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

1. Medical Issues At The Commonwealth Games:Lessons From The Youth Games Dr Eleanor Tillett Honorary Consultant in Sport & Exercise Medicine University College London Hospital 21.7.2010

2. Overview Setting the scene Medical issues Traveller’s diarrhoea Other issues Lessons for Dehli 2010

3. First Impressions!

4. The Plan! – Prevention of TD

5. Summary Of Medical Contacts • Total No. Contacts: 166 (122 team members) • New: 98Follow Up: 68 • Diarhhoea was the commonest reason to present • New presentations including symptoms of diarrhoea: 25/98 (26%)

8. Audit Standards All receive written & verbal advice re prevention All issued with & use alcohol hand gel No athlete required to withdraw from competition No official absent from duties for >24hrs ≤5% of cases presenting within 24hrs of a case in the same room ≤5% of cases presenting within 24hrs of a case in the same sport ≥95% cases managed according to protocol

9. 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

10. TD – How Did We Do? i.e. 24 cases of TD

11. Rates Of TD In Sub Groups

12. The Plan! - Management Non-significant TD Symptomatic relief (if required) Hygiene advice Significant TD Isolation Stool culture Abx Symptomatic relief

13. Did It Work…? No athlete missed their competition No official was out of action for more than 12hrs

14. Other Points To Note… • 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

15. The Plague!

16. Psychology & Boxers • Fumagation: • Heavy fumagation in communal areas • Light fumagation in bedrooms • ‘Psychology’ • Boxers room given ‘heavy’ fumagation & moved into isolation room for 24hrs

17. Lessons For Dehli 2010 We can take Team England into a challenging environment 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 & Loosemore Br J Sports Med 2009;43:1045-1048

18. 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)

19. All Worth It!