Fims position statements/clinical papers

Travelling medical kit for Sports Medicine professionals International SportMed Journal, Vol.12 No.3, International SportMed Journal
FIMS Position Statement 2011
Guidelines for the composition of the travelling medical kit for
Sports Medicine professionals
*Professor Wayne Derman, MBChB, BSc (Med)(Hons) Sports Science, PhD
UCT/MRC Research Institute for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Boundary Road, Newlands 7700, South Africa *Corresponding author. Address at the end of text.
Abstract
There has been a substantial increase in sports participation across the range of sporting events.
From the medal point of view, medical support staff present at these events should be prepared for
any form of medical emergency. Thus adequate and careful advanced planning for these possible
emergencies included the putting together of an emergence sports medicine kit which can be taken
for local events and if teams travel to other countries. Keywords: travelling medical kit

*Professor Wayne Derman, MBChB, BSc (Med)(Hons) Sports Science, PhD
Professor Derman is presently Professor of Sport and Exercise Medicine at the UCT/MRC Research
Unit for Exercise Science and Sports Medicine (ESSM) at the Sport Science Institute of South Africa
(SSISA), Newlands, Cape Town, South Africa. He is Co-Director of the Sports Medicine Services and
Research Group, incorporating the FIFA Medical Centre of Excellence and IOC Research Centre for
Injury Prevention and Health of the Athlete, both at SSISA. He has published and presented widely
both locally and internationally.
Professor Derman has played an important role in the clinical support for South Africa’s athletes at
International level. He fulfilled the positions of Chief Medical Officer for the South African Team to the
Sydney 2000, Athens 2004 and more recently, Medical Officer for the South African Paralympic Team
to Beijing in 2008. In December to May 2002, he served as Flight Surgeon to Cosmonaught Mark
Shuttleworth during the “First African in Space” mission in Russia. He also appointed as the Medical
Officer for Cape Town during the FIFA 2010 Soccer World Cup.
Introduction
sports events to long distance running and Over the last three decades participation in hiking events, cycle races, triathlons, rugby sporting events ranging from multi-coded Official Journal of FIMS (International Federation of Sports Medicine)
Travelling medical kit for Sports Medicine professionals International SportMed Journal, Vol.12 No.3, increased dramatically. From the medical medical care is provided for the accompanying perspective, increased participation at such officials than the athletes themselves. Thus the sporting events can be viewed as a potential travelling team physician has to plan for nearly major casualty situation. The medical support personnel covering the sports event should be The country or area to which you will be
Each type of sports event has unique medical travelling
problems, but these sporting events also share Whilst the support provided at a local school’s provided at the Olympic Games, the basic adequate preparation. Part of this preparation illness or injury in athletes is the same. includes the provision of an emergency sports medicine kit. This article provides a guideline support services in different countries varies for the contents of a sports medicine kit for use substantially18. Reports from colleagues who in the medical coverage of sports events. The have travelled to the host site, online research, kit’s composition is based on practical Sports or site visits prior to the event will help you Medicine experience1-5 and also aviation,6-8 learn about the destination country and will impact the contents of your travelling kit. It is important to determine the quality and quantity of local medical support, including access to other specialists, hospitals and emergency Considerations for the composition of
the kit
The composition of the medical kit should take
into consideration the nature of the sports event and the country or area to which the team will be travelling. Travel away from the home base and especially to countries with fewer resources will require a more expansive declaration procedures must be strictly followed and it might also be necessary to acquire a temporary medical license or The nature of the sports event
management of athletes’ illness and injury is similar regardless of the sports event, a good working knowledge of the sport you are covering allows improved prior planning for the type and quantity of supplies in a travelling medical kit.3;4;17 For example, supplies for a contact sport like rugby will differ from that for a swim team, or endurance events like a cycle disabilities also have different medical requirements that will affect the decisions for equipment and supples. Supply source for pharmacological agents and disposable supplies in A working knowledge of the nature and profile of injuries and illnesses documented in previous events is important in the decision tree. Furthermore, the age, gender health status, and chronic medication profiles of the accompanying officials will influence the decision process for the team. Often more Official Journal of FIMS (International Federation of Sports Medicine)
