Review of the Local Organizing Committee (LOC) medical services ...

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BJSM Online First, published on March 11, 2016 as 10.1136/bjsports-2015-095600 Original article

Review of the Local Organizing Committee (LOC) medical services during the 12th FINA World Swimming Championships (25 m) in Doha, Qatar H Paul Dijkstra,1 Liesel Geertsema,1 Nejib Benzarti,2 Elsbeth A L van Dorssen,1 Cees-Rein van den Hoogenband,3 Margo Mountjoy3,4 1

Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha Qatar 2 National Sports Medicine Program, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Qatar Swimming Association, Doha Qatar 3 Fédération Internationale de Natation (FINA) Sports Medicine Committee, Lausanne, Switzerland 4 Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada Correspondence to H Paul Dijkstra, Sports Medicine Department, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar; paul. [email protected] Accepted 13 February 2016

ABSTRACT Background One of the primary roles of Fédération Internationale de Natation (FINA) is to promote athlete health. The planning and delivery of major international event medical services is carried out in collaboration with the Local Organizing Committee Medical Commission (LOCMC). Aspetar Orthopaedic and Sports Medicine Hospital provided the medical services to the 12th FINA World Swimming Championships (25 m) creating a unique opportunity for collaboration with FINA. Aim The purpose of this paper is to review the planning and delivery of medical services and athlete health promotion projects during the 12th FINA World Swimming Championships (25 m) to facilitate the planning of future sporting events of this size and scope. Methods The 12th FINA World Swimming Championships (25 m) hosted 974 athletes from 166 countries. The LOC medical team recorded all medical encounters—newly incurred (or acute exacerbations of chronic) injuries and illnesses as well as follow-up consultations. Results More than 90% of teams did not travel with a team physician and relied on the LOCMC for diagnosis and treatment of injuries and illnesses in athletes and accredited team officials. The LOC medical team had a total of 554 medical encounters: 385 therapy, 34 athlete injury, 65 athlete illness and 70 non-athlete encounters. Conclusions The LOCMC in collaboration with FINA delivered comprehensive medical services to athletes, officials and spectators attending the 12th FINA World Swimming Championships (25 m). This review paper provides information relevant to the planning and delivery of LOCMC medical services for future international swimming events contributing to the FINA objective of promoting athlete health.

According to the FINA Medical Rules, guidelines must be established regarding the necessary medical support depending on the nature of the sports activities and the level of competition.1 These should address but not be limited to: ▸ The medical coverage of training and competition venues and how this is organised; ▸ The necessary resources (supplies, premises, vehicles, etc); ▸ The procedures in case of emergencies; ▸ The system of communication between the medical support services, the organisers and the competent health authorities; ▸ Cooperation with local public health authorities to ensure safety of the participants and local community. Aspetar Orthopaedic and Sports Medicine Hospital provided the medical services to the 12th FINA World Swimming Championships (25 m) creating a unique opportunity for collaboration in the planning and delivery of medical care in an integrated way and in accordance with the FINA Medical Rules. In addition to these services, FINA and Aspetar also collaborated on education and research projects during the event as a further extension of the comprehensive athlete health management remit. This paper provides an overview of the medical services and collaborative projects at the 12th FINA World Swimming Championships (25 m), thus facilitating the planning and delivery of LOCMC medical services of future international sporting events of similar size and scope, and to realise the FINA objective of promoting athlete health.

PLANNING AND DELIVERY OF LOC MEDICAL CARE INTRODUCTION

To cite: Dijkstra HP, Geertsema L, Benzarti N, et al. Br J Sports Med Published Online First: [please include Day Month Year] doi:10.1136/bjsports2015-095600

One of the primary roles of any International Federation Medical Committee is to promote athlete health. The Fédération Internationale de Natation (FINA) Medical Rules provide clear guidelines on the protection and promotion of athlete health during training and competition.1 These include the planning and delivery of medical services as well as research projects in Sports Medicine and Science to promote health and reduce the risk of injury and illness. The planning and delivery of comprehensive medical services to athletes, officials and spectators attending a major international event is carried out in close collaboration with the Local Organizing Committee Medical Commission (LOCMC).

