Team Physician Manual

International Federation of Sports Medicine (FIMS)

Lyle Micheli, Fabio Pigozzi, Kai-Ming Chan, Walter Frontera, Norbert Bachl, Angela Smith, S. Talia Alenabi, Lyle J. Micheli, Fabio Pigozzi, Kai-Ming Chan, Walter R. Frontera, Norbert Bachl, Angela D. Smith, S. Talia Alenabi

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136464744
• Edition: 1
• Topic: Medicine
• Subtopic: Sports Medicine

The FIMS Team Physician Manual is the official sports medicine handbook of the International Federation of Sports Medicine (FIMS), the world's oldest sports medicine organization. Now in a fully revised and updated third edition, the book offers a complete guide to the background knowledge, practical techniques and professional skills required to become a successful medical practitioner working in sport.

Well illustrated, with clear step-by-step guidance, plus text boxes and checklists for quick reference, the Team Physician Manual covers every key area of activity and intervention, from the preparticipation examination to rehabilitation. The book surveys every classification of sports injury, offering clear advice on fieldside assessment, diagnosis and treatment, as well as examining best practice in general aspects of sports medicine, such as prevention and the psychology of injury. Written by a team of world-leading physicians from North and South America, Europe, Africa and Asia, this book is a 'must have' reference for any doctor, physical therapist, or medical professional working in sport.

PART I

SPORTS MEDICINE FOR THE TEAM PHYSICIAN

CHAPTER 1

THE MODERN-DAY TEAM PHYSICIAN

Roles, responsibilities, and required qualifications

William D. Stanish, Marcus Van Aarsen, and Nicholas A. Evans

As the international world of sport grows and evolves, so too does the field of sports medicine, and with participation rates in sport on the rise there is an expanding list of countries producing world-class athletes. Modern-day athletes span age groups like never before, and a significant portion of them are recreational athletes who expect that their participation in sport will not adversely affect their day-to-day lives. Consequently, the sports medicine physician continues to play an increasingly important role in the diagnosis and treatment of athletic injuries, injury prevention, and maintenance of general health, as well as optimizing athletic performance through proper training, nutrition, and lifestyle. The health status of an elite athlete is often of such high profile that there is a great onus on the team physician to operate at an elite level by managing the interests of patients, teams, the media, and, unfortunately at times, the legal system.

The modern-day care of athletes requires a broad range of professionals, and as a result the sports medicine physician has an unprecedented level of responsibility to oversee the many aspects of care that an athlete may receive, and must have the ability to communicate effectively in order to ensure optimal outcomes for patients. Moreover, communication skills are essential for properly informing coaches, agents, parents, and other interested parties about the health status of an athlete.

As various sports have dramatically different rules, strategies, cultures, and hazards, there is a tendency for some physicians to become experts in the coverage of a specific sport while maintaining proficiency in all areas of sports medicine. This career path is often fueled by the personal commitment to a team or a sport felt by a physician, and is a testament to the uniqueness and passion that the world of sport provides.

DUTIES OF A TEAM PHYSICIAN

The team physician plays a dynamic role that changes with the time of the season, the location, and the facilities available. Duties in the early season largely consist of health and fitness screening, optimizing of training and nutrition, and other preventative-medicine strategies. The heavy training season requires more management of sports injuries and a mental focus on maintaining motivation, while competition necessitates that the team physician handle many different aspects of athletic care in order to optimize performance and health.

To truly understand their role within each sport, the team physician must possess, not only a strong medical knowledge, but also an understanding of the rules, risks, and culture of the sport. Team physicians must make every effort to ensure that they are available to their athletes pre-, post-, and during competition, as well as after hours. During events that span days or weeks, physicians must keep social and personal commitments to a minimum to ensure that they are available to their team in times of need.

Responsibilities of the team physician include:

pre-participation health screening and examination;

assessment and management of athletic injuries both on the field and fieldside;

triage;

immediate and long-term management of athletic injuries;

coordination of athlete’s rehabilitation and return-to-play;

counseling of athletes on proper training and nutrition habits to maintain health;

ongoing observation of chronic pre-existing medical conditions;

condemning the use of artificial performance enhancement and counseling athletes on substance abuse;

staying current with the medical knowledge of the field and upgrading skills as necessary;

integration of knowledge with other athletic and medical professionals to maximize the quality of care to the team and its athletes.

Having a physician who travels to competitions with a team is a luxury for most amateur sport teams, but a necessity for elite international competition. When traveling with a team and practicing in a foreign venue, there is added responsibility on the team physician to assure the team of safe and fair competition. Additional roles while “on the road” include:

Preparation for travel: Team members must be aware of the health implications of international travel and be counseled on ways to avoid jet lag as well as other conditions that may be caused by long-term immobility. This education may occur well in advance of travel.

Pre-competition site visit: The team physician should arrive at the competition venue well in advance to look for any potential hazards to athletes during competition, as well as plan and understand the logistics of medical services available at the event and any barriers that may arise. Will the team physician have immediate access to an athlete injured in the field of play? Will there be any barriers to emergency vehicles accessing the venue? Where is the nearest hospital? There may also be other environmental or social hazards in the vicinity that should be considered to keep athletes safe after hours.

Preparation for medical practice: Many of the resources a team physician will rely on during international competition will come from home, making preparations before travel essential. The team physician should be involved in selecting the medical team, as well as selecting the proper amount of staff to ensure a high standard of care without being overstaffed and causing athletes to be “overdoctored.” The medical team should meet prior to travel to delegate foreseen tasks and establish a line of communication between team members. Medical equipment and traveling pharmacy should remain in the care of the team physician, and any substances banned from competitors should be kept to a minimum.

Event coverage: Effective communication with all medical staff, coaches, athletes, and team officials is paramount during the excitement of competition. Be prepared to treat, educate, advocate for, and listen to the athletes. This is when athletes will experience their highest highs (victory) and lowest lows (defeat or injury). Athletes may also be subject to drug testing at this time. The team physician must be prepared for this by understanding policies and procedures of these tests and being aware of his or her role in the proceedings. Patient confidentiality is to be maintained at all times.

Finally, the mobile nature of the team physician’s practice while traveling should not distract from the necessity of proper documentation of medical occurrences. This will help clarify the status of the athlete during competition and will aid in medical debriefing and continued follow-up of athletes upon their return home.

Considering the amount of time that a physician may spend with a team, it is understandable and invaluable that they feel integrated into the team atmosphere. However, although it is rewarding to feel like part of the team, it is important to keep one’s professional role clear. The conduct and dress of a team physician should reflect that of a medical professional rather than a teammate.

CREDENTIALS AND QUALIFICATIONS

The primary concern of the team physician is to provide the best medical care for athletes at all levels of participation. To this end, the following qualifications are necessary for all team physicians:

have an M.D. or D.O. in good standing, with an unrestricted license to practice medicine;

possess a fundamental knowledge of emergency care regarding sporting events;

be trained in CPR;

have a working knowledge of trauma, musculoskeletal injuries, and medical conditions affecting the athlete.

In addition, it is desirable for team physicians to have clinical training/experience and administrative skills in some or al...