)Supervision of qualitative and quantitative aspects of meals served to participants, and generalfood sanitation in cooperation with the LOC; sealed water and drinks are preferred – both for
health and legal/doping problems – in competition venues and call rooms/medical room/antidoping rooms; drinkable tap water might be provided at accommodation sites to encouragesustainable behaviours; maximum attention should be paid to the choice, storage, conservationand presentation of foods; consider a wide choice of different meals, taking into accountdifferent needs linked to possible medical necessities (food allergy, coeliac disease, etc) and/or

10

different cultural, ethnic or religious uses (e.g. vegetarians, religious restrictions for meat, etc.);
the timing of meals should be as flexible as possible, and should take into account not only thecompetition schedule, but also possible particular needs (e.g. religious fasting.); ensure adequateand diversified collection of meal waste (e.g. humid, plastic, paper etc);m) Contribution towards the prevention or early detection of possible food-linked problems and/orof general epidemic diseases, if any;n)Provision of adequate support (fluid drinks, ice, hot drinks, blankets, conditioned or warmed
areas, etc.) in case of particular heat or cold environmental conditions, in accordance with
the LOC;o)Provision of information – by means of the team manual: website, or other tools – on particular
vaccinations requested by the World Health Organisation (WHO) and/or national or international
travel laws, if any;p)

An orientation session or medical meeting for visiting teams’ medical staff, outlining available
medical services;q)

Liaison with Security Services to facilitate access to medical areas for accredited team medical
personnel, when necessary, for athlete care; andr)

Producing a plan against full-scale disasters and accidents in cooperation with relevant LOC
departments.

s)

Develop a contingency plan to isolate and treat infected athletes and officials, for contagious
diseases.

4.

Pharmacy and prescription guidelines

The pharmacy should be supervised by a licensed pharmacist. Following a consultation, an athlete or
the team physicians should be provided with adequate medication for a duration of two (2) days, toinitiate optimal medical care, plus prescription so that the athlete or the treating doctor can have theremaining part of drugs delivered at a local pharmacy. The size and complexity of the supplies stored
and managed will vary considerably and will be determined by the size and number of teams, and theduration of the competition.
a)Medication should be dispensed only by a pharmacist or by a staff member of the local
Medical Team;b)

Only prescriptions from LOC physicians will be evaluated and honoured;c)Team physicians can only prescribe medication for members of their own delegation;

11

d)

Prescriptions should be written on a form provided by the organiser; ande)World Anti-Doping Agency (WADA) prohibited medication should be kept separately and beclearly marked. The responsibility for using these substances, due to emergent situations, will lie
with the prescribing physician and patient. Prohibited substances, according to WADA, should
be avoided, unless there is no therapeutic alternative. However, athlete health should be thefirst priority and prescriptions of prohibited substances should not be excluded if these areneeded to treat any particular medical condition. The pharmacist should inform the patient thatthe medication is in the WADA prohibited list, and the patient must acknowledge this fact bycounter-signing the prescription, prior to dispensing.

5.

Public Health and Safety

The LOC Medical Team shall supervise environmental health, sanitation of food and safety at allvenues, including housing facilities, training and competition sites. The Medical Team should be
informed about any possible reports of communicable and food-borne illnesses, and should cooperate with local public health authorities, especially in cases of infectious airborne diseases (e.g.
COVID-19, SARS, MERS), diseases manifested by a rash and fever (e.g. measles, rubella, varicella,dengue fever, etc.), gastro-intestinal illnesses (e.g. norovirus infections); hepatitis; influenza-like
illnesses; and sexually-transmitted diseases.
A Public Health Officer should be appointed. The Public Health Officer should be responsible for:•the preparation of a comprehensive public health plan (mitigation and contingency) incooperation with local public health authorities.

•

Maintain constant contact and ensure interaction with local public health authorities;•

Develop a specific plan for the isolation and treatment or hospital admission of individuals withcontagious diseases;•

Develop a communication, education and information plan, in cooperation with other LOC
Functional Areas, aimed at preventing all sorts of communicable diseases among athletes, staff,
workforce, volunteers and spectators.

5.1. Contagious diseases
Mass gathering events represent a public health challenge because of the gathering of large
numbers of athletes, spectators and working staff, for a prolonged period of time. Furthermore, such
events often result in mixing of populations that travel to the competition destination from different
parts of the world, thus are exposed to a different infectious risk (higher or lower) than the hosting
local community. It is of utmost importance that the risk of a potential disease outbreak is always

12

considered while preparing the medical plan, that specific mitigation plans are activated to reduce therisk and that contingency plans are ready to be implemented in case of an infectious outbreak.
Based on the principle that a certain level of risk will always be present and that a “zero risk” situation
does not exist, we developed the concept of the pendulum of risk (see Figure 1) and hypothesized
the existence of three infectious diseases outbreak phases: active pandemic, post-peak/contained
outbreak, and seasonal outbreak. These phases represent a simplified version of the WHO Pandemic
Phase Description and WHO Pandemic Severity Score which adopts three indicators: transmissibilityof a virus, seriousness of disease and impact. Whether in a seasonal outbreak or contained outbreakphase, the infectivity and transmissibility risk of any infectious disease will have to be considered andassessed before the organisation of all mass gathering and mass participation sporting events.

Active Pandemic

Post Peak/Contained Outbreak

Seasonal Outbreak

Figure 1 – The pendulum of risk

The partnership with local and regional health and safety agencies is strongly encouraged, as these
are absolutely necessary to properly assess the infectious risk, put the mitigation strategies in place
effectively and plan for efficient contingency plans. The collaboration and communication between
event planners and local health authorities should aim at bringing together the specific expertiseof the sports bodies with that of the local public health system within a defined framework for risk
assessment and risk management.
Based on the event characteristics, different risk assessment tools might be used to identify theinfectious risk and, consequently, define mitigation strategies and contingency plans. National and/or
local rules and regulations must be followed at all times. For In-Stadium and Out-of-Stadium events,
event organisers can refer to the World Athletics Health and Science department website https://worldathletics.org/about-iaaf/health-science/risk-assessment

13For out-of-stadium events, competition organisers are encouraged to use the online Infectious
Diseases Outbreak Management Tool that can be accessed through the following link https://idom.
worldathletics.org/
This web-based system provides event planners with the ability to assess the feasibility of staging
a mass participation event and should help by:•assessing the risk level of the event in both quantitative and qualitative manner,•

determining the public health and sport event’s mitigation preparedness,•

proposing the steps to take to further mitigate and reduce the risk.

5.2. Food Safety and Food manipulation Control
In close cooperation with the relevant LOC department, supervise the meal quality for participants
and general food sanitation; prevent from, or enhance early detection of, possible food poisoning, ifany; and make every best effort to guard against inadvertent food contamination.
5.3. Drinking water, air conditioning and swimming pool sanitation
Sealed water and drinks are preferred, both for health and legal/doping problems, and should beavailable at all competition venues. However at accommodation sites, for sustainability purpose,athlete should be encouraged to use their own container, filled with tap water, when the latter isdrinkable. The LOC will supply the stadium, warm-up, training and accommodation facilities withbottled water that is manufactured only by an authorised bottled water supplier. Tap water sanitation
at accommodation should be assured. Appropriate control of air conditioning and swimming pools toprevent legionella outbreaks should be implemented.
5.4. Vector control
Adequate programmes of sanitation in competing, training, accommodation and spectators’
areas should be implemented as well as appropriate control of animals mosquitos, rodents, etc.
Fumigation of the above-mentioned areas should be done an adequate number of times and, withappropriate timing.
5.5. Biological waste disposal
Clearly-marked “biohazard waste” disposal containers shall be provided at all medical sites, including
visiting teams’ medical treatment areas. Collection and disposal of containers will be carried out
according to treatment of contaminated medical waste, and national health and prevention rules.

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6.

Environmental conditions monitoring

6.1. Weather conditions
The risk of heat illness increases above 21ºC (70ºF) and 50% relative humidity. The wet bulb globe
temperature (WBGT) which measures the combined thermal stress from the wet bulb (WBT), drybulb (DBT), and black globe (BGT) thermometers has been widely used to assess environmental
heat stress. The WBGT is calculated as 0.7WBT +0.2BGT + 0.1 DBT, measured outdoors (see Table
1). Other thermal stress indexes have been developed through the years and provide with further
information, like the Physiological Equivalent Temperature (PET), modified PET (mPET) and Universal
Thermal Climate Index (UTCI). PET, for example, is a universal index that allows to characterise thethermal bioclimate and the evaluation of thermal conditions in a physiologically significant manner.
PET can be calculated with the radiation and bioclimate model RayMan, available at https://www.
urbanclimate.net/rayman/.
These more recent indexes allow for the quantification of thermal stress also in cold condition, unlike
the WBGT (see Table 2). A corresponding coloured flag system can be used to visually signal thethermal injury risk of current weather conditions to competitors and spectators.
Heat Index (WBGT)
Temperature in °C

Comment

Temperature in °F

Above 30°C

Above 86°F

Danger28°C to 30°C

82,4°F to 86°F

Severe Warning

25°C to 28°C

77°F to 82,4°F

Warning

21°C to 25°C

69,8°F to 77°F

CautionBelow 21°C

Below 69,8°F

Almost Safe

Table 1 – WBGT Heat Index and color coding system

15

PET
4ºC
8ºC
13ºC
18ºC
23ºC
29ºC
35ºC
41ºC

Thermal Perception

Grade of Physiological Stress

Very Cold

Extremem Cold Stress

Cold

Strong Cold Stress

Cool

Moderate Cold Stress

Slightly CoolSlight Cold Stress

Comfortable

No Thermal Stress

Slightly Warm

Slight Heat Stress

Warm

Moderate Heat Stress

Hot

Strong Heat Stress

Very Hot

Extreme Heat Stress

Table 2 – Ranges of the physiological equivalent temperature (PET) for different grades of thermal perception by human beings andphysiological stress on human beings; internal heat production: 80 W (W is the mechanical work done by the body), heat transfer
resistance of the clothing: 0.9 clo (Clothing insulation was calculated from clothing weight, covered body surface area, and the numberof clothing layers worn). (According to Matzarakis and Mayer 1996. Another kind of environmental stress: Thermal stress. WHO
collaborating centre for Air Quality Management and Air Pollution Control).

