Information Statement

Sideline Preparedness for the Team Physician: Consensus Statement

This Information Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

American Academy of Family Physicians; American Academy of Orthopaedic Surgeons; American College of Sports Medicine; American Medical Society for Sports Medicine; American Orthopaedic Society for Sports Medicine; and American Osteopathic Academy of Sports Medicine.

The objective of the Sideline Preparedness for the Team Physician Consensus Statement is to provide physicians, school administrators, team owners, the general public, and individuals who are responsible for making decisions regarding the medical care of athletes and teams with guidelines for identifying and planning for medical services to promote the safety of the athlete, to limit injury, and to provide medical care at the site of practice or competition.

Six major sports medicine organizations were asked to select two representatives to serve on an expert panel. The organizations were the American Academy of Family Physicians (AAFP), the American Academy of Orthopaedic Surgeons^® (AAOS), the American College of Sports Medicine (ACSM), the American Medical Society for Sports Medicine (AMSSM), the American Orthopaedic Society for Sports Medicine (AOSSM) and the American Osteopathic Academy of Sports Medicine (AOASM).

This Consensus Statement was adopted by the AAOS Board of Directors in September 2000 and retained in December 2007.

I. Definition

Sideline preparedness is the identification of and planning for medical services to promote the safety of the athlete, to limit injury, and to provide medical care at the site of practice or competition.

II. Goal

The safety and on-site medical care of the athlete is the goal of sideline preparedness.

To accomplish this goal, the team physician should be actively involved in developing an integrated medical system that includes:

• Pre-season planning
• Game-day planning
• Post-season evaluation

III. Pre-Season Planning

Pre-season planning promotes safety and minimizes problems associated with athletic participation at the site of practice or competition.

The team physician should coordinate:

• Development of policy to address pre-season planning and the pre-participation evaluation of athletes
• Participation of the administration and other key personnel in medical issues
• Implementation strategies

Medical Protocol Development

It is essential that:

• Prospective athletes complete a pre-participation evaluation

In addition, it is desirable that:

• The pre-participation evaluation be performed by an MD or DO in good standing with an unrestricted license to practice medicine

• A comprehensive pre-participation evaluation form be used (e.g., the form found in the current edition of Preparticipation Physician Evaluation^©)¹

• The team physician has access to all pre-participation evaluation forms

• The team physician review all pre-participation evaluation forms and determine eligibility of the athlete to participate

• Timely pre-participation evaluations be performed to permit the identification and treatment of injuries and medical conditions

Administrative Protocol Development

It is essential for the team physician to coordinate:

• Development of a chain of command that establishes and defines the responsibilities of all parties involved
• Establishment of an emergency response plan for practice and competition
• Compliance with Occupational Safety and Health Administration (OSHA) standards relevant to the medical care of the athlete
• Establishment of a policy to assess environmental concerns and playing conditions for modification or suspension of practice or competition
• Compliance with all local, state and Federal regulations storing and dispensing pharmaceuticals
• Establishment of a plan to provide for proper documentation and medical record keeping

In addition, it is desirable for the team physician to coordinate:

• Regular rehearsal of the emergency response plan
• Establishment of a network with other health care providers, including medical specialists, athletic trainers and allied health professionals
• Establishment of a policy that includes the team physician in the dissemination of any information regarding the athlete’s health
• Preparation of a letter of understanding between the team physician and the administration that defines the obligations and responsibilities of the team physician

IV. Game Day Planning

Game-day planning optimizes medical care for injured or ill athletes.

The team physician should coordinate:

• Game-day medical operations
• Game-day administrative medical policies
• Preparation of the sideline “medical bag” and sideline medical supplies

Medical Protocol

It is essential for the team physician to coordinate:

• Determination of final clearance status of injured or ill athletes on game-day prior to competition
• Assessment and management of game-day injuries and medical problems
• Determination of athletes’ same-game return to participation after injury or illness
• Follow-up care and instructions for athletes who require treatment during or after competition
• Notifying the appropriate parties about an athlete’s injury or illness
• Close observation of the game by the medical team from an appropriate location
• Provision for proper documentation and medical record keeping

In addition, is it desirable for the team physician to coordinate:

• Monitoring of equipment safety and fit
• Monitoring of post-game referral care of injured or ill athletes

Administrative Protocol

It is essential for the team physician to coordinate:

• Assessment of environmental concerns and playing conditions
• Presence of medical personnel at the competition site with sufficient time for all pre-game preparations
• Planning with the medical staff of the opposing team for medical care of the athletes
• Introductions of the medical team to game officials
• Review of the emergency medical response plan
• Checking and confirmation of communication equipment
• Identification of examination and treatment sites

In addition, it is desirable for the team physician to coordinate:

• Arrangements for the medical staff to have convenient access to the competition site
• A post-game review and make necessary modifications of medical and administrative protocols

On-Site Medical Supplies

The team physician should have a game-day sideline “medical bag” and sideline medical supplies. The following is a list of “medical bag” items and medical supplies for contact/collision and high-risk sports:

It is highly desirable for the “medical bag” to include:

General		Cardiopulmonary
•	Alcohol swabs and povidone iodine swabs	•	Airway
•	Bandage scissors	•	Blood pressure cuff
•	Bandages, sterile/non-sterile, band-aids	•	Cricothyrotomy kit
•	D-50%-W	•	Epinephrine 1:1000 in a pre-packaged unit
•	Disinfectant	•	Mouth-to-mouth mask
•	Gloves, sterile/non-sterile	•	Short-acting beta agonist inhaler
•	Large bore angiocath for tension pneumothorax (14-16 gauge)	•	Stethoscope
		Head and Neck/Neurologic
•	Local anesthetic/syringes/needles	•	Dental kit (e.g., cyanoacrylate, Hank’s Solution)
•	Paper
•	Pen	•	Eye kit (e.g., blue light, fluorescein stain strips, eye patch pads, cotton tip applicators, ocular anesthetic and antibiotics, contact remover, mirror)
•	Sharps box and red bag
•	Suture set/steri-strips
•	Wound irrigation materials (e.g., sterile Normal saline, 10-50 cc syringe)	•	Flashlight
		•	Pin or other sharp object for sensory testing
		•	Reflex hammer

It is highly desirable for sideline medical supplies to include:

General		Head and Neck/Neurologic
•	Access to telephone	•	Face mask removal tool (for sports with helmets)
•	Extremity splints
•	Ice	•	Semi-rigid cervical collar
•	Oral fluid replacement	•	Spine board and attachments
•	Plastic bags
•	Slings

In addition, it is desirable for the “medical bag” to include:

General		•	Scalpel
•	Benzoin	•	Skin lubricant
•	Blister care materials	•	Skin staple applicator
•	Contact lens case and solution	•	Small mirror
•	30% Ferric subsulfate solution (e.g., Monsel’s – for cauterizing abrasions and cuts)	•	Supplemental oral and parenteral medications
		•	Tongue depressors
•	Injury and illness care instruction sheets for the patient	•	Topical antibiotics
		Cardiopulmonary
•	List of emergency phone numbers	•	Advanced Cardiac Life Support (ACLS) drugs and equipment
•	Nail clippers
•	Nasal packing material	•	I.V. fluids and administration set
•	Oto-ophthalmoscope	•	Tourniquet
•	Paper bags for treatment of hyperventilation
•	Prescription pad
•	Razor and shaving cream
•	Rectal thermometer

In addition, it is desirable for sideline medical supplies to include:

General		Cardiopulmonary
•	Blanket	•	Automated external defibrillator
•	Crutches	Head and Neck/Neurologic
•	Mouth guards	•	A sideline concussion assessment protocol
•	Sling psychrometer and temperature/humidity activity risk chart
•	Tape cutter

There are many different sports, levels of competition, and available medical resources that must all be considered when determining the on-site medical bag and sideline medical supplies.

V. Post-Season Evaluation

Post-season evaluation of sideline coverage optimizes the medical care of injured or ill athletes and promotes continued improvement of medical services for future seasons.

The team physician should coordinate:

• Summarization of injuries and illnesses that occurred during the season
• The improvement of the medical and administrative protocols
• Implementation strategies to improve sideline preparedness

Medical Protocol

It is essential for the team physician to coordinate:

• A post-season meeting with appropriate team personnel and administration to review the previous season
• Identification of athletes who require post-season care of injury or illness and encourage follow-up

In addition, it is desirable for the team physician to coordinate:

• Monitoring of the health status of the injured or ill athlete
• Post-season physicals
• An off-season conditioning program

Administrative Protocol

It is essential for the team physician to coordinate:

• Review and modification of current medical and administrative protocols.

In addition, it is desirable for the team physician to coordinate:

• Compilation of injury or illness data

VI. Conclusion

This Consensus Statement outlines the essential and desirable components of sideline preparedness for the team physician to promote the safety of the athlete, to limit injury, and to provide medical care at the site of practice or competition

Expert Panel:

Stanley A. Herring, MD, Chair, Seattle, Washington

John A. Bergfeld, MD, Cleveland, Ohio

Joel Boyd, MD, Edina, Minnesota

Per Gunnar Brolinson, DO, Toledo, Ohio

Timothy Duffey, DO, Columbus, Ohio

David Glover, MD, Warrensburg, Missouri

William A. Grana, MD, Oklahoma City, Oklahoma

Brian C. Halpern, MD, Marlboro, New Jersey

Peter Indelicato, MD, Gainesville, Florida

W. Ben Kibler, MD, Lexington, Kentucky

E. Lee Rice, DO, San Diego, California

William O. Roberts, MD, White Bear Lake, Minnesota

Reference:

1. Preparticipation Physician Evaluation, 2nd edition. McGraw Hill Publishing. 1997

Physicians and others are encouraged to reproduce this Advisory Statement for widespread distribution. Permission to reprint the Advisory Statement is hereby granted by AAFP, AAOS, ACSM, AMSSM, AOSSM, and AOASM, provided that the Advisory Statement is reprinted in its entirety including citations and that such reprints contain a notice stating:

“© 2000 American Academy of Family Physicians, American Academy of Orthopaedic Surgeons^®, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society of Sports Medicine, and American Osteopathic Academy of Sports Medicine. Reprinted with permission.” If you wish to use the Advisory Statement in any other fashion, written permission must be obtained from the AAFP, AAOS, ACSM, AMSSM, AOSSM, and AOASM.

This guideline for identification and planning for medical services should not be construed as including all proper methods of care and planning or excluding other acceptable methods of care and planning reasonably directed to obtain the same result. The ultimate judgment regarding specific measures to be taken by a physician or the sidelines of an athletic event must be made in light of all circumstances which might occur and the needs and resources particular to the locality or institution.

© September 2000 American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society of Sports Medicine, and American Osteopathic Academy of Sports Medicine. Retained December 2007.

Information Statement 1022

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