The delivery of medical care at major sporting events presents a number of challenges to the LOC and to the international sport governing body. It is therefore important to implement detailed collaborative strategies to facilitate logistical planning and execution to account for and manage the challenges. We discuss five important collaborative focus areas to improve athlete health and performance.

Precompetition arrangements—early and regular communication to establish clear guidelines and terms of reference for LOC and FINA collaboration The FINA Sports Medicine Committee (SMC) manages the medical aspects of the different aquatic sports. These include:

Dijkstra HP, et al. Br J Sports Med 2016;0:1–8. doi:10.1136/bjsports-2015-095600

Copyright Article author (or their employer) 2016. Produced by BMJ Publishing Group Ltd under licence.

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Original article ▸ Injury and Illness prevention—including the development of programmes on Periodic Health Examination, instructional video production on medical topics, including shoulder and knee injuries as well as concussion in sport; ▸ Medical healthcare during events; ▸ Research on aquatic health issues; ▸ Organisation of educational conferences for team physicians including The FINA World Sports Medicine Conference on Aquatics every 4 years; ▸ Advising the FINA Bureau on health issues in Aquatics; ▸ Providing support to the Doping Control Review Board (DCRB) on medical aspects and health issues in antidoping procedures. During FINA events, the FINA SMC coordinates the provision of medical services in collaboration with the LOCMC, in particular with the LOC Chief Medical Officer (CMO). The Chairmen of the FINA SMC and DCRB visited Doha at the time of the 2013 FINA Swimming World Cup to review the facilities and to plan for the 12th FINA World Swimming Championships (25 m). The LOC CMO presented the medical plan to the FINA delegation including regulations on the importation of pharmaceuticals, public health policies, the medical services plan and an emergency medical care strategy, all of which were to be included as part of the final Team Leaders Guide.2 The specific demands of the event, the nature and layout of the competition and training venues and the key members of the LOC and FINA SMC were familiar to the members of the LOCMC as they were involved in the planning and delivery of medical services to the 2012 and 2013 Doha FINA World Cup events in Doha. The 7-member LOCMC, chaired by the LOC CMO, met monthly and in the weeks before the event on a weekly basis to plan the delivery of routine, emergency and special medical services during the 12th FINA World Swimming Championships (25 m).

Delivery of comprehensive medical care during the 12th FINA World Swimming Championships (25 m) The LOCMC provided medical care for all athletes, officials and spectators during the event. The delivery of quality medical services relies on professional infrastructure and teams working together to manage and coordinate athlete health and optimise performance. The nature of the event: The 12th FINA World Swimming Championships (25 m) was held from 3 to 7 December 2014 (5 competition days of 2 sessions per day) in Doha, Qatar. This is a short course (25 m) event as opposed to the long course (50 m) of the FINA World Championships and Olympic Games swimming events. The athletes competing in short and long course events are quite similar, with a number of Olympic and World Champion medallists and finalists competing at this short-course event. The average daily low and high temperatures for December 2014 in Qatar were between 15 and 25°C (the highest day temperature for the competition was 27°C recorded on 4 December). Infrastructure: The LOC MC provided medical care at one training venue, the competition venue (1 warm-up pool and one competition pool) and at the athlete and team official/FINA hotels (5 athlete and 3 team official/FINA hotels) (table 1). There were six medical clinics at the competition venue and a further six at the eight hotels—one for each athlete hotel, and one clinic shared by the three hotels for officials (FINA, media, etc). The LOC provided two therapy areas at the competition venue—one common team medical/therapy area (figure 1) and a 2