Travelling medical kit for Sports Medicine professionals International SportMed Journal, Vol.12 No.3, providing the primary care of the injured athlete, and (iii) the size of the overall team. Whilst it is acknowledged that each clinician will have their own preference in the design and composition of their medical bag, as a general guideline, a bag that is large enough stocks, but that can be adapted and carried as a back-pack when travelling distances between events, is ideal. The bag should be lockable and could have paramedic-style, contents of which can be packed according to broad categories, for example diagnostics, dressings, medications, splints, injectables and emergency drugs. This would facilitate easy held or fanny-pack style kit (without blades, knives, needles or Emergency drugs and other ampoules should be imbedded in a labelled sponge or foam sub-container that will help avoid breakages many airlines carry first aid kits for in air emergencies. The potential contents of a sports medicine kit are listed in Table 1 for use by a doctor or The design of the medical bag
team physician. It is important to note that each physician will have individual preferences The size and contents of the sports medicine regarding some items and the lists need to be kit may vary depending on (i) whether other modified to reflect individual choices and sources of equipment and medications are practice methods. Broad categories of agents easily available and if there are back-up are provided and the availability of these facilities for the team physician (e.g. a polyclinic), (ii) the training of the person Table 1: Contents of the Sports Medicine kit for the team physician a) Diagnostic and other hardware
Diagnostic ENT-ophthalmoscope set Blood pressure cuff Stethoscope “Pocket” AED (Automatic External Defibrillator) Pocket torch Pocket knife with multi-tool Scissors Airways of different sizes Disposable one-way resuscitation valve Laryngoscope Endotrachial tubes (various sizes) Ambubag Reflex hammer Peak flow meter and mouth pieces Urine test strips Glucometer with test strips Eye kit with flourocein strips Vaginal speculum Official Journal of FIMS (International Federation of Sports Medicine)
Travelling medical kit for Sports Medicine professionals International SportMed Journal, Vol.12 No.3, Nasal speculum Tongue depressors Tape measure Eye patch Cyoacrilate (super-glue) Sharps container Razors Space blanket Pen, paper, prescription pad Foley catheter (can be used as underwater drain) Emergency protocols International pharmacopeia. List of local emergency telephone numbers WADA list of banned substances Cotton tipped applicators Disposable ice pack b) Suture kit
Dental syringe and needles Needle holder Forceps Scalpel blades Scissors Artery forceps Disposable sterile pack and towel Absorbable and non-absorbable sutures in various sizes Wound closure strips Wound glue Staple gun Local anaesthetic e.g. lignocaine with & without adrenaline Long acting local anaesthetic e.g. bupivacaine Alcohol swabs, gauze swabs Disposable sterile gloves c) Dressings and other disposables
Plasters of various sizes Bandages – crepe & triangular, various sizes Elasticized bandages, various sizes Tubigrip elasticised bandage Rigid strapping Gauze swabs Jell-net dressing Transparent waterproof sterile dressing e.g. tegaderm or opsite Pad-like wound dressing e.g. primapore Scrubbing brush Iodine solution Shave gel (foaming soap) Antibiotic dressing cream e.g. muropuricin Merchurochrome solution Merthiolate solution Burn dressing Nasal tampons Vaginal tampons and pads Shoe laces Safety pins Plastic bags Sunblock Condoms Urine bottles Lubricating jelly Tape Official Journal of FIMS (International Federation of Sports Medicine)
Travelling medical kit for Sports Medicine professionals International SportMed Journal, Vol.12 No.3, d) Injections and emergency drugs
Syringes (3/5/10/20 ml with assorted size needles) Alcohol swabs Intravenous infusion cannulas (assorted sizes) Drip administration set Saline & dextrose infusion bags Adenosine Adrenalin pre-filled syringes (x2) e.g. epipen Aminophylline Atenolol Atropine sulphate Chlorpromazine Clonazepam Dexamethasone shock pack Diazepam Dopamine Furosemide Glucagon Hyoscine butrobromide Lignocaine hydrochloride Magnesium sulphate Mannitol Metoclopramide Naloxone hydrochloride Pethidine/Morphine (check legislation in foreign country) Prochlorperazine Sodium bicarbonate Verapamil Nitroglycerine spray Salbutamol inhaler Aspirin chew tablets Water for injection Tetanus toxoid e) Braces and orthopaedic equipment
Shoulder sling Wrist brace Finger splints Ankle/Knee brace Neck collar/brace Fiber-glass or other light-weight splinting f) Medications
Analgesics e.g. paracetamol, paracetamol & codeine, tramadol
Antibiotic, antifungal & antiviral agents
e.g. penicillin, cephalosporin, tetracycline, quinolone, macrolides, metronidazole, zanamivir, HIV exposure pack Anti-inflammatory agents e.g. diclofenac, ibuprofen, meloxicam
Antihistamines & corticoids e.g. fexofenadine, prednisone
Cardiovascular agents

Dermatological preparations

Bite & sting ointment e.g. mepyramine cream Antibiotic preparation e.g. mupirocin cream Corticosteroid preparations e.g. hydrocortisone acetale Combination antibiotic & corticosteroid preparations Antifungal preparation e.g. Clotrimazole Official Journal of FIMS (International Federation of Sports Medicine)
Travelling medical kit for Sports Medicine professionals International SportMed Journal, Vol.12 No.3, Combination anti-fungal & corticosteroid preparations Neurological agents

