Medical Issues At The Commonwealth Games:Lessons From The Youth Games

Dr Eleanor TillettHonorary Consultant in Sport & Exercise Medicine

University College London Hospital21.7.2010

• Setting the scene• Medical issues• Traveller’s diarrhoea• Other issues• Lessons for Dehli

2010

Overview

First Impressions!

The Plan! – Prevention of TD

• Total No. Contacts: 166 (122 team members)– New: 98 Follow Up: 68

• Diarhhoea was the commonest reason to present– New presentations including symptoms of

diarrhoea: 25/98 (26%)

Summary Of Medical Contacts

Type (Medical) No. New PresentationsGastrointestinal (inc TD) 25 (30%)

Ear, Nose & Throat 21 (26%)

Skin 17 (21%)

Heat illness 5 (6%)

Eyes 5 (6%)

Respiratory 3 (3.7%)

Central Nervous System 3 (3.7%)

Nail 2 (2.4%)

Mouth 1 (1.2%)

Total 82 (100%)

Type (Injury) No. New Presentations

Skin Trauma 4 (22%)

Joint Inflammation 3 (1.7%)

Sprain 3 (1.7%)

Spinal Dysfunction 2 (1.1%)

Soft Tissue Inflammation 2 (1.1%)

Bruising 1 (0.6%)

Periostitis 1 (0.6%)

Bursitis 1 (0.6%)

Tendinopathy 1 (0.6%)

Total 18 (100%)

1. All receive written & verbal advice re prevention2. All issued with & use alcohol hand gel3. No athlete required to withdraw from competition4. No official absent from duties for >24hrs5. ≤5% of cases presenting within 24hrs of a case in the

same room6. ≤5% of cases presenting within 24hrs of a case in the

same sport7. ≥95% cases managed according to protocol

Audit Standards

Prevention & Management Guide

Prevention Management

• Written & verbal advice• Staff offered antibiotic

prophylaxis• Isolation

• Simple:– immodium/codeine

– fluid replacement• Significant:

– antibiotics

– isolation

– stool cultures

Prevention Traveller’s Diarrhoea

Hill & Ryan, BMJ, Oct 2008

Published 6 October 2008

i.e. 24 cases of TD

TD – How Did We Do?

Rates Of TD In Sub Groups

The Plan! - Management

• Non-significant TD– Symptomatic relief (if

required)– Hygiene advice

• Significant TD– Isolation– Stool culture– Abx– Symptomatic relief

Did It Work…?

No athlete missed their competition

No official was out of action for

more than 12hrs

• More cases as the event went on• 10/24 cases occurred in last 48hrs!

– Eating off menu– Eating out of the village

• 2/24 cases occurred within 24hrs of someone else in the same room

• 10/24 cases occurred within 24hrs of another member of the same sporting team

• 2/24 cases treated in full accordance with protocol

Other Points To Note…

The Plague!

Psychology & Boxers

• Fumagation:– Heavy fumagation in communal areas– Light fumagation in bedrooms

• ‘Psychology’– Boxers room given

‘heavy’ fumagation &

moved into isolation room

for 24hrs

We can take Team England into a challengingenvironment a not have a single athletes miss

their event because of TD!Plus…• Advise not to eat off menu/outside of village• Ability to isolate• Consider rifampicin for athlete prophylaxis• Consider probiotics

Setting standards for the prevention & management of TD in elite sporting teams

Tillett & LoosemoreBr J Sports Med 2009;43:1045-1048

Lessons For Dehli 2010

Other Things Medical

• They had a polyclinic – very helpful

• They had ambulances but…• They had stretchers but…• They had doctors but…(not pre hosp/sem

specialists)

All Worth It!