separate Aspetar-staffed therapy area. Services started on 28 November, 5 days prior to the first day of competition. Hospital services: The LOC CMO coordinated all patient referrals to the Aspetar Orthopaedic and Sports Medicine Hospital (for the majority of sports injuries and illnesses in athletes and team officials) and the Hamad Medical Corporation (for emergency care, major trauma and significant illness). LOC medical staff (excluding antidoping): The LOC recruited a diverse medical team of doctors, physical therapists, nurses and paramedics—all Qatar-based. The majority of these individuals were from Aspetar, The Qatar Red Crescent (QRC) and Hamad Medical Corporation (HMC) (see tables 1 and 2). Emergency medical services: The QRC and HMC Ambulance services provided emergency medical services during the event. A total of four ambulances were used at the competition venue at any particular time during the event. The LOC doctors, paramedics and lifesavers practised pool rescue and spectator emergency response scenarios on two occasions prior to the event to facilitate teamwork and ensure an optimal response. Public health programme: The following policies and procedures were planned, discussed and agreed on before the competition in collaboration with the Qatar Supreme Council of Health and the HMC: ▸ Disaster Medical Plan: A strategic plan was developed and practised for the unlikely eventuality of major disasters including fire and stadium collapse. ▸ Ebola Viral Disease (EVD) plan: The WHO and the Qatar Supreme Council of Health (QSCH) and HMC advised against travel to and from the three affected countries (at the time of the competition) in West Africa. No athletes or officials from any of these three countries attended the competition. The LOCMC in collaboration with the QSCH, HMC

Table 1 Twelfth FINA World Swimming Championships (25 m): medical venues and staffing provisions

Athlete services

Venue

Daily staff numbers

Competition pool Medical clinic Competition pool deck

1 sports medicine physician 1 nurse 1 sports medicine physician 2 paramedics 2 sports medicine physicians 2 paramedics 1 nurse 1 on call emergency care doctor (in response car) 1 sports medicine physician on call 4 physiotherapists and 4 massage therapists Space shared between all teams —team doctors and therapists 2 cardiologists 4 physiologists Used only by team medical staff

Warm-up pool medical clinic and pool deck 5 athlete hotels: one medical clinic each

Aspetar therapy area

VIP and officials

Spectator and workforce medical services

Team therapy and medical area Swimmer’s heart study clinic Physiology room (lactate testing etc) VIP area medical clinic

1 nurse 1 emergency care doctor 2 paramedics 3 hotels: one medical 1 nurse clinic in main hotel 1 emergency care doctor 2 clinics in main stands 4 paramedics 2 emergency care doctors



Original article Figure 1 The common team medical and therapy area.

and the FINA SMC implemented and communicated to all stakeholders a specific plan to deal with any suspected EVD case (at the hotels or competition venue). The LOCMC did not implement additional strategies like daily temperature and symptom assessments. There were no suspected or confirmed EVD cases before or during the event. ▸ Food safety plan: A food safety plan was implemented, including hotel and competition venue food preparation area inspections, accreditation and licensing of catering companies. ▸ Illness prevention strategy: Hand sterilisation units were installed at the training and competition venue athlete areas. Team medical staff: A total of 166 countries competed at the 12th FINA World Swimming Championships (25 m). Less than 20% of teams (representing 465 of the 974 accredited swimmers who had access to a doctor (298), a physiotherapist only (101) or a massage therapist only (66)) travelled to this event with medical staff: 17 team doctors, 32 team physiotherapists and 22 massage therapists were accredited. The travelling team medical staff delivered clinical services to athletes from their respective countries at the hotels and also at the common team

Table 2 Staff and numbers on duty (each day) during the championships Type

Specialty

Number

Administrative Physician

Venue medical manager Sport medicine physicians Emergency care physicians Cardiologists* Physiotherapists Massage therapists Clinic nurses Paramedics Cardiac physiologists*

1 5 5 2 4 4 8 14 4

Physical therapists Nursing Emergency care Sport science

*As part of the Swimmer’s Heart Project.


medical/therapy area at the warm-up pool. It is unusual for teams to travel with unaccredited medical staff to FINA events. Logistical implementation of medical services: The Chairman of the FINA SMC, assisted by the LOC CMO, presented the medical plan to team leaders and team medical staff during the pre-event technical and medical meetings. A key element of the LOC medical operational plan was a well-signed central medical operations administration room at the warm-up pool close to the therapy areas, physicians consultation room and Swimmer’s Heart study venue. The strategic location of the LOC central medical operations administration room made it easy for the FINA SMC and LOCMC team members to interact and for swimmers to seek medical attention. The LOC CMO and Chairman of the FINA SMC met on a daily basis while the LOC medical team ( physicians, therapists and emergency staff ) also met daily during the event to ensure the coordination and quality of healthcare service delivery and to discuss health issues primarily related to the competing athletes. Medical encounters: The purpose of this section is to provide an overview and basic analysis of the total number of medical encounters to facilitate the planning of similar events in future. We did not conduct a formal injury and illness incidence study; the data presented here are from a retrospective analysis of the LOC CMO daily reports, LOCMC medical records, physiotherapy encounter reports as well as FINA accreditation records. A total of 974 swimmers from 166 countries were accredited to compete at the 12th FINA World Swimming Championships (25 m) in Doha, Qatar. The vast majority (more than 90%) of teams (representing 676 swimmers) did not travel with a team physician and relied on the LOCMC for the diagnosis and treatment of injuries and illnesses in athletes and accredited team officials. Injury and illness medical records were based on the validated forms used for the 2009 and 2013 FINA and IAAF World Championships surveillance studies.3 4 A reportable injury or illness was defined as any injury or illness that required attention from a physician at any of the official venues (warm-up pool, competition pool or athlete/official hotel medical clinics). Any swimmer who presented to the LOC therapy team first for an injury or illness was directed to one of 3