Thermal stress information must be provided to teams, staff and volunteers according to theabove-mentioned indexes. Based on these weather conditions, on the type of event (strong
endurance component) and the mitigation strategies available, the World Athletics Medical Delegate
can suggest, in coordination with the World Athletics Technical Delegate, a postponement or acancellation of one, or several, Athletics events.
The LOC shall work with local meteorology services to provide statistical information on prior weather
patterns and thus assisting in developing the competition schedule. Many athletes drop out ofendurance events due to heat casualty. LOC Medical Team should consider the risk of heat strokes
and heat injuries and plan proportionate strategies to prevent and promptly treat these medical
conditions.
The LOC Medical Team should implement a thorough monitoring system of weather conditions.
During the competition, daily and hourly weather forecast information should be available on thecompetition’s Official Website. For the period of the competition, and on race days, the LOC shallarrange to take frequent readings of temperature, humidity, WBGT and PET at different competition
sites in order to assess possible heat stress for athletes, officials, volunteers and spectators. Readings
will be performed at various times and the measurements displayed in banners of sufficient size tofacilitate information available to athletes, officials, and health staff:•

Warm-up Area: one banner indicating the health-care staff measured every 60 minutes on-site;•

Road races: one banner at the start line, one at the finish line and another one showing the
WBGT/PET measured every 20 minutes on-site; and16•Race walking: one banner in front of the Team-Refreshments Station showing the WBGT/PET
assessed every 20 minutes on site.

The Medical Team will work with the Supply Department, Venue Management, and Competition
Management to ensure that, during competitions held both in hot or cold weather conditions,adequate shelters (tents, canopies, awnings, umbrellas, raincoats etc.) are provided for athletes
and officials in events, where prolonged exposure is likely to occur. Adequate water and glucose/electrolyte solutions shall be provided at each site. In general, particularly considering endurance
events, better performance and less adverse results are obtained when the environmental conditions
are going to improve, rather than worsen, during the event. As an example, in hot environmental
conditions, start times would be better set for late afternoon or evening, rather than early morning(increased thermal stress in sunny morning). The Medical Team should work together with theCompetition Department to monitor weather conditions and a specific contingency plan should be
implemented to consider the scenario of extreme meteorological situations that could force a delay
or even cancel the competition.
6.2. Air Quality Monitoring
Considering the impact of air quality on athletes’ health and performances, the LOC should
implement monitoring programmes of local pollution and pollen ratings before and during thecompetition. LOC should provide teams, staff and volunteers with daily average of main pollutants(NO2, O3, PM2.5, PM10, CO) starting 2 weeks prior to the competition and for the entire durationof the competition. A yearly analysis of the pollutants will be required by World Athletics Health andScience Department to monitor the air quality trend in the competition location. Pollution and pollen
forecasts shall be available and published in the Team Manual. For indoor events average indoor andoutdoor pollutants levels should be provided too.
For road races, pre-race air quality measurements of main pollutants (NO2, O3, PM2.5, PM10, CO)and pollens, should be provided for the two weeks prior to the race. Average values of pollutants
should be available at the start and finish lines during the race. Forecasts and average values ofpollens are particularly relevant for all running events, including road races, cross country, trail runningand mountain running events.

17

Chapter 2
Medical management for In-Stadium athletics events
1.

Scope of the services

The scope of services includes critical care; first-aid, treatment for environmental illnesses, as well as
the general medical problems associated with In-Stadium athletics events
Spectator care should also be provided, under the responsibility of the LOC, in World Athletics InStadium Events.

2.

Workload

Information concerning the number and type of injuries and illnesses seen during major athletics
competitions are available in the scientific literature. The Medical Director is urged to maintaincomplete records which should be included in the final report to the LOC and to World Athletics
Health and Science Department.
Previous experience suggests the following numbers:•

General medicine/sports care: 40-60 visits/1,000 athletes/day.

•Physiotherapy: 40-50 visits/1,000 athletes/day; and•Massage therapy: 40-50 visits/1,000 athletes/day

During the competition period, 5-10% of the total number of athletes and staff will consult for
diagnosis and/or treatment of injuries or illnesses.
Staffing for ancillary facilities and spectator care will depend upon the number of venues required fortraining, housing of teams, officials, VIPs and media.

3.

Staffing

Staffing at events is recommended to be as outlined in “Appendix B”. These recommendations
provide approximate staffing guidelines for the minimal number of on-duty personnel needed tocover all official sites and venues during In–Stadium World Athletics championships:

18

•

Physicians, one per 100 athletes;•

Nurses, one per 50 athletes;•

Physiotherapists/Massage Therapists, one per 60 athletes

Staffing for ancillary facilities care will also depend on the number of official sites, venues andaccommodation areas.
Depending on the level of competition, a pharmacy will be organised, and should be supervised bya licensed pharmacist.
The provision with adequate medical equipment is of paramount importance. Detailed suggestionsof equipment can be seen in the appendix section. Above all, the setting up of Automated External
Defibrillators (AEDs) at the competition track, warm-up, training sites and accommodation is crucial to
implement adequate secondary prevention of sudden cardiac death/arrest. AEDs should be available
in all areas accessible to spectators, athletes, officials, workforce, staff and volunteers.
Distinctive identification markers including caps, arm bands, vests, T-shirts and/or bibs labelled withindividual training level (e.g. physician, physiotherapist, nurse, Emergency Medical Technicians – EMT,etc.) allow for easy recognition of the medical team by competitors.
All staff members (physicians, nurses, members of medical staff etc.) must be officially accredited.

4.

Venue Medical Manager

An experienced sports medicine professional should be appointed to supervise the medical
function at venue (training, warm-up or competition sites). These professionals play a key role in theimplementation of a high-quality medical care
Duties include:a)Supervising venue healthcare services;b)

Working with the Medical Director to determine daily staffing needs;c)Assigning daily duties to all medical personnel;d)Ensuring adequate supplies and equipment for the medical stations;e)Coordinating requests for consultations with physicians;f)Coordinating the requests for ancillary support services, transportation, specialty referral andtransfer to Accident and Emergency (A&E) department or Emergency Department (ED) at
Hospitals etc. according to the Medical Director, or whoever he/she nominates;

19

g)

Ensuring maintenance of complete medical records;h)Supervising the use of diagnostic or therapeutic medical instruments, if any; andi)

Ensuring continuous availability of sealed drinks for athletes (water) and of ice.

5.

Organisation of Venue Medical Stations

Medical services must be available at all official sites related to the competition, and available to
all accredited persons, including teams’ medical staff. Full details on staff, facilities, location andequipment at each site can be found in the appendix section.
5.1. Polyclinic/Central Treatment Area
This is the primary care centre for medical evaluation and treatment. If athletes are dispersed over
several locations, a central location must be selected. The clinic should include treatment areas,
examining rooms, offices, dispensaries, and waiting area with all necessary equipment. Physical and/or
massage services should be offered to athletes from countries without medical staff.
Ambulance service should be located on-site or, alternatively, be easily available by phone/radio.
5.2. Competition Stadium
Medical staff must be available at least 1.5 hours before the start of the competition and remain
until all spectators leave the stadium after the competition is over. The medical areas provided must
include, as a minimum, a pre-competition treatment area (near the call room); a triage/emergency area(with an ambulance stationed nearby); and the main treatment area.
At major championships, 4 field of play emergency medical teams should be stationed at theperimeter of the track. All should be connected by radio to the Medical Director or the Venue Medical
Manager, who should watch the competition from a prominent place in the Stadium, so that he/she
has an overall view of the whole competition, enabling him/her to notice immediately any medical
incident on the field of play that would require prompt medical assistance. Upon notification fromeither the Medical Director or the medical teams themselves, under strict co-ordination with marshals
and judges/referees, the first-aid teams should assist speedily, at the earliest time, all injured/sickathletes on the track, and transfer them immediately to the main treatment area in the Stadium. AED
should be available at the competition track, as well as a variety of appropriate medical emergency
equipment.
Ensuring the immediate care of an injured or ill athlete on the field of play is of utmost importance.
The chain-of-command to allow first-aid teams to intervene should be quick and efficient. Firstaid teams and medical staff, as well as marshals and judges/referees, should be trained to activate

20immediate assistance to injured/ill athletes without unnecessary delay. Neither the injured athlete,
nor the first-aid teams, should interfere with the competition, or disturb other competing athletes.
Evacuation from the field of play and subsequent transfers to the Main Treatment Area in the Stadium
should always be done at the earliest time.
Team Doctors should be permanently informed whether their athletes required medical assistance inthe field, or in the main treatment area. The Medical Director should make the necessary arrangements
to ensure that a member of the Medical Team, in constant communication with the main Polyclinic/
Central Treatment Area, will liaise with Team Doctors and provide them with any medical informationon their athletes.
5.3. Training Venues
Medical care must be available whenever these sites are in use and be staffed, at a minimum, bya physician and physiotherapists. An emergency physician and an ambulance service should beavailable by phone/radio.
5.4. Warm-up Area
This is the most important site for medical teams from member federations. It should be open at least
2 hours before the start of the competition and remain open until 1 hour after the last competitionis over.
A wide area should be made available to all team doctors and team physical therapists to provide
care to their own athletes. This area should be in the shade and/or air conditioned/warmed and beequipped with power supply and lightning for night hours.
Cold water immersion therapy for recovery should be provided (see “Appendix A”). Medical care mustalso be available, including first-aid and ambulance services. Physical and/or massage services should
be offered to athletes from countries without medical staff. It is usually recommended to mark areas of
5 x 5 metres for national teams. Team tents should be air-conditioned in hot and humid environment.
5.5. Spectators Area
The provision of emergency care and first-aid for spectators is a responsibility of the medicalorganisation, according to the national health and security rules on public events. Community
resources, such as the Red Cross or Local Emergency Services may be recruited to assist.
AEDs have to be available to implement adequate secondary prevention of sudden cardiac arrest.
An ambulance service, proportional to the number and/or sectors of spectators, should be available
to evacuate, if any, patients to a critical care facility. First-aid teams should be available at easily
accessible, well-identified, areas for the treatment of minor medical problems.

21

5.6. Athletes’ Accommodation and World Athletics/LOC Official Hotels
In hotels accommodating Teams, a medical care or facilitated contact must be established and staffedby physicians and physiotherapists/athletic trainers during the day and evening hours (according to
the schedule of the competition). Physicians should establish medical care hours and be available oncall for emergencies at all other times. It is preferable that each Team with a medical staff is placed inseparate room for medical care as part of the Team’s housing allocation.
For all other World Athletics and LOC official hotels, as a minimum, first-aid should be available onsite, with access to on-call at all times.
5.7. Patient’s transfer organisation
Advanced Cardiac Life Support (ACLS) emergency ambulance coverage should be available atthe polyclinic/central treatment area. Medical support vehicles or ambulances should be reserved
for transportation of injured or sick athletes. A minimum of one ambulance should be located attraining and warm up venues (depending on the number of competitors and distance to the main
medical centre/polyclinic). All should be in communication with the main medical centre/polyclinicand Medical Director.
5.8. Communication resources for staff
Medical staff operating at the different venues should be given communication means to directly
contact the Venue Medical Manager or the Medical Director (telephone landline for indoor and/or
mobile or radio).