Anti-migraine agents e.g.zolmitriptan, sumitrptan Sleep inducing agents e.g. zolpidem, zopiclone Ophthalmics

Respiratory agents

Long & short acting beta agonist inhaler Agents for nebulisation e.g. salbutamol, ipratoprium Ear, nose and throat agents

Decongestant nasal spray e.g. oxymetasoline Decongestant/analgesic/anti-pyretic oral agents Corticosteroid nasal spray e.g. budesonide Gastrointestinal agents

Anti-nausea agents e.g. cyclizine hydrochloride Antacid agents e.g. cimetidine, magnesium tricilicate Pro-motilic agents e.g. metoclopromide Anti-constipation agents e.g. sennosides, ispaghula husk Pro-biotic agents Anti-haemorrhoid medication e.g. prednisolone ointment Uro-genital & gynaecological agents
Urinary alkaliser e.g. Sodium citrate/bicarbonate granules Oral contraceptive pil (post exposure contraception) Oestrogenic/progestrogenic agents e.g norethisterone, medroxyprogesterone acetate, norgesterel Vitamins, minerals & electrolytes
Vitamin BCo; B12 vials for intramuscular injection The choice of medications for travel
on a single trip to be expected to manage a minor outbreak of gastroenteritis, renal stones, physician, one of the more difficult decisions is myocardial infarction, diabetes complications, successfully manage the athletes’ and officials’ medical problems at an international destination. For example, it is not uncommon Official Journal of FIMS (International Federation of Sports Medicine)
Travelling medical kit for Sports Medicine professionals International SportMed Journal, Vol.12 No.3, It is prudent to select a sufficient variety of Address for correspondence:
independent of the services provided by the host country. Estimating the quantity of agents Research Institute for Exercise Science and is difficult; however, formulas to assist in the Biology, Faculty of Health Sciences, University comprehensive list of potential medications has been suggested in this guideline, it may not be possible to carry all of these agents in the physician’s kit bag, as it would be too large and heavy. For this reason, it is suggested that References
the majority of agents are kept in a locked cupboard at the base facility and at least one 1. Buettner CM. The team physician's bag. medication (or a small quantity) from each category is kept in the physician’s kit bag so that the physician may be prepared to treat 2. Derman WE. Medical care of the South most medical problems. It is also worthy of apparatus, oxygen supplies, a spinal board, scales and portable high-resolution ultrasound equipment are also useful and sometimes essential equipment for the team physician, injury consultations during the Games of yet will be too bulky to carry in a portable Whilst host country services can be excellent and “state-of-the-art,” they can vary greatly depending on the geographical location and selected by the local pharmacist. Furthermore, available in the host country or stock might be limited, or there might be delays in accessing 5. De Jager, P. The doctor's sports bag. host polyclinic services leading to a delay in patient management. In some countries, the constituents of certain common medications can vary and, contamination of agents can also occur. Thus a comprehensive, sufficiently stocked medical supply kit is important. medical kit on El Al passenger aircraft. medications should be kept at a temperature of 4-25°C, whilst some, including tetanus toxoid and insulin, require refrigeration. After each event or trip, the supplies of the sports 8. Thibeault C. Emergency medical kit for medicine kit need to be restocked and updated and modification made based on needs for the next event. A consistent method of restocking with reference to a master list is advised. 9. Neumyvakin IP, Krupina TN, Polevoi LG, Providing a medical service to travelling athletes and officials would necessitate carrying agents in the travelling kit, which are prohibited in sport by WADA. It is important that these agents are colour coded in the bag 10. Gardner P. Immunizations, medications, so that the team physician is constantly traveler. Infect.Dis.Clin.North Am. 1990; 4: 179-197. Official Journal of FIMS (International Federation of Sports Medicine)
Travelling medical kit for Sports Medicine professionals International SportMed Journal, Vol.12 No.3, 11. Dardick KR. Travel medicine: General 15. Townes DA. Wilderness medicine. Prim 12. Deacon SP,.McCulloch WJ. Medical kits 13. Goodyer L,.Gibbs J. Medical supplies for medications by Canadian athletes at the Atlanta and Sydney Olympic Games. medical kit. Lancet 2003; 362 Suppl: s4-s5. 18. Milne CJ, Shaw MT. Travelling to China for the Beijing 2008 Olympic Games. Br J Sports Med 2008; 42: 321-326.
Official Journal of FIMS (International Federation of Sports Medicine)

Source: http://www.femmede.org.mx/wp-content/uploads/2013/11/PS08.pdf