Original article the LOC sports physicians for primary assessment and diagnosis.

Frequency and characteristics of injury in athletes The LOC Sports Medicine Physicians recorded 34 injury encounters (32 new and 2 follow-up). This relates to an acute and chronic injury incidence of 3.5 per 100 registered athletes. This is less than the 6.1 injuries per 100 registered athletes competing in the long course swimming events during the 2013 FINA World Championships.4 The majority of these injuries were lower limb injuries in male swimmers (see table 3). Two injuries required imaging at Aspetar (table 4).

Frequency and characteristics of illness in athletes The LOC Sports Medicine Physicians reported 65 illness encounters (53 new and 12 follow-up). This relates to an acute and chronic illnesses incidence of 6.7 per 100 registered athletes. This is less than the number of illnesses reported during the 2013 FINA World Championships (8.9/100 registered athletes competing in the swimming event).4 The majority of these illnesses were acute infections of the upper respiratory tract (URTI) and gastrointestinal illness—25 in male swimmers and 19 in female swimmers (table 5). Athletes and officials who presented with symptoms and signs of possible contagious infection (URTI/gastrointestinal) were advised to stay away from the competition venue and other team members at the hotel. We did not follow a strict isolation policy for these minor infections. The LOC Therapy team had 385 athlete encounters for physiotherapy and massage therapy; this is 39.5 encounters per 100 registered athletes. The vast majority of these encounters were routine maintenance in non-injured, competing swimmers. We did not keep a separate clinical record of each of the LOC physical therapy encounters for injury management, which represents a limitation of this report. A total of 8 swimmers (0.8/100 registered athletes) had to be withdrawn from competition due to illness or injury (table 4). The reasons for sport participation withdrawal were: acute URTI with systemic symptoms (3), gastroenteritis (2), metacarpal fracture (1), muscle strain (1) and rotator cuff tendinopathy (1). There were no incidents requiring pool rescue or emergency transfer to hospital. A total of five patients (athletes and officials) were transferred to Aspetar Hospital or HMC for illness or injury.

Table 3 Acute onset injury and acute exacerbation of chronic injury in athletes

Male swimmers

Female swimmers

Injury

Number

Acute injury

16 (47%) Knee (5) Foot and ankle (3) Hand and fingers (2) Groin (2) Head, back, chest and shoulder (each 1) 5 (15%) Shoulder (4) Back (1) 6 (18%) Shoulder (2) Back (2) Ankle and head (each 1) 7 (20%) Shoulder (3) Wrist, elbow, knee and Hip (each 1)

Acute exacerbation of chronic injury Acute injury

Acute exacerbation of chronic injury

Other types of medical consultations

Type of medical consultation Therapy consultations (LOC therapists) Transfers to hospitals

Number Comments 385

Imaging Withdrawal from competition due to illness or injury

39.5/100 registered athletes

5

All non-emergency cases (4 athletes and 1 non-athlete): gastrointestinal in a non-athlete, laboratory tests (2 athletes) and imaging (2 athletes) Performed at Aspetar Hospital 0.8/100 registered athletes

2 8

LOC, Local Organizing Committee.

