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Common sense—small price to pay for life

Friday, November 27, 2015
Dirt Under the Nails

The sudden death of a participant in the recent Hardcore challenge has prompted me to think about the responsibilities of sporting event organisers, and the competitors themselves, in ensuring the safety of the athletes. This article is by no means a commentary on Hardcore or the incident that occurred, as I am unaware of the circumstances under which it happened. The incident is just the stimulus that drove an exploration of this topic. 

We usually erroneously assign sole responsibility for athlete safety to the event organisers. These organisers are supposed to conduct a thorough medical and risk assessment. This should include identification of areas or obstacles that are high risk, identification of the location of the emergency services and verification that they have access to these high risk areas, anticipated composition of spectators/crowd with appropriate crowd control systems, as well as a consideration of the type of injuries and medical conditions that occur at such events, among other concerns. 

A medical plan should be put in place based on this medical/risk assessment. In Trinidad, I suspect that this “plan” is nothing more than having an ambulance on site. 

This medical plan should include details of hierarchy of command structure of the medical team. I have been the unfortunate witness to this lack of command structure, and the risk it can pose to the athlete. I was recently at a small sporting event which had an athletic therapist (AT) who was highly qualified to respond to injuries on the field. There was also an ambulance and “medical personnel” from the ambulance.

While the AT introduced himself to the “medical personnel,” and attempted to delineate roles and qualifications, there was no reciprocation, but rather a wall of egos put up by these “medical personnel” who seemed more like massage therapists than trained first responders. This was evident when an athlete received a blow to the head.

The AT responded first, followed closely by the “medical personnel” who whisked her from his care and up to their room and began massaging her head. No medical history was taken, despite the fact that she was wearing a medical bracelet and was allergic to NSAIDS (anti-inflammatory medication).

There was no consideration of the fact that she could have a possible concussion or whiplash injury from the blow to the head. Rather than stabilise and monitor the athlete, the “first response” of these “medical personnel” was to massage her head and neck. Instructions from the AT were met with blank faces and that great big wall of egos.

It is obvious that there are poorly trained medical personnel operating in capacities which they should not. This is detrimental to athletes and can mean the difference between a severe injury or even death, and a successful outcome. I have also been informed by a reliable source that many of the ambulances are not equipped with a defibrillator and some of the medical personnel attached to these ambulances are not trained in its use or in advanced life support, but rather basic life support. 

It is imperative that event organisers delineate a clear command hierarchy with the help of medical professionals who are properly qualified. Communication must be clear with the role, number and location of ambulances, their capabilities and their crew competencies identified, so that the proper care providers are accessed immediately, and in the correct sequence.

The above are only a few considerations for event organisers. Safety and medical plans entail much more, including an understanding of the capabilities of competitors who register for the event. Events and obstacles must be designed with this in mind.

If elite participants are the target group for the event, then measures must be put in place to ensure the competitors are “elite” enough to handle the course/event. Otherwise, the course/event design should allow for a variety of competitor abilities, and consideration of the fact that many recreational participants do not understand their own limitations and often bite off more than they can chew. 

That said, there is however, considerable responsibility on the part of the competitor as well to know his/her own limits, and understand the nature of the event in which he/she is participating. At a recent trail run event, a gentleman with known cardiac issues and a laundry list of medication was feeling unwell before the event, yet he still participated. He had a massive heart attack and died there in the middle of the bush.

Some incidents occur without warning, and no amount of planning can prevent them. However it is imperative that the organiser institute strict safety practices, and the athlete employ some level of sensibility when thinking of participating in these events. Proper planning and common sense is a small price to pay for a life.

Carla Rauseo, DPT, CSCS, ATRIC is a Doctor of Physical Therapy and a Certified Aquatic Therapy Rehabilitation Instructor at Total Rehabilitation Centre in San Juan.


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