Microsoft word - appendix_26_medical memorandum for isu events

The ISU Medical Commission is appointed to assist local Organizing Committees and to report to the ISU Council on medical and Anti-Doping matters. Rule 140 of the ISU General Regulations requires that the Organizing Committees of ISU Events provide emergency medical services for all participants at the competition and practice sites. Details of the personnel and the facilities required are outlined below. The ISU Medical Protocol and Anti-Doping Protocol must be completed and returned to the ISU Director General as follows: a) if a site visit is conducted, the Medical Protocol and Anti-Doping Protocol will be provided to the Organizing Committee at that time. The ISU Medical Protocol must be completed and signed during the site visit and returned to the ISU Director General. The Anti-Doping Protocol must be completed and returned within four weeks of the site visit to the ISU Director General. b) if there is no site visit, the ISU Medical and Anti-Doping Protocols will be sent to the Organizing Committee and must be completed and returned to the ISU Director General within four weeks of receipt.
Members are responsible for obtaining their own health care coverage (insurance) for athletes
and other team members and must present proof of coverage at registration for the
competition/championship as per Rule 119 of the ISU General Regulations.
1. Documents / Announcement

For all ISU Championships the ISU office will forward to each organizer a Medical
Information Package that contains the following:
ISU Memorandum: Medical Section for appropriate discipline Copy of current ISU Anti-Doping Rules (new Rules valid from January 1, 2009 will be issued later in the year) Copy of current ISU Anti-Doping Procedures (new Procedures valid from January 1, 2009 will be issued later in the year) Procedures for Chaperones for Anti-Doping Testing Sample Doping Control Chain of Custody Form Current WADA List of Prohibited Substances (please note that the 2009 version of the List will be valid from January 1, 2009) 10. Current list of WADA Accredited Laboratories 11. Skater Health Care Form 12. Confidential Medical Report Form 13. ISU Withdrawal Notification Form 14. Standard Therapeutic Use Exemption Form for Emergency Use of Prohibited
2. Personnel

The following recommendations regarding medical personnel are for the safety and treatment
of skaters.