Non-athlete healthcare delivery There were 70 non-athlete medical encounters (venue staff, team support staff, FINA officials and others (including a few hotel guests)—see tables 6 and 7). This is 13% of all encounters and 41% of all non-therapy encounters, which should be considered when planning medical services for future events. There were a total of 50 hotel encounters (21 athletes and 29 non-athletes), which is approximately 9% of all encounters (see table 6). The burden of delivery of healthcare to non-athletes is an important consideration when planning for any major sporting event. During the 2nd Summer Youth Olympic Games (2014) in Nanjing, there were more medical encounters for nonathletes than for athletes.5 A small number of hotel consultations were for non-accredited guests. None of these were emergencies, highlighting the importance of a clear message to medical teams and hotel management about who can and who cannot access the LOC medical services provided at the hotel.

POSTEVENT REVIEW OF MEDICAL CARE DELIVERY It is important to critically review the challenges of planning and delivery of comprehensive medical services at major sporting events and to provide key recommendations to the relevant stakeholders for future reference. This analysis was performed

Table 5 Acute onset illness and acute exacerbation of chronic illness in athletes

Male swimmers

Illness

Number

Acute illness

28 (43%) Upper respiratory tract (URT) (16) Gastrointestinal (9) Neurological/central nervous system (2) Dermatological (1) 1 (2%) Cardiovascular

Summary

Total injury encounters: 34; 3.5/100 registered athletes (2 were follow-up consultations).

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Table 4

Female swimmers

Acute exacerbation of chronic illness Acute illness

Acute exacerbation of chronic illness

Summary

30 (46%) Upper respiratory tract (12) Gastrointestinal (7) Urogenital (6) Other (non-specific fatigue) (3) Haematological/allergic/ Immunological (1) Psychiatric/psychological (1) 6 (9%) Neurological/central nervous system (5—primary encounter and 4 follow-up encounters in same athlete) Gastrointestinal (1)

Total illness encounters: 65; 6.7/100 registered athletes (12 were follow-up consultations).



Original article Table 6 Number and venue location of non-athlete encounters and hotel consultations LOC venue staff consultations (including 5 hotel guests) Team officials’ consultations FINA officials’ consultations Hotel consultations

28 Injury (9) and illness (19) 36 Injury (5) and illness (31) 6 Injury (4) and illness (3) 29 Injury (3) and illness (26) (there were 21 additional athlete hotel consultations contributing to a total of 50 hotel consultations)

LOC, Local Organizing Committee.

through formal and informal meetings and discussions during and after the 12th FINA World Swimming Championships (25 m). Formal reports were presented to FINA, the LOC and the Aspetar senior management. It is beyond the scope of this paper to review all the recommendations. Some key recommendations resulting from the review are to: ▸ Establish early collaboration and communication processes between the FINA SMC and the LOCMC ( providing the detail of medical planning and delivery standards). Consider the following for future events: – Regular FINA SMC and LOCMC meetings (at least daily between the FINA SMC Chairman and the LOC CMO). – WhatsApp groups; one for the LOC medical team and a separate one including all the individual medical team members accredited for the event. This is an excellent way to communicate short and important logistical medical matters. – One medical radio channel (LOC medical team—physicians, therapists and emergency team); the LOC CMO should also have access to the general LOC radio channel. It is important to establish a protocol and practise the use of radio communication (especially for physicians and therapists who might not be familiar with the technology). – An LOC sports physician should be available on call providing 24 h service. The on call mobile number as well as the LOC CMO mobile number should be communicated to all the individual team leaders and accredited visiting medical staff.

Table 7 Characteristics of non-athlete injury and illness encounters at the training or competition venue (excluding hotel encounters)

Officials and LOC venue staff

Officials and LOC venue staff

Injury/illness

Number Summary

Acute injury

11

Acute exacerbation 7 of chronic injury Acute illness 53

Acute exacerbation of chronic illness

4

Back (3), leg (1), foot and ankle (2), wrist (2), hand and finger (2) and thigh (1) Back (3), wrist (2), ankle and leg (each 1) URT (28), gastrointestinal (7) and neurological/central nervous system (11), dermatological (2) chest (3) other (2) URT (2), gastrointestinal and ophthalmological (each 1)

Total: 57 illnesses (4 were follow-up consultations), 18 injuries. The gastrointestinal illness recorded as an acute exacerbation of chronic illness was a case of acute pain due to pre-existing gall bladder stones. This person was transferred to hospital. LOC, Local Organizing Committee; URT, upper respiratory tract.