22

Chapter 3
Medical management for Out-of-Stadium events andelite race competitions (including Race Walk, Marathon,Half Marathon and Cross Country)
1.

Scope of the services

The scope of services include critical care, first-aid, treatment for environmental illnesses, as well as
the general medical problems associated with endurance events. The Race Medical Director (RMD) is
asked to maintain records of all medical encounters, which should be included in the final report to the
LOC and to World Athletics Health and Science Department.
Depending on the level of competition, a pharmacy will be organised, and supervised by a licensed
pharmacist.
Spectator care should also be provided in World Athletics Out-of-Stadium Events.

2.

Medical consideration for safe race course planning

The medical set up for an Out-of-Stadium endurance event should consider multiple factors,
including:•competition length•competition course characteristics (uphill/downhill segments)•

race-course design (possibility of running several loops over the same course)•

environmental conditions (ambient temperature, humidity, WBGT, altitude, wind speed anddirection, hours of sunrise and sunset, air pollution levels)•

expected participants’ number•

medical facilities and available medical staff

When planning a race is fundamental that race organisers include, from a very early stage, the LOC
RMD and the World Athletics Medical Delegate in the discussion and decision-making process of the
final course set up. The provision of adequate medical care is central to the planning of any Out-ofStadium event.

23

3.

Workload

There is usually a smaller number of participants in World Athletics elite road races, compared to mass
participation races, and competitors are expected to be well-trained for World Athletics road events.
However, many athletes face medical problems during road races, depending on the environmental
conditions and racecourse characteristics. While most of the infrastructure and services provided toelite athletes competing in endurance events are similar to that of mass events, the proportions but
also the medical needs are different between the two types. Many mass-races athletes face medical
problems during road races, and up to 10% of participants retire due to heat exhaustion in races of
10 kilometres or longer on average (depending on weather conditions).
Optimum medical support for elite and mass-road race events should be:a)

Minimisation of the potential hazards of road racing by scheduling events at the safest
possible period of the year, time of the day, and by modifying the event’s schedules in extreme
conditions;b)Organisation of medical personnel, communications systems, equipment and supplies to swiftly
handle medical emergencies;c)Appropriate triage and management of injuries and illnesses that affect competitors;d)Education of runners by means of printed material in race packs and prerace announcements,
to allow informed and rational decisions with respect to participation in an event given theenvironment, distance, and individual factors which affect risk on a specific race day;e)

To ensure continuous and adequate supply of sealed drinks (e.g. water, etc.) along the race;f)

To ensure adequate protection tools, according to hot or cold weather conditions;g)To ensure adequate number of AEDs, throughout the race course;h)To ensure cold water immersion treatment is available throughout the course and at the finish line.

4.

Staffing

Each race should appoint a Race Medical Director (RMD), knowledgeable in runners’ health problems.
Other healthcare personnel include:a)Physicians with experience and expertise in sports medicine and emergency medical care;b)

Registered Nurses (RN) with critical care and/or emergency room experience;c)

Paramedics and emergency medical technicians (EMT);d)Sports physiotherapists and physical therapists (PT);

24

e)

Certified athletic trainers (ATC); andf)First responders.

All personnel should be familiar with medical problems associated with runners and be Basic Life
Support with Device (BLSD) certified. The RMD should check that the certification is renewed every
1 year. Non-medical support staff should act as recorders, transporters, and supply technicians.
The number of medical personnel should be proportional to the number of participants and also take
into consideration the expected weather conditions. The following numbers are recommended:•

Physicians, 2-3 per 1,000 runners;•

Nurses, 4-6 per 1,000 runners;•

Other professional staff (EMTs, paramedics and athletic trainers), 4-6 per 1,000 runners; and•Non-medical staff (stretcher bearers, spotters, walkers, clothing fetchers, drivers andadministrative recorders), 4-6 per 1,000 runners.

Distinctive identification markers including caps, arm bands, vests, T shirts and/or bibs labelled withindividual training level (physician, physiotherapist, nurse, EMT, etc.) allow for easy recognition of the
medical team by competitors.
All staff members (physicians, nurses, members of medical staff etc.) must be officially accredited.
Staffing for ancillary facilities care will depend on the number of official sites, venues andaccommodation areas.

5.

Site coordinator

An experienced sports medicine professional should be appointed to supervise the medical function
at each medical station. These health-care staff professionals, play a key-role in delivering highquality medical care
Duties include:a)Supervising venue healthcare services;b)

Working with the RMD to determine staffing needs;c)Assigning duties to all medical personnel;d)Ensuring adequate supplies and equipment for the station;e)

Coordinating requests for consultations with physicians;f)Coordinating the requests for ancillary support services, transportation, specialty referral andtransfer to A&E/Hospital etc. according to the RMD, or whoever he/she nominates;25

g)Ensuring maintenance of complete medical records;h)Supervising the use of diagnostic or therapeutic medical instruments, if any, and ensuringcontinuous availability of sealed drinks (water) and of ice for athletes.

i)

Ensuring adequate numbers of personal protective equipment (PPE) for medical staff;j)Ensuring isolation procedures for individuals infected with contagious transmissible diseases.

6.

Spectators and traffic control

There must be adequate crowd, and traffic-control, to allow for the unimpeded flow of runners’ traffic.
The LOC should communicate with the local Police and Law Enforcements prior to the events.
Cordoning off starting pens, finish line area, and designated medical areas should help yield an
efficient flow of runners. At the finish line, good security will allow an efficient flow of runners throughthe chutes.

7.

Health and Weather Announcements

Pre-race announcements should be made describing the current and anticipated weather conditions.
The race medical team (including those at aid stations) and medical volunteers should activate
relevant actions according to the weather changes and provide the proper types of fluid (hot andcold fluids and hydration supplies).
Colour coded WBGT/PET index flags for heat stress should be displayed prominently at the startarea and announced in the pre-race weather announcement. Colour coded flags can be placed atselected aid stations along the course to alert runners of changing conditions.

8.

Medical Care Sites

Medical services must be available at all official sites related to the competition, and available to all
accredited persons, including mass race participants and teams’ medical staff. Full details on staff,
facilities, location and equipment at each site can be found in the appendix section.
The medical areas should include:•

a pre-competition treatment area (near the call room);•

medical first-aid teams along the course (Minor medical first-aid teams along the course every
three kilometres or in strategic positions and Major aid stations along the course every fivekilometres or located in strategic positions), that would allow medical first-aid teams to keep
constant eyesight over the participants;

26•a triage/emergency area at the finish line;•

the main treatment area at the finish line (with ambulances stationed near-by).

Advanced life support emergency ambulance coverage should be available along the whole course,
up to the finish line. Automated External Defibrillators (AEDs) should be available along the course
and the finish line, to be able to reach the emergency scene as soon as possible. The first-aid teams
should evacuate all injured or sick athletes from the course at the earliest time, and transfer all ofthem to the main treatment area at the finish line. Medical assistance in cross country events, should
follow the same principles and be proportional to the number of participants, the characteristic of thecourse and comply with specific rules and regulations (see Appendices F and G).
The provision with adequate medical equipment is of paramount importance. Detailed suggestions ofequipment can be seen in “Appendix B”. Above all, the setting up of AEDs at the competition venues
and accommodation is crucial to implement adequate secondary prevention of sudden cardiac arrest.
Field care for major and minor medical, dermatologic, and orthopaedic problems should be
provided. The evaluation and treatment of environmental and exercise related medical problems likedehydration, hyperthermia, hypothermia, and exercise associated collapse, and problems associatedwith road racing, including allergic responses such as anaphylactic shock, hives, asthma exacerbation,and diabetic insulin reactions are of notable importance.
Toilets or portable commodes should be provided for runners. Ensure the availability of the availabilityof adequate facilities for female participants. The providers of such services should have charts toestimate the number of commodes necessary for an event, based on duration, number of expectedparticipants, and gender distribution.
8.1. Pre-competition/Start line
A medical point should be organised in close vicinity of the start line. This will minimise transport ofrunners that need assistance in other medical stations or to the finish line. The size of the medical
point depends on the number of participants, type, distance of race and weather conditions. The
medical point should be staffed with enough human resources and include physicians, nurses,
paramedics, and/or EMTs (PT, ATC, or massage therapist optional). The medical point should havemedical staff and supplies to treat the most common medical problems. The medical point shouldhave appropriate ventilation with fans or heaters based on weather conditions. Easy access toemergency transport and unobstructed access points from the start line and to emergency routes arefundamental.

