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Caring for the Olympic Athlete
Kristine Karlson MDDHMC
1992 OlympianUS Rowing Team Physician
1997-Olympic Team Physician 2008
Who am I (and why am I talking about this)?
Not an athlete in high school Tried some new things in college Worked out pretty well…
My Career Spread medical school to 5 years Intern year in family medicine split
into 2 years 3 world championship gold medals 5th in 1992 Olympics
Retired from rowing, finished residency
But Olympics called again
Tried out for 1996 Olympics, 2nd (earns trip home)
Sports medicine fellowship Started at DHMC in 1997
Current practice: Half family medicine, primary care
ages birth to 94 Half non-operative orthopedics Dartmouth College training room
clinic
Travel with US rowing team
Elite Athlete Care
Elite Athlete Issues
Drug testing and drug/supplement use
Public health concerns
Acute illness and infectious disease
Accidents/injuries
Travelling with Athletes Positives
Part of elite group Watch events up close as insider Meet interesting people Interesting locations “Free” vacation USA gear Improvising care
Travelling with Athletes Negatives
On call 24/7 Demands for inappropriate care Hard decisions Boring “Interesting” locations Improvising care Vacation time used up Babysitting adults
The Medical Kit Antibiotics NSAIDs Wound care Ortho ENT/eye/GI Gyn Misc.
Drug Testing Issues WADA
Prohibited list Therapeutic use exemptions
http://www.wada-ama.org/en/ As much as possible done before
leaving the US Asthma testing if needed
NO supplements!
Doping Control
Public Health Officer Food
Anderson Br. J. Sports Med. 1996;30;347-348 – Salmonella at 1996 Junior Worlds
Water Safety
Bikes Walking
Unusual Care in Unusual Locations “Now” care – gyn exam at 11 PM,
earache overnight Pressure to use antibiotics for URI Lower threshold to use antibiotics Close followup
Care of team staff and family members
Improvising/ “Other Duties”
Boring/ Down Time
Babysitting Adults Pre-event safety Post competition party
Seeing other Cultures
Beijing 2008 Staff 32 athletic trainers 16 physicians (some ortho, some
not) 1 chiropractor 1 massage therapist
Beijing 2008 Staff Each sport assigned ATC Some sports shared ATC, many
shared physician
Usually ATC and physician known to the sport and athletes, not always
How did we get there? USOC volunteer medical program
Emphasis on staff who have worked with elite sports
Selected/ sanctioned by NGB 2 weeks volunteer at training center “Minor” trip(s) International games such as Pan Am’s
USOC Medical Volunteers
http://www.teamusa.org/medical/volunteers 5 years experience, 2 years with team Preferred to have worked with NGB US citizen, malpractice insurance, no
criminal background, letters of reference, etc
USOC Medical Staffing Training centers
Resident athletes Camps
Staff at training centers ATC’s Fellows Local MD’s Volunteers
USOC Training Centers Colorado Springs
Largest and “home” for USOC Chula Vista CA
Field sports, rowing, canoe/kayak Lake Placid NY
Winter sports
Beijing 2008 Anticipated issues
Heat Pollution GI illness
Beijing 2008 Village medical clinic USA medical clinic
Always staffed (one ATC always slept there, MD on call)
First contact with ATC ATC may involve MD
BNU Training Center USOC staff, training partners, spares
Beijing 2008 Medical clinic
Lots of rub downs Some rehab for athletes with injuries
who were still able to compete Wound and illness care Heat, ice, modalities
Beijing 2008 At the Venues
Depended on set-up Team room vs sidelines ATC always present, physician during
competition and maybe during training
Beijing 2008 Emergency services
Staff responsible for knowing plan If transported, go with athlete
Beijing 2008 Cases seen
Buttock blister URI Mild diarrhea Fever Asthma Tooth pain/
vaginal yeast infection
Diverticulitis
Knee effusion Foreign body foot Shin abrasion Allergic reaction Post race collapse
Beijing 2008 Worst case for Team USA was
wrestler hospitalized for kidney failure after dehydrating to make weight
Stress fracture Plantar fascia rupture