1. A qualified medical doctor with emergency/trauma and or sport medicine training or
equivalent must be present during the scheduled practice sessions and competitions. At all other times a qualified medical practitioner must be available by phone. 2. All medical and paramedical personnel at rinkside must be trained in emergency first aid 3. Medical personnel (for example paramedics, emergency medical technicians, emergency first-aid responders, nurses, sport medicine physicians, emergency physicians or surgeons etc.) must be present at rinkside during all scheduled practice sessions and competitions. They must be able to respond quickly and with enough staff (minimum 2) and equipment to remove the injured skater safely from the ice and to manage any emergency resuscitation and treatment necessary. This includes cardiovascular collapse, respiratory compromise, lacerations (minor or major), upper and lower limb, spinal and head trauma. 4. For all practices at the competition/main rink there must be a minimum of 2 persons at rinkside and one in the medical room, one of whom must be a Physician. At the practice rink there must be 2 persons at rink side one of whom is a physician if the practice rink is not located in the same building as the competition rink. 5. For competition times there must be a minimum of 3 persons at rinkside, one of whom is a physician. Two persons should be located at one corner/side of the rink with the equipment and one person at the diagonally opposite corner of the ice surface. See attached Appendix A. 6. The designated medical area(s) at rinkside must be well marked, and have easy access to the ice surface. During competition these designated areas must be an area large enough for the two host emergency personnel and one visiting team medical person at one corner and one or two medical personnel at the opposite corner of the ice surface. The medical area must have an unobstructed view of the ice surface. 7. Only medical and paramedical staff with emergency first aid skills and the visiting team medical staff are allowed at the designated medical areas at rinkside during competition. 8. Pre hospital care including the personnel and equipment to provide airway management, supplemental oxygen, cardiac monitoring and defibrillation, head and spinal injury management and immobilization, and extremity injury management and immobilization must be present at the rink(s)at all times when skaters are on the ice. The equipment for this pre hospital care may be provided at the rink(s) by the Organizing Committee or by an onsite ambulance. If the equipment is provided by the Organizing Committee on site, then the ambulance response time must be less than 10 minutes. If the equipment is provided by an onsite ambulance then a back-up ambulance must be available within 10 minutes if transport is necessary. 9. At the rinkside there must be the following equipment: - spine board and cervical hard collar - resuscitation equipment for airway maintenance (oral airways, pocket mask, bag valve mask /ambubag, portable suction) - supplies for lacerations ( compression dressing pads, gloves) - stretcher (preferably with wheels) must be available for easy transport of skater 10. A member of the medical team who is able to communicate in English must be available 11. There must always be sufficient emergency staff available to provide care at the ice surface if others are busy in transport to the hospital or in the medical room. 12. Medical personnel must always be available in the first aid room and at rinkside while competitors are on the ice. At rinkside the medical personnel must have easy access to the ice surface and be able to communicate with the Technical Delegates and medical staff at all times. 13. Medical personnel are expected to be on site 15 minutes before the start and 15 minutes after the end of practice and competition. 14. There must be a Chief Medical Officer, who is an appropriately trained physician, appointed by the Organizing Committee, who is responsible for prearranging liaison with the clinics, hospitals and appropriate specialists for the care of the competitors during the competition. 15. It is the responsibility of the Chief Medical Officer that all medical encounters are 16. Physiotherapy care must be made available to skaters during ISU Championships and 17. All personnel must be aware of` the disaster plan and location of emergency exits for the facility and their responsibilities for the skater in their care. 18. Protocols must be in place for emergency procedures such as evacuation of the skater from the ice surface. All medical personnel must have their roles in this situation clearly defined before the competition. The ISU Medical Advisor will review this with the Chief Medical Officer on arrival. 19. Before the beginning of the competition emergency medical personnel must review or, if time permits, carry out, a practice session with the ISU Medical Advisor or ISU Technical Delegate, to ensure that all equipment is tested and all personnel understand and are able to carry out all emergency procedures. 20. All medical personnel must wear similar, specific clothing that easily identifies them as 21. Administrative staff must be available from the first day of the accreditation process in the registration room to collect the Skater Health Care forms from the Team Leaders, skaters or team doctors. The Skater Health Care Form will be collected by a designated staff person who will be responsible for providing the forms to the Chief Medical Officer.
3. Facilities
1. A telephone must be available in the medical room.
2. There must be a means of communication between the emergency medical personnel at
rinkside and the medical/physiotherapy treatment room(s). 3. There must be a TV feed in the medical room. 4. If physiotherapy is provided in a room separate from the medical room there should be a 5. Communication with the physician must be possible at all times. 6. The ISU Medical Advisor must be provided with a means of communication. 7. Each medical encounter must be recorded on an ISU Confidential Medical Report form. 8. In the event of blood stains on the ice it is the discretion of the Referee to conduct a flood and/or to decontaminate the area/s by spraying them with a 1:10 dilution of household bleach. Medical Room 1. The medical room should be well signed and easily identified. 2. It should be close to the dressing rooms and ice surface and have clear access to the ice surface. 3. There must be an unobstructed and secure passage from the medical room and the ice surface to the ambulance. 4. The ambulance entrance should be as close as possible to the medical room and the exit from the ice surface. Treatment Room The treatment room must: 1. Be available and staffed at all times during official practice and competition. 2. Be large enough to deal with expected medical encounters. 3. Have at least two treatment tables, with blankets, table and chairs. 4. Have washing facilities i.e. a sink with running water. 5. Have medical equipment and pharmacological agents necessary for the examination and treatment of respiratory illness (for example, asthma), cardiovascular stabilization (for example, blood loss, lacerations, or collapse), neurological complications (for example concussions, seizures) musculo-skeletal problems (for example fractures and soft tissue injury)- Gastrointestinal illness (for example dehydration due to vomiting and diarrhoea), and minor skin care (for example lacerations and abrasions) 6. Cooler with ice bags must be available in the room and /or at rinkside. 7. Have a secure area for medical record keeping. 8. Have an area available for the visiting medical staff to use to treat their skaters. 9. Have a wheelchair available. Physiotherapy Room The physiotherapy services provided during the competition may be provided at the rink, or the hotel or both. An area should be available for the visiting physiotherapists to examine and treat patients. Skater Areas 1. Refreshments: drinks must be provided at the ice rink at competition and practice sites. Small sealed individual portion bottles must be available for all skaters. Snacks such as fruit, sandwiches, nutrition/fruit bars and soup should be available at the rink. 2. The proposed menu for the Event must be sent to the ISU Medical Advisor and/or the Technical Delegate for approval well in advance of the Event. 3. There will be no smoking in any skater areas at the rink or hotel. This includes the dining areas, dressing rooms, transportation, washrooms, anywhere skaters are warming up and all medical and Anti-Doping facilities.
Spectator Medical Care
If spectator medical services are available, these services must be provided in a room separate
from the medical room and treatment room for security reasons.
4. Information