27

8.2. Medical first-aid teams
Physicians, nurses, paramedics, and/or EMTs (PT, ATC or massage therapist optional) should takecare of injured runners. Aid stations shall be located every three to five kilometres or at pre-defined
medical points along the course. In case of marathons with multiple loops, walk races, cross country,
aid stations should be located in strategic positions allowing to keep participants always within the
medical team eyesight. AEDs and first-aid kits must be available. Aid stations can be located next todrinking stations, in order to use the latter as point of reference for runners. Equipment and supplies
for obtaining vital signs, performing BLSD and Advanced Cardiovascular Life Support (ACLS) should
be available at major on-course medical stations.
8.2.1. Types
Major aid stations should be equipped and staffed with the capacity to deliver the same careprovided at the finish line medical station. Minor aid stations are usually located in conjunction
with water stations to provide comfort care and minor first-aid with the intent of transporting
any serious medical casualties to a facility equipped to deliver definitive care.
8.2.2. Location
Major aid stations are usually placed at high risk areas on the course which have high casualty
rates or difficult access for evacuation or every five kilometres. Minor aid stations should belocated at a minimum every three kilometres. In case of cross country, aid stations should be instrategic positions that would allow medical first-aid teams to keep constant eyesight over theparticipants.
8.2.3. Medical Personnel
Aid station staff should include: physician, nurses, paramedics, EMTs or BLSD trained first-aid
volunteers, communications person; and a recorder.
8.2.4 Supplies
Aid stations should have: sealed drinks, ice and small plastic bags, towels, petroleum
jelly, blankets for races under 21ºC (70ºF), athletic therapist kit and supplies for minor
musculoskeletal injuries, chairs, cots, and covered shelter (van or tent).
8.3. Roving medical vehicles and critical care teams along the course
8.3.1. Roving vehicles
Roving medical vehicles and mobile medical aid, though they are impeded by runners, offer thebest solution for rapid response to a collapsed athlete on the race course. These should be
staffed with physicians, nurses, paramedics or EMTs and equipped with adequate supplies for
obtaining vital signs and deliver ACLS. Defibrillator or AED experience is fundamental. The use
28

of fully-equipped ambulances on the course is advantageous and increases the medical
response capabilities.
The race aid vehicles should be supported by local emergency vehicles through thecommunications network. Medical vehicles should have access lanes to the course. Course
configuration and access may dictate a greater number of vehicles or the use of “first response
teams” on bicycles, motorcycles, or motorised carts equipped with minimal supplies and AED.
8.3.2. First response teams
AED-equipped motorcycles or bicycles should have rapid access to collapsed athletes withpotential cardiac arrest must be available on the course. Operators must be trained in the useof AED, and the team must be integrated with the local emergency medical system. Several
teams must be assigned along the course to follow the runners. First response teams should
be prepared to evaluate and treat cardiac arrest, exertional heat stroke, hyponatremia, diabetic
insulin shock, status asthma, and exercise-or allergic anaphylaxis.
8.4. Finish line area
It has been widely demonstrated that the number of medical encounters in the final quarter of therace is significantly higher in respect to other segments. Therefore, in the last two kilometres of thecourse, medical staff and supplies should be increased. Usually at this stage of the race, runners are
tired but still try to increase their pace as they approach the finish line, thus the number of collapses
increases. The last 500 meters should have several medical staff deployed along the course to act
as spotters for runners in distress. This is particularly important for mass road races. Equipment andsupplies for obtaining vital signs, performing BLSD and ACLS should be available at the finish line.
The layout of the medical area should allow for efficient movement and easy access from the finishline. The medical area can be divided by function, between medical and skin, bone, and joint sections.
It is most efficient if type of casualties are grouped in the same section of the tent. Emergency
vehicle access should be arranged to allow unimpeded entrance and exit to the medical area.
8.4.1. Finish line Medical Facilities (including internal organisation and layout)
The main medical point should be organised in close vicinity to the finish line and, in any case,not more than 100 meters away. This will minimise transport of runners who collapse just before
or after the finish line. It must be large enough, considering the continuous arrival of exhausted
athletes at the same time (mainly in case of severe hot conditions). The medical point should havemedical staff and supplies to treat the most common race-related problems. The main medical
point should be surrounded by enough space to allow participants to keep walking after the endof the race as sudden stop has been demonstrated to be one of the leading causes of collapses.
Medical staff and volunteers should be able to keep participants within eyesight after they havecrossed the finish line.
29

The size of the medical point depends on the number of participants, type and distance of race
and weather conditions. Usually a medical point should be able to cope with a 1, 2 up to 3% ofparticipants. The medical point should have appropriate ventilation with fans or heaters based on
weather conditions. Easy access to emergency transport and unobstructed access points fromthe finish line and to emergency routes are fundamental.
A secondary medical point, of smaller size, should be located further along the finish area as
many runners cross the finish line and walk away of the finish area before collapsing or suffering aproblem. This is particularly important for mass races.
Facilities should be accessible to accommodate athletes on stretchers, wheelchair athletes andother types of disability.
The area should be cordoned off and secured from spectators and media. Rigid barriers such as
temporary fences are recommended. Credentials should be required to enter the medical area.
Runners should be permitted to enter only if they are injured or sick.
A separated heat-deck must be organised and equipped with enough bathtubs, water and ice
to treat runners experiencing a heat-related illness. Enough rectal thermometers with single-use
probes should be available. Ice should be stored in refrigerated thermic containers or trucks.
A specifically trained team of 4-5 (1 physician, 1 nurse and 3-4 EMTs/ATCs/physiotherapists)
members should be assigned to each athlete needing cold water immersion.
Finish line medical centre supplies should include: a large tent or adequate shelter fromweather, with heaters if cool weather is expected; or fans and ice immersion tubs if hot weather
is expected; toilet facilities; lighting, electricity source or generator; defibrillator, cardiac
resuscitation drug kit; intubation kit; oxygen tank and administration sets; personal protective
equipment for staff and patients; hand-washing stand; cots; chairs; blankets; towels; water inlarge containers; ice in plastic bags or ice chest; tables for medical supplies and equipment;
stethoscopes; blood pressure cuffs; rectal thermometers with long thermistor probes (including
standard clinical thermometers); hyperthermia thermometers to 44ºC (110ºF) and hypothermia
thermometers to at least 21ºC (70ºF); elastic bandages; inflatable arm and leg splints;
intravenous fluids and administration equipment (supervision by a physician required); dressings;
blister prevention tape; and adhesive dressings for minor musculoskeletal injuries.
8.4.2. Finish line staff
The finish line is usually where most medical encounters occur. Especially for mass road races thisis the location where most medical staff and volunteers should be.
The finish line team should include:a.

30

A Triage Officer who is, preferably, a primary care or emergency room physician with special
interest in sports medicine, to direct the flow of casualties to the proper area for care; andb.

Other physician staffing can include orthopaedic surgeon; family practice; emergency
room; internal medicine; and intensive care physicians. Nurses; physicians’ assistants; EMTs;
paramedics; and athletic trainers make up the remainder of the medical team.

c.

Sweep team/field medical personnel divided into medical care teams that can spot runners
as soon as they show signs of distress, transporting them to the closest medical point ormanage medical illnesses or injuries on site.

Dedicated medical areas may be organised for participants based on injury or illness. The triage
team should direct runners to the proper care centre. Non-medical staff should also be available
for recording medical data, retrieving dry clothing, distributing census information to concerned
parties (such as the RMD) and for general assistance.
8.5. Drinking stations and other facilities
Water and other suitable refreshments must be available at the start and finish area of all races. For all
events up to 10 kilometres, drinking/sponging must be provided at regular intervals and according to
the competition rules, if weather conditions warrant such provision. For all events of 10 kilometres or
longer, refreshment stations must be provided at regular intervals and according to the competition
rules. In addition, drinking/sponging stations, must be placed approximately mid-way between therefreshment stations, or more frequently, if weather conditions warrant such provision.
The amount of fluid to be provided depends on the number of participants, the race distance andcharacteristics, and the environmental conditions. A minimum of 180-300 ml (6 to 10 oz.) of waterand appropriately-mixed glucose-electrolyte replacement drink solutions, per runner, in sealed bottles
totalling 1.5 times number of entrants for each fluid type, should be provided at all water stations.
Double this total if the course is out-and-back. Unnecessary drinking stations should be avoided asthese may encourage over-drinking. Over-drinking should be discouraged as it can lead to Exercise
Associated hyponatremia (EAH). Salty snacks might also be provided at the finish line drinking
stations.
8.5.1. Signs
Provide adequate signs notifying competitors of the fluid type and the location of medical
personnel. Colour-coded flags describing current environmental heat stress should be locatedat each station, or at a central aid station, if marked changes in conditions are expected during
the race.
8.5.2. Toilet Facilities
Portable toilets should be located at aid stations along the course based on the number ofentrants and recommendations of the portable toilet vendor.

31

8.6. Patient’s transport
ACLS emergency ambulance coverage should be available at the finish line and along the course.
Medical support vehicles or ambulances should be reserved for transportation of sick or injured
runners who are unable to finish the race. A minimum of one ambulance should be at the finish
line Medical Station, and others (depending on the number of competitors and on the length orcharacteristics of race) should be located in different sites along the course or moving behind thecompetitors. All should be in communication with the finish line and course Aid Stations.
8.7. Athlete’s transport
Transportation for drop-outs without medical problems should be arranged separately, so that those
who cannot complete the event due to fatigue or minor injury/illness do not suffer further problems
due to exposure, after their race participation has stopped. Vehicles for runners who drop out of theevent should be equipped with cell phones, fluids, and blankets.
8.8. Spectators Areas
The provision of emergency care and first-aid for spectators might be responsibility of the medicalorganisation, according to the national health and security rules on public events. Community
resources, such as the Red Cross or Local Emergency Services may be recruited to assist.
AEDs must be available to implement adequate secondary prevention of sudden cardiac arrest.
An ambulance service, proportional to the number and/or areas of spectators, should be available
to evacuate, if any, patients to a critical care facility. First-aid teams should be available at easily
accessible, well-identified areas for the treatment of minor medical problems.
8.9. Athletes’ Accommodation and World Athletics/LOC Official Hotels
Medical care must be provided at all official sites and be staffed by physicians and physiotherapists/
athletic trainers during the day and evening hours (according to the schedule of the competition).
Physicians should establish medical care hours and be available on-call for emergencies at all othertimes. It is desirable that each Team with a medical staff is placed in separate room for medical care aspart of the Team’s housing allocation.
For all other World Athletics and LOC official hotels, as a minimum, first-aid should be available onsite, with access to on-call at all times.

9.

Medical evaluation of impaired runners

Medical evaluation of impaired runners should be allowed at the discretion of the medical staff but
should not result in automatic runner disqualification. According to the competition rules, the Medical

32

Delegate is the only official who can decide whether a runner must be removed from the competition
or not. The Medical Delegate can transfer the authority and responsibility of the decision to any
medical official, that has the capacity to examine a runner who appears ill, and to remove that runnerfrom the competition if, in the medical official’s opinion, it is in the runner’s best interest for healthand safety. The medical staff should evaluate runners who appear compromised and are proceeding
toward the finish staggering or weaving; or are disoriented in time and space; or are not maintaining
good running posture; or are not appearing clinically fit. Runners and medical staff should be
informed in the registration materials and pre-race announcements of the evaluation criteria, and that
aggressive or emotional behaviour is an early sign of hot-and-cold-injury which will be interpreted
as such by the medical staff. Stopping the runner and checking mental status, blood pressure, pulse
and respirations will allow for decision making on medical disqualification, and transport to Finish Line
medical station or local hospital emergency facility. If medically warranted after evaluation, the runner
may return to the race.

10. Public authority notification
Coordination with local hospitals, emergency medical vehicles, fire fighters, and police is crucial.
They must be notified of the race date, start and completion times, course route and intersection
closures, and anticipated casualties. The set up of a centralized command center, ensuring that all
representatives from health, safety and security departments, are informed and act together, isfundamental.

