Health care teams must increase their vigilance in preparing for events for physically challenged athletes, with plans to handle issues such as skin breakdown, thermoregulation problems, dehydration, autonomic dysreflexia, infections, orthotic and prosthetic issues and psychiatric comorbidities, according to a paper published recently by the American College of Sports Medicine.
Preparation should include “obtaining appropriate medical supplies, ensuring disability-compatible access to medical areas and preparing for emergency extraction from adaptive equipment,” Lauren M. Simon, MD, MPH, FACSM, and David C. Ward, MD, wrote.
“You need to know all the factors and the types of medical conditions your athletes and support staff may be having that you may see at these events,” Simon told O&P Business News.
Preparation, planning, practice
Health care personnel for an event involving physically challenged athletes should focus on preparation, planning and practice.
“One of the first things you need to have is an appropriate emergency consent form,” Simon said. An emergency contact should be established for each athlete. Athletes also should be given the opportunity to provide information about any conditions that could affect their health, such as allergies or diabetes.
A knowledge of the formal classification system used by sports federations for events will aid in preparation, since each disability can bring its own set of challenges. For example, athletes with spinal cord injuries (SCI) are more susceptible to heat and cold injuries due to thermoregulatory problems. Those with SCI above T6 level are at risk for autonomic dysreflexia (uncontrolled sympathetic discharge caused from noxious stimulus) which is a medical emergency that can lead to uncontrolled hypertension, myocardial infarction, cerebral hemorrhage or other severe complications.
Event personnel also should plan to provide accessible care and should develop a familiarity with adaptive equipment. A plan should be in place to extract athletes from adaptive equipment, such as prostheses, paracycles and wheelchairs, in case of emergency. Simon recommends simulation practice for medical injuries and injured athlete extraction from equipment that will be used during the event.
“If you have, for example, somebody in a ski sled or hockey sled, and you are used to dealing with an able-bodied athlete and being able to move them around when they are injured, it is a different scenario to come up to a piece of adaptive equipment. You haven’t seen it, practiced taking somebody out of it nor practiced moving the person in the adaptive equipment to get them out of harm’s way,” Simon said. “The biggest thing I can say for people preparing for an event like this is to go over extraction plans, emergency plans and hazardous conditions plans and practice them.”
Research in advance
The health care team also needs to know what level of assistance they can provide without causing the athlete to incur a penalty or be disqualified.
Researching the venue in advance of the event is key to forming comprehensive plans, Simon said. In addition to the medical supplies needed, factors to consider include type/structure of medical venue, disability-accessible restrooms/accessible portable toilets, power sources, water sources and standard and optional diagnostic or therapy equipment. Competition site preparation should include particular attention to injury risks such as uneven ground, wires, sand or debris that can create danger for cyclists or athletes using prostheses. A power supply should be equipped to supply both medical instruments and athletes’ adaptive equipment, such as motorized wheelchairs, when needed while receiving care. In addition Simon recommends that events establish at least two forms of communication, such as cell phones, land lines, two-way radios or walkie talkies.
“Communication is huge … not only communication [within] your venue, but communication with your first responders, your emergency personnel, communication with your surrounding emergency rooms, urgent cares. They need to know you are in town with your event and who is going to be getting the first injured, [as well as] what level of injury they are going to get,” Simon said.
Location, venue top considerations
A hazardous conditions plan should take into account the location of the venue and the environment’s possible effects on athletes. Simon said some locations should prepare for possible ice or snow storms, while others need to be ready for high winds, extreme heat, a possible tornado or lightning.
“These things need to be thought of in advance and then obviously decisions will be made on a minute-by-minute, hour-by-hour plan as you come closer to your event,” she said. “There are some things, like nature, that we cannot predict, but we need to be able to appropriately react to it.”
Thermoregulation can become an issue for athletes competing in extreme hot or cold temperatures as well as in water events. For athletes who use O&P devices, temperature changes can cause limbs to swell, leading the devices to put additional pressures on athletes’ skin. Athletes using O&P devices also may deal with skin breakdown. Travel or changes in training can affect the skin integrity at an athlete’s prosthetic socket interface.
“These athletes have to be extra vigilant because they are traveling and going to environments they are not familiar with. This could certainly affect their residual limb,” Simon said.
Noise and psychological issues
Events for physically challenged athletes also should take into account psychological issues and potential aversion to noise. Athletes with disabilities – particularly veterans – may have post-traumatic stress disorder that can be triggered by noises such as track and field guns or fireworks. Athletes should be aware of any planned noises in advance, and Simon recommends designating a quiet room for athletes to reduce or block the noise. An onsite physical structure designated for quiet – such as a motor home transported to the event, if no buildings are accessible – should be provided.
Psychological support also needs to be provided during the event. In addition to post-traumatic stress, some psychological issues to prepare for include performance anxiety, injury- or performance-related depression and attention deficit disorder.
“Event personnel want to make sure that athletes are psychologically being supported,” Simon said. “While promoting optimal health through sports, they want to make sure that they are addressing those issues.”
Planning for fatality
While no one expects a fatality to occur at a sporting event, Simon said having a plan in place to deal with a fatality or severe morbidity is crucial.
“Sports have inherent risks, whether you are able-bodied or physically challenged. We assume risks when we play sports and when we are covering events. Unfortunately … we have to be prepared to handle the emotional trauma that can come with injuries or a fatality.”
An emergency chain of command should be established for an untoward event. Emergency consent forms and a communication plan also will come into play.
“If a fatality occurs, there could be a lot of disorganization and panic if you are not prepared,” Simon said. Medical personnel should have a plan to debrief the support staff and know who to contact for emotional support on site. The event should have designated psychologists or crisis counselors who can be available to support athletes, support staff and other event attendees if needed.
Still evolving events
Simon said technological advances, particularly in the O&P field, will cause continual changes in events for physically challenged athletes, from the rules and classifications to the preparation needed for a successful event. Classifications for physically challenged athletes, made to group athletes with similar functional abilities, could change. Simon also anticipates implications for sports ethics as adaptive devices change. A multi-disciplinary approach will be essential in planning these events in the future, she said.
Learning as much as possible about the event and the athletes will help medical personnel make sure the athletes have the best possible experience, she said.
“It is just becoming more important that more clinicians and more health care professionals know about this so that it takes away fear or reluctance, because knowledge is freeing in that regard,” Simon said. “It makes practitioners feel more comfortable and gets them excited to help all patients – both able bodied and physically challenged athletes – live optimal lives.” — by Amanda Alexander
Disclosures: Simon and Ward have no relevant financial disclosures.