▸ Appoint an experienced specialist Sports Medicine Physician to lead the LOCMC. ▸ Recruit qualified and experienced clinicians (Sport Medicine Physicians, therapists and emergency care medical staff ) to deliver medical services. ▸ Appoint an LOCMC project manager to assist the CMO with the logistical elements of planning and delivery. ▸ Plan for appropriately equipped clinical areas of sufficient size to deliver medical services at hotels, training and competition venues. – The busiest clinical areas were the physician’s consulting room and the team therapy areas at the warm-up pool. These areas should be close to each other and also in close proximity to a medical operations administration room. – The common team therapy area is unique to this type of event and should be big enough to accommodate all teams. – Not all teams travel with their own equipment and the LOCMC should provide enough therapy beds, chairs, benches and therapy mats as well as ice and ice bags. ▸ Document all the medical encounters, while respecting patient privacy and confidentiality laws, to facilitate a post event audit. – The most common LOC medical encounter was physical therapy followed by athlete illness. A more detailed official recording of all the maintenance physical therapy encounters is an important consideration for future FINA events to provide better-informed planning of physical therapy services. – A significant number of physician encounters were due to illness in non-athletes. Officially recording all non-athlete physician encounters to document injury and illness trends at FINA events would also provide useful information. ▸ Plan and implement an infection prevention strategy including: hand washing and clean rest room facilities; alcohol hand gel dispensers throughout the venue, food safety inspections and certification of service providers.

Medical education for athletes and coaches—Aspetar Sports Medicine Journal The Aspetar Sports Medicine Journal, with free full text online access, is one of the fastest growing Sports Medicine Journals in the world today with over 4000 hard copy issues sent to 104 countries on a bimonthly basis. The Aspetar Sports Medicine Journal published an article on shoulder injuries in swimming and an interview with Chad le Clos (World Record holder, World and Olympic Champion) at the time of the 12th FINA World Swimming Championships (25 m) (figure 2).6 7 The printed version of this journal was distributed to athletes and team officials at the competition venue as part of an Aspetar education project. In addition, an Aspetar Sports Medicine Journal target issue on medicine in aquatic sports was published in October 2015 in collaboration with FINA. This serves as an extension of the collaborative service to further promote athlete health through the education of athletes, coaches, sports medicine and sport science professionals globally.

Projects focusing on injury and illness prevention The FINA SMC implemented two projects during the 12th FINA World Swimming Championships (25 m) in collaboration with the Aspetar Orthopaedic and Sports Medicine Hospital in order to fulfil the FINA medical rule (Preamble #1) of health promotion of the aquatic athlete.1 5


Original article Figure 2 The December 2014 Aspetar Journal cover page.

Consensus meeting on the methodology of injury and illness surveillance in aquatic sports FINA has engaged in athlete health surveillance since 2004 to better understand the injuries and illnesses that affect the health and performance of the aquatic athlete.3 4 8 It became apparent from these experiences that the FINA injury and illness surveillance protocol was not optimal. On the basis of this analysis of the FINA Injury and Illness methodology, a consensus meeting between experts in aquatic sports medicine, sport injury epidemiology, sport psychiatry and an athlete representative was held during the 12th FINA World Swimming Championships (25 m). The aim was to achieve consensus on new recommendations for injury and illness definition and surveillance research methodology monitoring the health of athletes in all the aquatic disciplines. The consensus statement is published in this edition of BJSM.9

The Swimmer’s Heart Project The second collaborative project between FINA and Aspetar was the ‘Swimmer’s Heart Project’ (figure 3). Given the infrastructure and expertise of sports cardiology at Aspetar as well as 6

the logistical support and facilities conducive to this type of project in Doha, it was feasible to develop and implement a pilot research project during the 12th FINA World Swimming Championships (25 m) with two principal aims: 1. To undertake a needs analysis to ascertain the feasibility of implementing a cardiovascular screening programme across all FINA events. 2. To establish the prevalence of normal and abnormal cardiovascular screening results in a cohort of elite swimmers participating in the 2014 12th FINA World Swimming Championships (25 m). Ethical approval for this study was obtained and all the participants completed an informed consent form. FINA invited an expert sports cardiologist to advise and to provide on-site support to the local experts. A total of 127 athletes underwent cardiovascular screening during the 5 day period of the event, the future goal being to protect the health of the athlete through ultimately lowering the risk of sudden cardiac death in this population. There are a number of challenges when conducting cardiac screening during a major sporting event. FINA and Aspetar will continue this project in the form of a prospective cohort study Dijkstra HP, et al. Br J Sports Med 2016;0:1–8. doi:10.1136/bjsports-2015-095600


Original article Figure 3 Banner used to advertise the Swimmer’s Heart Project.

in collaboration with the different FINA member country medical teams.