11. Communication
To speed delivery of medical care, it is essential to use radio communication among medical personnel
in spotter vehicles located at the start; aid stations; stationary points on the course, and finish line, orin roving medical vehicles; dropped out runner vans; sweeper buses; and on bikes. Mobile phones canbe used as back up.
The telephone-accessible emergency notification system should be used by race volunteers, whenavailable. Every volunteer who has his/her own cell phone can become a medical spotter. A phone
directory for the race printed on a small card distributed to all volunteers will speed communications.
Information can be directly conveyed to the medical communications director who can dispatch
the nearest medical or pickup van to the scene. A finish line telephone or direct communication
to emergency aid vehicles can act as a backup source of communication for medical assistance.
A radio back up system should be available and ready to be activated in case the mobile phonesystem goes down.

33

12. Medical encounter system
A medical encounter system should be available to gather all clinical data, for epidemiological andlegal purposes. These data are extremely helpful to improve the medical care provided, establish
injury and illness rates, and adjust staff and supplies accordingly. In order to make valid comparisonsamong endurance race events world-wide, it is strongly recommended that all medical encounters arerecorded in the proper medical encounter form (see “Appendix A”).

34

Chapter 4
Most frequent medical conditions in endurance events
Medical personnel should be familiar with the wide variety of medical conditions which may be
associated with endurance events. Education in these areas should be addressed as part of a medical
team orientation.

Allergic Reactions
Exercise-induced/related asthma, hives, and anaphylactic shock are sometimes experienced, and, if
not controlled medically, might preclude racing. The medical team must be prepared to handle these
problems on an emergency basis, and transport to established medical facilities, if necessary.

Cardiovascular Collapse
Sudden death of cardiac origin occurs more frequently in runners with known heart disease and thosewith clearly defined risk factors. However, it should be stressed that sudden cardiac death occurs
in runners even without any documented heart diseases. The risk of death from cardiac events at allages during marathon competition is in the range of 1 per 50,000 –100,000 finishers. Heat strain
markedly increases cardiac workload and, ultimately, increases the risk of cardiovascular collapse,
especially when combined with dehydration. Runners should be warned of the risks on the entry
form, and with pre-race announcements. They should also be advised to seek medical clearance fromtheir personal physician, and to avoid “sprinting” to the finish line, especially if they are in higher-risk
categories. Pre-race medical questionnaires have been proved to be effective in identifying highrisk runners and to reduce the number of acute cardiovascular events. Integrating a self-assessment
cardiovascular questionnaire in the online registration procedure would raise awareness among
participants and reduce the number of cardiac and fatal events during the race, thus it is highly
recommended.

Dehydration
This is the most common problem encountered in participants under hot-and humid conditions.
Appropriate fluid intake before, during, and after the race is essential. Medical personnel should
remind race staff and athletes of the risks of over-drinking, which can be fatal as it might lead to
Exercise Associated Hyponatremia. Runners should replace sweat losses but should not assume that35

fluid replacement beyond the losses is beneficial. Maintaining intravascular volume is the critical factor
for thermoregulation. Rapid rehydration after the race will speed recovery and decrease incidence of
post-race collapse.

Exercise Associated Collapse (EAC)
One of the most common medical problems is likely to be with athletes who collapse at, or after thefinish. EAC is most accurately viewed as a symptom, with many possible aetiologies or diagnoses(including post-exercise postural hypotension). EAC is simply defined as a situation involving an
athlete requiring assistance during or after endurance activity, not of orthopaedic or dermatologic
origin (including: post-exercise postural hypotension; exertional heat induced and associated injury;
exercise exhaustion; exertional leg cramps; and hypothermia). Post exercise postural hypotension isbest prevented by keeping the subject moving, possibly walking, until it progressively gets back to arest condition.

Exertional Hyponatremia
Athletes who ingest more fluid than the amount lost through sweating, or who lose excessive salt insweat, can dilute serum sodium to dangerous levels, and develop cerebral and pulmonary oedema.
Athletes should be encouraged to replace sweat losses, but never to drink “as much as possible”.
Exertional hyponatremia should be suspected in marathons when a collapsed or ill runner has a finish
time greater than 4 hours and is known to have been drinking constantly. Treatment of hyponatremia
might require hospitalisation.

Skin wounds
Blisters and blood blisters should not be opened. If the lesion is on a pressure area, or is very tense, it
may have to be drained. Make several openings in the blister roof, but do not remove the skin. Coverwith an antibiotic compound and a sterile bandage or blister pad. If the athlete wants to continue
running, a low friction tape will help decrease the shear stresses on the blister area. Subungual fluids
may be drained dorsally through the nail plate by using a heated needle or drilling through the nailwith an 18-22g hollow bore needle.

36

Chapter 5
MCM algorithms
Adapted from “Managing the Collapsed Runner: Marine Corps Marathon, Medical Triage andAlgorithms 2019” by Champ, the Marine Corps Marathon and the International Institute for Race
Medicine.

Francis G. O’Connor, MD, MPH
Medical Director, Consortium for Health and Military Performance (CHAMP)
Uniformed Services University of the Health Sciences
W. Bruce Adams, MD
Former Medical Director, Marine Corps Marathon
C. Marc Madsen, DO
Medical Director, Marine Corps Marathon
Bradley Branch Health Clinic, Naval Health Clinic Quantico
Anthony I. Beutler, MD
Associate Medical Director and Fellowship Director, Sports Medicine
Intermountain Healthcare, Provo, Utah
Fred H. Brennan, Jr., DO
Chief Medical Officer, Finish Line Tent B, Boston Marathon
Assistant Sports Medicine Program Director, Baycare – University of South Florida
Jesse DeLuca, DO
Chief Medical Officer, Army Ten-Miler
Experimental Therapeutics, Walter Reed Army Institute of Research
Korin Hudson, MD
Team Physician, Georgetown University
Georgetown University School of Medicine & MedStar Sports Medicine
Robert A. Huggins, PhD, LAT
President of Research and Athlete Performance and Safety
Korey Stringer Institute, University of Connecticut

37

Chad Hulsopple, MD
NCC Sports Medicine Fellowship Director
Uniformed Services University of the Health Sciences
John Jardine, MD
Medical Director, Falmouth Road Race
Chief Medical Officer, Korey Stringer Institute, University of Connecticut
Scott Pyne, MD
Former Medical Director, Marine Corps Marathon
Team Physician, US Naval Academy
Matthew D. Sedgley MD
Director of Emergency Action Planning, MedStar Health, North
Director of Running and Walking Medicine, MedStar HealthChris Troyanos, ATC
Medical Coordinator, Boston Marathon
Shelly Weinstein, PT, MS, SCS, ATC
Medical Operations Coordinator, Marine Corps Marathon

38

Table of algorithms
I.

COLLAPSED ATHLETE TRIAGE (Master
Algorithm) 			

II.

Emergency Cardiac CareIII.

Exercise-Associated Collapse

IV. Hyperthermia
V.

IX. Hypoglycemia
X.

Respiratory

XI. Allergy/Anaphylaxis
XII. Hydration Guidance
XIII. Tent Discharge Considerations

Hypothermia

VI. Exercise-Associated Muscle Cramps
VII. Chest Pain
VIII. Hyponatremia

Glossary of algorithms
AED: Automated external defibrillator

EHS: Exertional heat stroke

AMP: Ampule

EMS: Emergency medical services

BP: Blood pressure

FS: Fingerstick

CNS: Central nervous system

H&P: History and physical examination

CPR: Cardiopulmonary resuscitation

IV: Intravenous

CV: Cardiovascular

IVF: Intravenous fluid

D50W: 50 grams of dextrose in 100 ml of water.

MCM: Marine Corps Marathon

ECC: Emergency cardiac care

MS: Mental status

ECG: Electrocardiogram

NS: Normal saline

ED: Emergency department

PO: Per os

39

I. Master algorithms – Collapsed athlete triage
ASSESS RESPONSIVENESS(ALERT, VERBAL, PAIN, UNRESPONSIVE)

UNRESPONSIVEYes

ASSESS PULSE
AND RESPIRATIONSNoYesNORMAL

ALTERED MENTAL STATUS

No

No EXIT TO ECCALGORITHM

BRIEF HISTORY PHYSICAL AND VITAL SIGNSEXIT TO APPROPRIATE ALGORITHM

Yes
BRIEF HISTORY AND PHYSICALVITAL SIGNS + RECTAL TEMPRECTAL TEMP
>104ºF / 40ºC

EXIT TOHYPERTHERMIA ALGORITHM

Yes

EXIT TOHYPOTHERMIA ALGORITHM

No
RECTAL TEMP
95ºF / 35ºC TO 104ºF / 40ºC
No

RECTAL TEMP <95ºF/35ºC

40

Yes

EXIT TOEXERCISE-ASSOCIATEDCOLLAPSE ALGORITHM

II. Exercise-associated collapse
PLACE PATIENT SUPINE WITH LEGSELEVATED 12-24 INCHES ABOVE THE HEARTASSESS MENTAL STATUS

Yes

No

MENTAL STATUS
IMPROVING (2-5 MIN)ASSESS HYDRATION STATUS1HYDRATEDREASSESS VITAL SIGNS+/- RECTAL TEMP,
EPOC/i-STAT, GLUCOSE,HYDRATION STATUS1No
Yes

EXIT TOHYDRATION GUIDANCEEXIT TO DISCHARGEPROTOCOL

IDENTIFIABLE CONDITIONNo
Yes

ALERT EMSFOR TRANSPORTEXIT TO APPLICABLE
MCM ALGORITHM

1. ASSESS HYDRATION STATUS
a. MILD TO MODERATE DEHYDRATION: signs and symptoms include thirst, fatigue, malaise, headache, vomiting,
reduced sweating, cold/clammy skin, decreased skin turgor, and sunken orbits.
b. SEVERE DEYHDRATION: signs and symptoms include orthostatic hypotension, relative tachycardia,
and capillary refill of > 2 seconds, in addition to those described with mild to moderate dehydration.

