Section 5. Comprehensive player management
Travelling with a team258
Patient confidentiality263
Drugs in sport266
Hot climates270
Cold climates271
Hydration272
Travelling with a team
International events and major games can be the pinnacle of a physiotherapist’s career with a team and can be a very rewarding experience. They can also provide nightmares that can easily be avoided by following some simple do’s and don’ts. This list is by no means exhaustive but will give you some ideas of what to look for if you are facing your first big trip. Of course it depends on what other personnel you have around you; you might be travelling as part of a large squad with a big medical team, in which case you will have plenty of support. More often than not you will be the only “medical” person with little to call on in the event of an emergency.
Preparation
The basic premise when travelling with a team is to be completely self-sufficient. You then won’t fall short unless there is an emergency and you should plan contingency for these. Preparation is the key to success.
Find out as much as you can well before you are due to set off. If you are not involved in a recce prior to the event, give a list questions about the facilities and equipment available at the hotel, training and competition venues to someone who is.
• Transport available
• Food: sample menus/portions/timing
• Hydration: water/isotonic drinks
• Ice
• Treatment plinths (adjustable or fixed)
• Dedicated space to set up own medical/treatment area
• Emergency back-up
• Specialist referral ± diagnostics, e.g. blood tests and imaging
(See also Section 1: Know your location.)
What to take with you?
Take everything you anticipate needing. Even if you are visiting a country with access to good medical supplies, you will not have time to go out sourcing and shopping for these. Competition is an intense time and your focus should be on the athletes. Make sure any electrical equipment has had the appropriate checks, that you have extension leads and the right adaptors for the country in which you are competing.
Check whether any vaccinations or anti-malarial medications are required, together with any certification necessary.
Make sure you have a current passport with at least 6
months until its expiry date and check whether a visa is required – there is nothing more embarrassing than arriving at the airport to find it has expired. The Foreign and Commonwealth Office web site is a useful source of information for health and travel regulations worldwide when travelling from the UK (www.fco.gov.uk/en).
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You will possibly be travelling with athletes you are familiar with and whose medical and musculoskeletal history is known to you. But you could also be covering a team you don’t know or are relatively unfamiliar with. In the latter scenario it is very useful to try and gain as much knowledge about the athletes beforehand and for them to meet you as well. Get in touch with their regular clinician (if they have one) to find more information. Try and attend some training sessions prior to departing and / or shadow the regular clinician. I have never travelled with a squad of athletes that have been completely injury-free; it is therefore useful to know the problems you are going to have to deal with.
If possible, get to meet the rest of the team beforehand as well; this includes the team manager, coaching and any other medical and support staff. It is important that you and everyone else are clear as to exactly what your role is during your time with the squad. Likewise it is essential that you understand the role of all other members of the team. Don’t forget, you may be asked to help with any injuries of the non-athletes in your team – be prepared for this. See also Section 1: Know your team.
Travelling
Dealing with jet lag and time zones
It is recommended that the athletes start to prepare roughly a week beforehand (for large time differences) and gradually changes their sleep patterns to adjust to the country where they are going. Melatonin and sleeping tablets go in and out of fashion but are best avoided unless an athlete is used to taking them. On arrival, try and get everyone into the local time as soon as possible. Remember that the effects of jet lag are worse travelling east compared to west. After a long haul flight, do not allow the athletes to train too hard for the first few days.
A general rule of thumb is to allow one day’s recovery for each time zone change.
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Be prepared for travel delays with food and medication. Ensure athletes have a warm jumper / fleece in their hand luggage. Planes can often be quite cold.
During the event
See Section 1 for details to check at local venues. It is worth investigating referrals to local specialists if required. There is normally a medical contact or liaison officer for the local organizing committee who can answer any queries.
Clinic set-up
Ideally, there should be a dedicated room in the accommodation to set up a clinic. However, many times when space is at a premium or it is too costly to do this, your bedroom doubles as a clinic space – this is not ideal, but it does happen and you have to be flexible in these situations and provide a professional service regardless of the scenarios you may be faced with. Do you take your own treatment tables? Yes, if you can. I have been to tournaments where provision of a treatment table was promised, only to find there were not enough for the number of clinicians and athletes. I would recommend a minimum of one portable plinth per clinician. There is a wide variety available on the market and my personal preference is a light plinth, with a lifting end (so the player can sit up) and adjustable height.
Hours of work and access
Be clear about your hours of work and where and how the athletes can access you. A timetable outside the treatment room of available appointment slots that the athletes can sign up for normally works well. A mobile contact number should also be on the door so the players can contact you when you are not there. If you are working with a team, access to you is straightforward – you follow the team. If it is an individual sport, e.g. swimming or athletics, depending on how many clinicians there are you will allocate your time accordingly between the hotel and competition venue to suit the warm-up and race times of the athletes. Arrange your schedule so you can accommodate all the athletes as necessary but also give yourself some downtime as well. You don’t want to burn out halfway through a competition because you have been doing 16 hour days. How late is it reasonable to work? This will vary depending on the competition schedule and you have to be flexible to accommodate this. Don’t forget to allocate time to non-treatment activities such as paperwork, liaising with other medical staff, attending meetings, etc.
Illness
Athletes are in continual close proximity, often sharing accommodation, and any cold can quickly travel round an entire squad. Additionally, travel in certain countries carries a higher risk of gastrointestinal problems and travellers’ diarrhoea.
Any of these illnesses can have a devastating effect on a squad. The key here is prevention.
• Wash your hands regularly with alcohol gel especially before eating
• Only drink bottled water
• Never add ice to any drinks
• Drink from straws that are wrapped rather than directly from a bottle or can.
• Avoid salads, raw fruit and vegetables
It is essential to discuss these tips with the athletes, especially the importance of hand washing. I always travel with a packet of “wet wipes” as well as the hand gel, as in some places access to good hand washing facilities may be difficult.
Immediate isolation and management of any affected team or team member is essential to avoid cross infection.
Communication
You need to establish an effective communication system, especially if you are working at an event where there are multiple sites. This may be by walkie-talkie or mobile, but make sure you have the contact numbers of all the team.
Documentation
It is a real challenge working at any venue as opposed to a clinic based situation. Section 1 includes an easy form that can be used in a first aid situation; however, there should be a standard format whereby any intervention / consultation is recorded. This is a statutory requirement, for your and the athlete’s protection. Continuity of care for athletes who spend a lot of time travelling from one training camp / competition to another, often with different support teams, is a challenge. It is often difficult for the medical team to monitor and assess the athlete’s progress. Paper report systems have largely been superseded by injury databases such as Injury Zone, a web-based database through which clinicians can access an athlete’s information anytime and anywhere.
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