Information on access to medical care must be available to skaters, officials and ISU Office
Holders at all times. This should include physician on call numbers and hospital numbers.
At the team leaders meeting, the ISU Medical Advisor or Chief Medical Officer will
emphasize the important points and will answer any questions.
5. Anti-Doping

See the current ISU Anti-Doping Rules and Procedures. For specific details refer to the
Anti-Doping Facilities and Equipment document attached as Appendix B
Arrangements must be made to have all necessary personnel to conduct the required Anti-
Doping testing. It is the responsibility of the Organizing Committee to ensure that the Anti-
Doping testing personnel are trained in ISU Anti-Doping procedures and that the chaperones
are aware of their responsibilities. The chaperones must be of legal age under the laws of the
host country. The facilities and the equipment to carry out Anti-Doping testing at an ISU
Championship or ISU Event and secure transport of the samples to a WADA accredited
laboratory are the responsibility of the Organizing Committee. ISU Doping Control Forms
and Anti-Doping equipment can be obtained from the ISU Secretariat. The ISU Anti-Doping
Protocol must be completed and returned, within four weeks of its receipt, to the ISU Director
Arrangements must be made for the ISU Medical Advisor or ISU Technical Delegate and all Anti-Doping personnel to discuss the Anti-Doping procedures and review or practice the Anti-Doping procedures prior to the date the testing officially begins. At Championships and the Grand Prix Final Events, the Anti-Doping Draw will be conducted in the Anti-Doping Room by the ISU Representative 30 minutes before the Opening Ceremonies on the ice. Facilities The Anti-Doping station should be well signed and easily identifiable. The Anti-Doping station must consist of two separate and secure (lockable) rooms of adequate size for use as a waiting room and an administrative room with a toilet and washing facilities. The Anti-Doping station should be close to changing rooms yet secure from media and spectators. If the samples will be stored on site prior to transport to the laboratory the administration area should contain a refrigerator or cabinet, which is lockable with only two keys. There must be a telephone or an alternate means of communication in the Anti-Doping station. There must be a live feed TV in the Anti-Doping station. The waiting room must contain a refrigerator for the storage of cold sealed drinks (sealed, small bottles, boxes or cans of caffeine-free, alcohol-free drinks). There must be a means of communication (walkie-talkies or cell phones) between the Anti-Doping station and all of the chaperones. After completion of Anti-Doping testing the Organizing Committee must provide transportation, food and refreshments for the ISU Medical Advisor and the skaters if the dining room is closed. Only the ISU Medical Advisor/ISU Delegate and the Chief Doping Control Officer will have access to the Anti-Doping rooms, outside of the testing periods. Appendix A
Figure Skating Medical Coverage for Events
Note: This is the minimum coverage for the Competition venue. Minimum coverage for practice venue would be two persons at rinkside. For World Championships or Olympics the coverage may increase to two personnel at at either corner of the ice surface. There should always be space available for one medical person from the team of the skater performing to be present with the host medical team. Suggested List of Supplies for Medical Room WADA List of Prohibited Substances and Methods disposable suture kits or sterile needle driver, forceps, scissors gauze pads large and small absorbent large pressure dressing pads anti-emetic (gravol/stemetil) injectable and PO anti-histamines (benadryl/ claritin/beconase) inhalers: ventolin, beclovent nebulizers-ventolin/atrovent anti-seizure (ativan/valium), injectable and PO Steroids: Prednisone 5mg tabs, depomedrol, topical steriods anti-inflamatories: motrin, naproxen, voltaren PO and suppository analgesics: ASA, Tylenol plain /paracetamol, , tylenol # 3 with codeine, antibiotics: penicillin, erythromycin, ceftin, Septra DS, doxycycline GI: maalox/diovol, pepcid, immodium, kaopectate, proctosedyl, gravol, ducolax, lubricating jelly, occult blood samplers and solution ENT: aluminum shield, otowicks, antibiotic ear/eye drops, soft eye patch, tape, floresceine, alcaine, surgicel, nasal packs, silver nitrate sticks otrivin, saline drops, #25 gauge needle, 4% xylocaine, mydriacil.5%, All drugs on the WADA List of Prohibited Substances should
be clearly marked