41

II. Emergency cardiac care (ECC)
ACTIVATE EMS CALL FOR AED
RAPID ASSESSMENT*PULSE PRESENTCONTINUOUS CYCLESOF CPR AND PULSEASSESSMENT UNTIL
RETURN OF PULSE
AND RESPIRATIONSOR RELIEVED BY
EMS PERSONNELSHOCK
ADVISEDRESCUE BREATHING**CHECK PULSE
Q 2 MINUTESYes

No
CAB***
Perform high quality CPR
until AED available andattached to patient

FOLLOW AED PROMPTDELIVER SHOCK

TRANSPORTTO EDNO-SHOCKADVISEDNo

RESUME CPR FOR
5 CYCLES(< 2 MINUTES)PULSEPRESENTRESUME CPR FOR
5 CYCLES(< 2 MINUTES)Yes
DO NOT DELAY
TRANSPORT OR
TRANSFER OF CARE
TO EMS FOR REPEAT
INTERVENTIONS‡ASSESS VITAL SIGNS
CV & RESPIRATORY SUPPORTAS NEEDED
TRANSPORT TO ED

FOR CARDIAC ARRESTREFRACTORY TO INITIALRESUSCITATION AND
DEFIBRILLATIONATTEMPTS, CONSIDER
1 AMPULE OF
SODIUM BICARBONATE
IV PUSH* open airway, assess breathing and pulse (no more than 10 seconds)** adult rescue breathing rate: 1 breath every 5-6 seconds*** ABC priority changed to CAB (circulation, airway, breathing) – start compressions ASAP
† adult CPR : 30 compressions per 2 ventilations / compression rate = 100/minute (compression depth = 2" with full chest recoil)‡ patients who collapse in midst of strenuous exertion often have a concomitant profound lactic acidosis

42IV. Hyperthermia
RE-CONFIRM RECTAL TEMP > 104ºF / 40ºC &ALTERED MENTAL STATUS / CNS DYSFUNCTIONREMOVE EXCESS CLOTHINGINITIATE RAPID EXTERNAL COOLING1PERFORM RAPID EXTERNAL COOLING
MONITOR RECTAL TEMPERATURE (CONTINUOUS OR Q 5 MIN)REASSESS VITAL SIGNS Q 5 MIN
Consider IV access and EPOC/i-STAT as clinically indicated.

T < 102.5ºF / 39.2ºC
Yes

No

CONTINUE COOLING ANDCONSIDER OTHER CAUSESOF HYPERTHERMIA2STOP ACTIVE COOLING TREATMENTCONTINUE MONITORING RECTAL TEMP IF REBOUND3No

ASSESS FOR DISPOSITION
Consider ED transport if
Initial Temp >106ºF / 41ºC,
persistent mental statuschanges, history of EHS,
and/or no adult to accompany
after discharge.

PERSISTENT MENTALSTATUS CHANGES4

T < 95ºF / 35ºCNo

Yes

ASSESS FOR HYPOGLYCEMIA,HYPONATREMIA OR OTHER ETIOLOGY5 EXIT
TO APPROPRIATE ALGORITHM AS APPLICABLE
Yes

IMPROVEMENTNo

Yes
EXIT TO DISCHARGECONSIDERATIONS

Yes

TRANSPORT TO ED

EXIT TO HYPOTHERMIAALGORITHM

ALL TEMPERATURES ARE RECTAL; COOL FIRST, TRANSPORT SECOND!
1. Preffered/proven cooling options: 1) ice water bath immersion 2) ice water dousing with whole body ice massage and packing(fans if available). May add cooled IV fluids if sodium is normal.
2. Consider malignent hyperthermia, underlying infection, and neuroleptic malignant syndrome.
3. Return to active cooling as clinically indicated; monitor until clinically stable.
4. Be aware, not all exertional heatstroke patients have complete mental status recovery with temperature drop;
Mental status recovery is variable and can be delayed.
5. IMMEDIATE Na, Gluc, K +/- Cr, BUN, Cl & Hct (e.g. EPOC/i-STAT); treat hypoglycemia and hyponatremia per protocols.

V. Hypothermia
RE-CONFIRM CORE TEMPERATURE IN SYMPTOMATIC PATIENT#< 95ºF / 35ºC

INITIAL THERAPY FOR ALL HYPOTHERMIC PATIENTS:
1. REMOVE WET CLOTHING
2. PREVENT FURTHER HEAT LOSS (MOVE TO WARMER ENVIRONMENT, BLANKETS)
3. MONITOR CORE TEMPERATURE (CONTINUOUS OR Q 5-10 MIN)
4. INITIATE PASSIVE EXTERNAL RE-WARMING*
5. AVOID ROUGH MOVEMENTS/PATIENT HANDLING

CORE TEMPERATURE#
93ºF / 35ºC - 95ºF / 36ºC

86ºF / 30ºC - 93ºF / 34ºC

<86ºF / 30ºCREASSESS IN
15-20 MINUTES:INITIATE ACTIVE
EXTERNAL REWARMING**

INITIATE ACTIVE
EXTERNAL REWARMINGREASSESS IN
15-20 MINUTES:CONSIDER ACTIVE
INTERNAL REWARMING***

TEMP/SYMPTOMSIMPROVED?

No
Yes

Yes

SEE DISCHARGECONSIDERATIONSREASSESS IN
15-20 MINUTES:TEMP/SYMPTOMSIMPROVED?

TEMP/SYMPTOMSIMPROVED?

Yes

No
CONSIDER TRANSPORT TO
EMERGENCY DEPARTMENT# RECTAL TEMPERATURE*

Passive external rewarming: apply cotton, wool and/or mylar blankets.

** Active external rewarming: warmed blankets, heating pads, forced warm air.
*** Active internal rewarming: warmed oral fluids (if normal mental status & tolerating PO). Consider warmed iv fluids (40ºC to 42ºC)
and/or warmed humidified O2.
GENERAL TREATMENT GUIDANCE•

Rewarm the trunk before the extremities to minimize risk of core temperature afterdrop•

If altered mental status: consider EPOC sodium & glucose; move to appropriate algorithm•

If patient becomes pulseless or APNEIC: activate EMS, call for AED, go to ECC algorithm

VI. Exercise-associated muscle cramps

AMBULATINGYes
INITIAL TREATMENT PROTOCOLNo•PATIENT ACTIVE MOBILITY & STRETCHING•ORAL REHYDRATION1•

10 TO 15 MINUTES

No

Yes

CRAMPS IMPROVED

EXIT TO DISCHARGECONSIDERATIONSSECONDARY TREATMENT PROTOCOL•PLACE SEATED IN CHAIR OR COT•

ORAL HYDRATION1•PROVIDER ASSISTED MANUAL THERAPY•

10 TO 15 MINUTESINFORM TENT PROVIDER
CRAMPS IMPROVED

No

Yes

•

REASSESS VITALS•CONSIDER EPOC/i-STAT + RECTAL TEMP•CONSIDER SICKLE CELL TRAIT2DISCHARGE AS APPROPRIATEYesCONSIDER IV NSNoSYMPTOMS IMPROVEDTEMP <95ºF / 35ºC
OR >104ºF / 40ºC
LOW GLUCOSELOW SODIUMNo

Yes

EXIT TO:HYPERTHEMIAHYPOGLYCEMIAHYPONATREMIA
HYPOTHERMIACONSIDER TRANPORT TO ED

1. Oral hydration with clear fluids (water, sports drink, broth) per patient preference.
2. Consider exercise collapse associated with sickle cell trait and/or compartment syndrome if: African American,
persistent cramping without visible cramp/fasiculations, muscle rigidity, and/or sustained severe pain.

45

VII. Chest pain

• 12 LEAD ECG IF AVAILABLE• CHECK O2 SATURATION (SAT)

Yes

CHEST PAIN SUGGESTIVE
OF ISCHEMIA• ACTIVATE EMS• INITIATE GENERAL TREATMENT1

1. IMMEDIATE GENERAL TREATMENT GUIDANCE••OXYGEN: BY MASK OR CANNULA IF O2 SAT <93
ASPIRIN: 325 MG TABLET SHOULD BE ADMINISTERED:CHEWED (unless contraindicated)•

NITROGLYCERIN:-ADMINISTER (unless contraindicated)•

ONE SUBLINGUAL TABLET (0.03 TO 0.04 MG)

OR
•

46

ONE SUBLINGUAL SPRAY-

MAY REPEAT TWICE AT 5 MINUTE INTERVALS-SYSTOLIC BP SHOULD BE GREATER THAN 90-100 MM HG

No

EVALUATE AND
TREAT AS INDICATEDVIII. Hyponatremia
EPOC/i-STAT SODIUM<135#
Patients with Na 130-135
are rarely symptomatic.
Consider other causes for AMS.
#No

ALTERED MENTALSTATUS (AMS), HEADACHE,VOMTING or Na <125

CONSIDER
3% NS 100ml IV PUSH
POSSIBLE REPEAT BOLUS*

ORAL TREATMENT• HYPOTONIC FLUID RESTRICT• HYPERTONIC BROTH• CRACKERS/PRETZELSSYMPTOMS IMPROVINGAND TOLERATING ORAL FLUIDNoCONSIDER ED TRANSFERSEE DISCHARGECONSIDERATIONS

Yes
30 MIN REASSESSMENT• PATIENT ABLE TO VOID
• SYMPTOMS RESOLVED• REPEAT EPOC IMPROVED

Yes

No

Yes
DISCHARGE HOMESEE DISCHARGE CONSIDERATIONS*100ml 3% NS will raise serum Na 1-2 mEq/liter
CONSIDER REPEAT BOLUS FOR:•

Delay in transport•

Worsening mental status/symptoms•

Serum Na < 124

NOTE: There have been no cases of CNS myelinolysis reported from 3% NaCl treatment of race-associated hyponatremia.
47

IX. Hypoglycemia
SIGNS/SYMPTOMS OF HYPOGLYCEMIA AND/ORKNOWN DIABETIC
FS <60mg/dl

ASSESS RESPONSIVENESS*
ALERT ANDORIENTEDBRIEF H&P
VITAL SIGNS+/- IV ACCESS

Consider GLUCAGON 1mg IM
in patients who have alteredmental status or seizures AND
in whom IV access isdelayed or impossible

ORAL GLUCOSE 15-30 gm
OBSERVE
10 TO 15 MINUTESRECHECK FSG IN 15 MIN

FS >60 mg/dl &ASYMPTOMATIC

ALTEREDMENTAL STATUS

BRIEF H&P
CAB’s
OXYGEN for O2 sat <93%
IV ACCESS+/- MONITOR

1 AMP (25gm) D50W
START IVF
RECHECK FSG IN 15 MINUTES
Yes
FS > 60 mg/dl &IMPROVING MS

No

No

Yes

REPEAT ORAL GLUCOSE AND
OBSERVE
10 TO 15 MINUTESRECHECK FSG IN 15 MIN

FS >60 mg/dl &ASYMPTOMATIC

REPEAT 1 AMP (25g)
D50W
TRANSPORT TO ED

Yes

OBSERVE &CONSIDER PO TRIAL
FOR DISCHARGE***EVALUATE FOR INSULIN PUMP.
IF PRESENT, PAUSE THE PUMP.