SUMMARY Detailed and advanced planning to facilitate collaboration between the LOCMC and FINA SMC impacts on the quality and delivery of medical services and the success of concomitant education and research projects at major aquatic events. These initiatives contribute to the FINA objective of promoting athlete health and reducing the impact of injury and illness on health and performance.1 It would be prudent for future FINA events to implement specific quantitative and qualitative outcome measures to accurately assess the effectiveness of these FINA objectives. The LOC Medical Team reported a total of 554 medical encounters, of which 385 were routine maintenance physiotherapy or massage, 34 athlete injury (medical encounter), 65 athlete illness and 70 non-athlete encounters (illness and injury). Not all of the new and acute exacerbations of chronic injuries or illnesses were seen by the LOC medical team as the travelling medical teams will have managed these medical issues which were not captured in this review. The LOC Sports Physicians, however, saw a number of acute injuries or acute exacerbation of chronic injuries with the therapists of teams who travelled

What are the findings? ▸ This is the first paper on the planning and provision of medical services to a short course FINA World swimming Championships (25 m). ▸ We describe how the world governing body (FINA) and local organising committee worked in an integrated way on medical service delivery and projects to promote athlete health. ▸ It is possible to include health promotion projects as part of the medical services during major sporting events. Dijkstra HP, et al. Br J Sports Med 2016;0:1–8. doi:10.1136/bjsports-2015-095600

How might it impact on clinical practice in the future? ▸ Comprehensive physical therapy services should be one of the key priorities when planning and providing medical services to a short course Swimming World Championships. ▸ Projects to promote athlete health should be considered as a standard part of future sporting events of a similar nature. These projects depend on the experience and resources available to the local organising committee. ▸ This paper will assist in improving the planning and provision of medical services to future events of a similar nature.

without team physicians. Illnesses were the most common LOC medical encounter for both athletes and officials. The LOC for future events of a similar size and competition level might consider recruiting a family physician to assist with the majority of medical encounters in team officials, workforce and FINA Officials. This paper will contribute to the literature on health promotion and injury and illness prevention in swimming as well as the planning of health services by the LOC of future aquatic events and other sporting events of a similar magnitude. Twitter Follow Hendrik Dijkstra at @DrPaulDijkstra and Elsbeth van Dorssen at @DrElsbethVanD Acknowledgements The authors would like to offer their thanks to FINA, The Qatar Swimming Association, The Local Organizing Committee, Mr Petros Tsiallas, Aspetar, The Qatar Red Crescent and Hamad Medical Corporation for their full support and assistance with the organisation, planning and execution of medical services to the 12th FINA World Swimming Championships. The authors are also indebted for the substantial contributions of Mr Alistair Cameron and Mr Gregg Krahulec in their assistance with event organisation and planning. The authors are grateful for the assistance of Dr Nathan Riding with the final manuscript preparation. Contributors HPD substantially contributed to conception and design, coordination of authors, drafting and revising the manuscript and approval of the final version to 7


Original article be published. LG, NB, EALvD and C-RvdH contributed to drafting and revising the manuscript and approval of final version to be published. MM contributed to conception and design, coordination of authors, drafting and revising the manuscript and approval of final version to be published.

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Competing interests None declared. Provenance and peer review Not commissioned; externally peer reviewed.

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Review of the Local Organizing Committee (LOC) medical services during the 12th FINA World Swimming Championships (25 m) in Doha, Qatar H Paul Dijkstra, Liesel Geertsema, Nejib Benzarti, Elsbeth A L van Dorssen, Cees-Rein van den Hoogenband and Margo Mountjoy Br J Sports Med published online March 11, 2016

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