If physiotherapy is available at the rink, the area will be larger and require more supplies that include: physiotherapy tables Electrical modalities at the host discretion Tape 1 ½” elastic tape Pro wrap Heel lace pads Second skin Moleskin Anti-septic. Anti-bacterial spray Tensors 2”, 4”, 6” Massage lotion Crutches available Ankle splint available Slings, Plaster to make splints if necessary Appendix B
FACILITIES: Please refer to attached diagram o access to the Anti-Doping rooms must be controlled with only two keys, so it may be necessary to provide a padlock for the competitions o large enough to accommodate the skaters, chaperones and the persons accompanying the skaters (one for each skater), minimum 15 persons o fridge available to store individual sealed drinks o table and two chairs for administration person to sign athletes and chaperones and accompanying persons in and out of the Anti-Doping station o radio or telephone contact with the chaperones o TV or video feed of the Event o 2 large garbage cans o large enough to accommodate sturdy table and four to five chairs two on one side of the table and two or three on the other. o separate table for selection of Anti-Doping control equipment o washroom large enough for two persons yet private from others in o sink /washing facility o if samples will be stored on site until transportation to the accredited laboratory then a lockable cupboard or refrigerator is required o telephone in Anti-Doping station o chaperones to have walkie-talkies to communicate with Anti-Doping station o sealed individual drinks: no caffeine or alcohol o collection vessels o Versapak or Bereg kits for sample control o partial sample kits o transport bags for Versapak or Bereg containers o seals for transport bag o tape o scissors o signage on doors o clipboards and pens -enough for each test being carried out for that day. o paper towels and kleenex o pH and specific gravity measurement sticks o gloves the numbers of collection vessels and sampling containers will vary depending on the competition, please refer to attachment for recommended numbers to order for each Event. o adequate number of chaperones of appropriate sex, all of whom must be of legal age under the laws of the host country,. o male and female trained witnesses or DCOs for sample collection o one administration person o one person responsible for running results of the competition to the Anti- o one certified Anti-Doping control officer to conduct tests and arrange courier to transport samples to the WADA accredited laboratory o ISU Anti-Doping Forms (may be ordered from the ISU Secretariat)
o ISU Chain of Custody Form for transfer of samples to the laboratory
(may be ordered from the ISU Secretariat)
o Chaperone procedure information o Anti-Doping Sign in Form o Form posted on door which lists competitors to be tested MINIMUM NUMBER OF TESTS AT INTERNATIONAL

Please confirm with the Medical Advisor or the ISU Technical Delegate how many tests are
anticipated for your specific competition.
The following are the lists of the minimum tests to be conducted at each competition and the
suggested number of sampling kits and partial sample kits to be available.


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