No**CONSIDER DISCHARGE WHEN:CONSIDER ½ to 1 AMP(12.5-25g) D50W
TRANSPORT TO ED
48

ENCOURAGE POINTAKE & DISCHARGE
WHEN STABLE**•

blood glucose >60gm/dl•

NOT on a long acting hypoglycemic agent•

normal MS / no focal neurologic deficits•

tolerating PO / can eat a full carb meal•see “Discharge Considerations”

X. Respiratory
SIGNS/SYMPTOMS (S/S) OF
SEVERE RESPIRATORY DISTRESS*Yes

No
EMS TRANSPORT TO ED

S/S OF ALLERGY/ANAPHYLAXISTREAT WHILE WAITING(O2, Albuterol, EpiPen)

Yes

EXIT TO ALLERGY/
ANAPHYLAXISALGORITHMNoASSESS BREATHING

MILD/MOD
BRONCHOSPASM

SEVERE BRONCHOSPASM

HYPERVENTILATION

Poor air exchange,labored breathing,&/or hypoxia(No bronchospasm)

Adequate air exchange
Not labored, no hypoxia

BRIEF H&P
MAINTAIN CABVITALS, O2 SAT

FOCUSED H&P
MAINTAIN CABVITALS, O2 SATCONSIDER O2, IV

ALBUTEROL:
4 PUFFS WITH SPACER(ALT: 1 NEB)

ALBUTEROL: 4 PUFFSWITH SPACER X 3
BACK TO BACK
(12 PUFFS TOTAL)

No

Yes

Yes
SYMPTOMS IMPROVINGSTOP TREATMENTOBSERVE X 20MIN

No
No

REPEAT ALBUTEROLHIGH FLOW O2CONSIDER SQ EPIYesEXIT TODISCHARGECONSIDERATIONS• ISOLATE FROM OTHERS(including med staff)• REASSURE PATIENT• PATIENT RELAXATION/
BREATHING CONTROL• LOW FLOW/ NO FLOW O2(O2 mask but no O2)(ALT: NEB x3 IN A ROW)SYMPTOMS IMPROVINGSTABLEBRIEF H&P
MAINTAIN CABVITALS, O2 SATSYMPTOMS IMPROVINGNoCONSIDER OTHER CAUSESEMS TRANSPORT TO ER

Yes
EXIT TODISCHARGECONSIDERATIONSMCM respiratory algorithm notes* SEVERE RESPIRATORY DISTRESS = TRIPOD POSITION, 2-WORD SENTENCES, STRIDOR, CYANOSIS
1. Bronchospasm can limit air flow; wheezing may be louder *after* albuterol.
2. Albuterol may cause tachycardia and drop serum potassium.
3. Aid stations have limited inhalers. DO NOT give the inhaler away.
4. If no spacer is available, improvise: cut a small hole in a cup, toilet paper roll, etc.

EXERCISE-INDUCED HYPERVENTILATION
1. Common cause of shortness of breath in athletes, particularly at the finish.
2. Contributing factors: new to this event, sprinting to the end, faster pace than normal.
3. Some individuals get anxious from the acidosis

hyperventilation.

Characteristics:•

Symptoms include chest tightness, lightheadedness, perioral/hand/feet paresthesia, carpo-pedal spasms, nausea,
and possible vomiting.

•Normal Sa02•

Clear to auscultation with good air movement throughout all lung fields.

•

Patient may have referred vocal cord sounds (louder on auscultation of larynx).
–

50

Instruct the patient to stop making noise.

XI. Allergy/anaphylaxis
ASSESS SEVERITY OF SYMPTOMSNoTWO OR GREATER
ANAPHYLACTIC SYMPTOMS*Yes
REMOVE OFFENDING
AGENT(IF POSSIBLE)**EPIPEN ADMINISTRATION:• 0.3MG• ADMINISTER TO MIDANTEROLATERAL THIGH• HOLD FOR 10 SECONDS
NOTE: PEDS PATIENTS MAY
USE ADULT EPIPEN DOSE
BENADRYL: 25-50 MG POZANTAC: 150 MG PO• ACTIVATE EMS• IM EPINEPHRINE REPEAT
AS NEEDED Q 5-15 MIN• 1-2 L IV 0.9% NS VIALARGE BORE
• ALBUTEROL NEBS OR MDI
FOR BRONCHOSPASMS• IF AVAILABLE, GIVE 8-10 L
O2 BY FACE MASKCONSIDER BENADRYL
AND/OR ZANTACYes

WORSENING
SYMPTOMSNoDISCHARGE INSTRUCTIONS:• Seek support immediately if recurs• Avoid known allergens• Follow-up for specialty care

TRANSPORT TO ED
VIA EMSDO NOT DELAY TRANSFER TO EMSFOR REPEAT INTERVENTIONS* ANALPHYLAXIS HIGHLY LIKELY WITH RAPID ONSET (MINUTES TO HOURS)IF TWO OR MORE OF THE FOLLOWING AFTER EXPOSURE TO ALLERGEN(S):-RESPIRATORY COMPROMISE (e.g. wheezing, cough, stridor, shortness of breath, choking, throat closure)-

HYPOTENSION OR END ORGAN DYSFUNCTION (e.g. syncope, hypotonia, dizziness, collapse)-

SKIN OR MUCOSAL SYMPTOMS (e.g. hives, itching, flushing, swelling of the lips-tongue-uvula, periorbital edema)-

GASTROINTESTINAL SYMPTOMS (e.g. vomiting, crampy abdominal pain, diarrhea)

51

XII. Hydration guidance
POTENTIAL NEED FOR
INTRAVENOUS HYDRATION1POSSIBILITY OF
EXERCISE ASSOCIATED
HYPONATREMIA (EAH)2

Yes

EPOC/i-STAT SERUM
ELECTROLYTENo
Yes

CLINICALLY SUSPECT:EHS, Severe Rhabdomyolysis,
Exercise Collapse Associatedwith Sickle Cell Trait

No

EXERCISE ASSOCIATED
HYPONATREMIAPRESENTNoCONSIDER EPOC/
i-STAT2
CRYSTALLOID IV
1-2 L BOLUS--------------------------ASSESS RESPONSE &NEED FOR ONGOING
IVF ADMINISTRATION--------------------------TREAT & DISPOSITION
IN ACCORDANCEWITH RELEVANT
ALGORITHMOR
CLINICAL INIDICATIONNo
RETURN TO
APPROPRIATE
ALGORITHM

Yes

POSSIBLE DIABETICKETOACIDOSIS ORMETABOLIC D/O
REQUIRING IVF

Yes

EPOC/i-STAT
SERUM
ELECTROLYTESGO TO
HYPONATREMIAALGORITHMNo

ORAL FLUIDS3
Frequent small sips,
increase as tolerated

DKA / METABOLIC D/O
CONFIRMEDNo

YesCONTRAINDICATIONTO IV ACCESS/FLUID HYDRATION4

Yes

REFRACTORY EMESISORREFRACTORY
ORTHOSTATIS (w/o EAH)2

Yes

No

1

Dehydration, orthostasis, EAC, muscle cramping, EHS, DKA, AKI, rhabdomyolysis.

2

If potential EAH, check sodium level before fluid administration.

3

Electrolyte drinks are preferred, but high sugar content may affect tolerance; consider concurrent salt replacement /salty foods if heavy sweating, salt lines in clothing, or salt crusting on skin.

4

Cellulitis at site; obvious signs of overt fluid overload (e.g. pulmonary edema) warrant precaution.

XIII. Discharge considerations

General Discharge
1. Provide a copy of the medical encounter form to the patient
2. Ensure patient’s information is complete in the medical database
3. Recommend follow-up with appropriate provider
4. Patients should be discharged with dry clothing if at all possible

EMS Transfers
1. Provide a copy of the medical encounter form to the patient/EMS team
2. Notify the Medical Information Tent of the transport
3. Notify Medical Director/Coordinator of the transport

Pediatric
1. Notify emergency contact as soon as patient enters Aid Station
2. Release patient to an adult/guardian only
3. Provide a copy of the medical encounter form to the adult/guardian

Signing Out Against Medical Advice (AMA)
1. Ensure they sign the encounter form with AMA circled
2. Provide a copy of the medical encounter form to the patient
3. Notify Medical Director/Coordinator of the AMA
4. Flag the encounter in the medical database

Exertional Heat Stroke
1. Ensure temperature remains within 95.5-102.0oF (35.3-38.9 oC) prior to discharge
2. Notify Medical Director/Coordinator of injury and max temperature
3. Ensure temperatures/labs/data is entered in the medical tracker
4. Flag the encounter in the medical database
5. Inform patient of contact from race organisation 24-48 hours after event

Exertional Hyponatremia
1. Ensure EPOC/ISTAT/ lab values are entered into the medical tracker
2. Recommend follow-up with appropriate provider

Exercise-Associated Muscle Cramps
1. Provide precautions regarding muscle soreness and worsening symptoms
2. Recommend gentle stretching, oral hydration and salty foods for 24 hours

53

AppendicesA.

Medical encounter forms

B.

Recommended staff and equipment for WAS eventsC.

Recommended medication and medical supplies for WAS events

54

Appendix A
Medical encounter forms

55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

WheezeSeizureCoughing

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% SatsGlucose

Other

%

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/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:

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: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 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
Other
Factors 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

Swelling

Confusion

Spine/back injury

Unresponsive (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% SatsGlucose

Other

Admission

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 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:

Chest injury
Knee injury

Appendix B
Recommended staff and equipment for WAS
eventsRecommended numbers of medical and paramedical
personnel for In-Stadium athletics events

PhysicianSports Physician

Pharmacist

Nurse

EMT

Physiotherapist

Room Manager

Receptionist

Translator

1

1

1

2

2

1

1

1

severalTraumatology

PhysicianEmergency

Practitioner

General

Medical Doctor

Main Stadium
Athlete’s Medical Center
Finish Line
Track Perimeter1114 (any of 3 specialties)

2
4

Post Event Control Room

4
2

VIP Area

1

Media Area

1
1

Warm Up Area
Medical Center
LOC Physio Room

60

1

1

2

1
10

1

Translator

1

Receptionist

Physiotherapist

1

Room Manager

EMT

Nurse

Pharmacist

Sports Physician

PhysicianTraumatology

PhysicianEmergency

Practitioner

General

Medical Doctor

1

severalTraining Venue
First Aid Station

1

Athletes’ Accommodation
Medical Center

1

1

2

LOC Physio Room

5

1

VIP Hotel
First Aid Station

1

1

61

Recommended numbers of medical and paramedical
personnel for Out-of-Stadium athletics events
Road Races and Race Walking Events

Nurse

EMT

Physiotherapist

Room Manager

Receptionist

Translator

Sports Physician
2

Pharmacist

Physician

1

Traumatology

PhysicianEmergency

Practitioner

General

Medical Doctor

5

4

1

1

2

severalStart and Finish
Main Medical Center

1

Finish Line

1

8

Post event recovery room2

On the courseFirst aid station (staff per/station)*

1

Roving vehicles *1

2
2

Note: numbers and suggested coverage locations can vary based on weather conditions and course route (point to point or aloop course).
*Please refer to paragraphs 8 and following of the chapter on out Stadium events62Cold water
Immersion

Crutches

Diag Echo

ECG monitor

Ice maker

IV Drip kits*

OxygenOxygen saturation
monitorStretcher

1

tbd

4
pairs

1

1

1

5*

2

1

2

Wheelchair

Ambulance

2

WBGT

AED

Recommended medical equipment and supply for
In-Stadium athletics events

Main Stadium
Athletes’ Medical
CenterClose to the finish
line, ample space,
6 bedsFinish Line
Track Perimeter

1

2

4

2

2

Post Event Control
Room

1

2

1

VIP Area

1

1

1

1

1

1

Media Area

1

1

1

1

1

1

2

1

1

1

Warm Up Area
Medical Center2 bedsLOC Physio Room

10 boxes

Team Physio Room

30 boxes

1

2
pairs

1

1

1
1

2-4

2

Training Venue
First aid station

1 bed

Team Physio Room

3 boxes

1

1

1

1

1

1

Athletes’ Accommodation
1

4
pairs

Medical Center3 bedsLOC Physio Room

10 boxes

1

Team Physio Room

10 boxes

1

2

1

1

1

1

1

VIP Hotel
First aid station

1 bed

1

1

1

* These figures of Drip IV are a suggested minimum. Increase if in severe weather conditions (hot).

63

Recommended medical equipment and supply for
Out-of-Stadium athletics events

OxygenOxygen saturation
monitorStretcher

WBGT

Wheelchair

2
paris

IV Drip kits*

Crutches3

Ice maker

Cold water
Immersion2

ECG monitor

Ambulance

1

Diag Echo

AED

Road Races and Race Walking Events

1

1

10

3

1

2

1

2

Start and Finish

Main Medical Center

Ample space.
Should be able toaccommodate andtreat between 1 and
5% of the number ofathletes competing

Finish Line

4

Post event recovery
room

2

On the courseFirst aid stations

Fixed tent or mobile

1

1* These figures of Drip IV are a suggested minimum. Increase if in severe weather conditions (hot).

64

1

1

1

2

Recommended numbers of medical and paramedical
personnel in World Athletics Cross Country
Championships

Nurse

EMT

Physiotherapist

Room Manager

Receptionist

Translator

Pharmacist

Sports Physician

PhysicianTraumatology

PhysicianEmergency

Practitioner

General

Medical Doctor

4

4

1

1

2

severalStart and Finish
Main Medical Center2 (any of 3 specialties)

Finish Line

1

8

Post event recovery room2

2

On the courseFirst aid station (staff per/station)*

1

1

Roving vehicles *1
2

Athletes’ Accommodation
Medical Center

1

1

1

1

2

LOC Physio Room

8

1

2

several1

VIP Hotel
First Aid Station1(on call)1

Note: numbers and suggested coverage locations can vary based on weather conditions and course route (point to point or a loop
course). *Please refer to paragraphs 8 and following of the chapter on out Stadium events65Stretcher

1

10

3

1

2

Wheelchair

Oxygen saturation
monitor

1

WBGT

Oxygen2
pairs

IV Drip kits*

Crutches3

Ice maker

Cold water
Immersion2

ECG monitor

Ambulance

1

Diag Echo

AED

Recommended medical equipment and supply for World
Athletics Cross Country Championships

Start and Finish

Main Medical Center

Ample space.
Should be able toaccommodate andtreat between 1 and
5 % of the number ofathletes competing

Finish Line

1

6

Post event recovery
room

2

2

1

4
2

On the courseFirst aid stations

1

1

1

1

1

1

1

1

Athletes’ Accommodation
Medical Center2 bedsLOC Physio Room

5 boxes

Team Physio Room

10 boxes

1

2
pairs

1

1

1

6

VIP Hotel
First Aid Station

66

1

1

1

Appendix C
Recommended medication and medical supplies for
WAS events
1.

Anti-infective agents
Anti-bacterials-oral and systemic Anti-fungal-oral, vaginal and topical Anti-viral-oral and topical2.

Anti-histamines (local, nasal, ophthalmic and systemic)
Cetirizine Loratadine

3.

Central Nervous System Agents
Analgesics, Anti-pyretic (Acetaminophen, Salicylates, Morphine and/or similar for emergencies)
Anxiolytics, Sedative, Hypnotics (Diazepam, flurazepam, lorazepam, midazolam etc.)
AnticonvulsantsNaloxone
Myorelaxants

4.

Non-steroidal anti-inflammatories (NSAID’s) local and systemic
Ibuprofen Declofenac Piroxicam Ketorolac

5.

Electrolyte and Fluid Balance
Calcium gluconate Sodium Chloride 0.9% in Water Sodium Bicarbonate injection
Glucose (dextrose) water solution 5-10-20-33%

67

6.

Eye, Ear, Nose and Throat Preparations
Anti-bacterial Ophthalmic solution and/or ointment Optic solution
Anti-inflammatory Ophthalmic solution and/or ointment; Nasal aerosol
Vasoconstrictor Oxymetazoline or naphazoline (local solutions or nasal spray)
Expectorant/Anti-tussive Dextromethorphan, Levodropropizine, etc. Acetylcisteine,carbocysteine, etc.

7.

Gastro-intestinal
Antacids Anti-diarrheic Antispastics Antiemetics Stool softeners Histamine (H2) antagonist and/or proton pump inhibitors (PPI)8.

Hormones and Synthetic Substitutes
Glucocorticosteroids (see 10.c) oral, local and systemic Beclomethasone, Budesonide,
Fluticasone Methylprednisolone Betametasone, Dexamethasone Hydrocortisone,
Fludrocortisone
Oral contraceptives

9.

Local Anesthetics
Lidocaine, xylocaine, carbocaine, mepivacaine, procaine, etc.

10. Skin and mucous membranes
11. Cardiovascular system (emergency)
Nitrates (oral and/or systemic)
Diuretics (furosemide)
Heparin, enoxaparin etc.
Beta-blockers (atenolol)

68Medical supplies and equipment
Tape
• 4cm
• 2.5 cm
• 2.5 cm elastic tape 5 cm elastic tape
• 7.5 cm elastic tape Under wrap
Suture Supplies• Suture sets w/tape envelopes Disposable suture sets 3-0, 4-0, 5-0, 6-0 polypropylene sutures
4-0, 5-0, 6-0 vicryl, chromic gut Suture removal sets Sterile gloves Sterile towels Eye drapes
Sterile saline Instrument germicide Instrument trays Alcohol preps Iodine preps 60mm & 30mm
Steri-strips Xylocaine 1% with epinephrine
Pharmaceutical Supplies• Assorted prescription and non-prescription medications needed by physicians.
Record Keeping• Pharmaceutical record forms Medical Encounter form Treatment forms Referral forms Insurance
forms Prescription pads Anti-doping Prohibited Substances and Methods List “Safe” Substances
List Drug information booklets Prescription/non-prescription clipboards Pens/pencils/markers/hilighters Tape – packing/mending Stapler File folders Post-it notes Note pads Legal pads
Chemicals• Skin lubes Analgesic lotion Athletic liniment Massage lotion/oil Tape adherent Powder Ammonia
Inhalants Isopropyl Alcohol Tape Remover
Syringes/Needles/others• TB syringes w/needles 3 ml syringes w/needles• 5 ml syringes w/o needles 20 ml syringes w/o needles Needles, assorted gauges Tourniquets
Needles 18G, 20G and 23G
Diagnostic Instruments• Electrocardiograph Oximeter Oto/ophthalmoscopes, Stethoscopes, Sphygmomanometers Reflex
hammers, Neurological pinwheels Tuning forks Nasal specula, ear syringes, ear curettes Vaginal
specula Electronic thermometers, w/probe covers rectal thermometers; or Tympanic membrane;
Thermometers lab supplies
Treatment Modalities• Cardiac and respiratory monitor Cardiac defibrillator and resuscitation equipment Whirlpool(Laryngoscopes, endotracheal tubes, various adult sizes) For physio areas:• Ultrasound

69

•
•
•
•
•

Laser therapy
Electrical stimulation
TENS units
Electrophoresis units w/electrodes
Pression unit w/sleeves

Miscellaneous• Felt padding Rolls 125 mm vinyl foam
• Rolls 30 mm adhesive foam
• 7.5 cm x 7.5 cm adaptic dressings Large dermicel pads XL band-aids ointment tins Iodine solution
Moleskin Topper sponges Cotton swabs Cotton balls Plastic bags Prep razors KY jelly Eye-aid eye
wash aspirin Pill envelopes Assorted foam 60 mm adhesive foam Steripads• 7.5 cm x 20 cm adaptic dressings• 2.5 cm band-aids bacitracin ointment Iodine scrub Hydrogen peroxide packages 2nd skin Basins
emesis Basins portable Tongue blades Back plasters #15 sunscreen Scalpel, #11 & #15• Exam gloves Flexible collodion Paper towels 150 ml paper cups 300 ml paper cups Electrolyte
drink• Non-Expendable Items• w/cases air splints Spine boards/scoop stretchers 15-litre coolers 30-litre coolers 1-litre squeeze
bottles Universal knee mobilisers Air-cast standard ankle brace, right Air-cast standard ankle brace,left• Air-cast training ankle brace, right Air-cast training ankle brace, left Heel cups, padded/nonpadded Felt podiatry supplies Tape cutters• 7.5 cm elastic wraps 10 cm elastic wraps 15 cm elastic wraps Crutches (various sizes) Cervicalcollars (s, m, l, xl) Clavicle and Gilchrist straps (s, m, l, xl) Triangular bandages Thigh elastics (s, m, l, xl)
Double length 10 cm elastic wraps Double length 15 cm elastic wraps

70

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©World Athletics 2020
72

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