THE PHYSICIAN AND SPORTSMEDICINE - VOL 30 - NO. 2 - FEBRUARY 2002

Olympic Medical Plan Incorporates Business and Technology Updates

Request Raises Complex Issues

For those who track how each Olympic host city handles the world's biggest sports medicine event, the 2002 Winter Olympics in Salt Lake City offers some ambitious new developments.

For the first time in Olympic history, an organizing committee has contracted with a large healthcare network to provide medical care. Another first is a computerized infectious disease surveillance system that will use real-time data to quickly identify illness outbreaks.

A New Provider Model

The decision by the Salt Lake City Organizing Committee (SLOC) upon winning its bid to award Intermountain Health Care (IHC) a contract to provide medical care at the Olympics and the Paralympics (held at the same sites in March) offers several important benefits, says Ginny Borncamp, an executive with IHC who is director of medical services for the SLOC. "We're already well acquainted with suppliers, primary care, and sports medicine, and there's a huge benefit for volunteer recruitment, screening, and selection," she says.

The response to medical volunteer recruiting efforts was vigorous, attracting 13,000 applicants for 1,500 positions at the Olympics and 300 at the Paralympics. The response allowed screeners to be selective in the skill sets of the physicians, nurses, and emergency medical technicians, which is appropriate for the primary care needs of the event as a whole. "In addition to sports medicine injuries, we'll be seeing a lot of upper respiratory infections, GI complaints, and minor injuries," she says.

There will be about 35 clinics, two for each venue: one to handle only athlete and field officials and one for spectators, staff, and media. IHC, a regional nonprofit healthcare organization, has designated 5 of the hospitals in its system as Olympics hospitals. IHC contracted with the University of Utah to operate the polyclinic for athletes at the Olympic Village, located on the residential campus of its school in Salt Lake City.

Roving medical teams, identifiable by their red uniforms, will monitor the crowd. IHC's air ambulance fleet, including five high-altitude helicopters, has been assigned to cover the venues and surrounding areas.

One concern is altitude sickness. Borncamp notes that two venues—the cross-country ski area and the long-track speed skating oval—are located at the highest altitude in Winter Olympics history. The pool of 270 physician volunteers includes many who have expertise in treating altitude sickness.

Tracking Disease Outbreak

An improved system for tracking infectious diseases will help the medical team identify if, for example, an influenza outbreak is exceptional or normal, says Borncamp. Without such a system, medical officials at the 1998 Winter Olympics in Nagano, Japan, had a hard time determining the appropriate response to a flu outbreak among athletes, she says.

The Salt Lake City area was able to institute the state-of-the-art tracking system thanks to a grant it received from the US Department of Health and Human Services. The system records sets of symptoms that surface among patients at emergency departments, clinics, and labs. Patterns identified on analysis of real-time data will be relayed to the medical team across the state via cell phones, pagers, and the Internet. "If prevention doesn't work 100%, this allows healthcare providers to initiate a quick response," Borncamp says.

Terrorism Plans

The surveillance system will be useful in identifying any chemical attack or bioterrorism-related illness such as anthrax or smallpox, though development was in place well before the September 11 terrorist attacks. Borncamp says the attacks prompted the SLOC to incorporate extra training for medical volunteers about identifying and treating bioterrorism-related infections.

During the initial part of medical planning, the Utah Department of Health (UDH) had requested that the Centers for Disease Control and Prevention (CDC) position a National Pharmaceutical Stockpile at a site near the Olympics. However, Borncamp said that after the September 11 attacks, the UDH quantified then resubmitted its request to the CDC, and it was confirmed.

Because of the high-profile nature of the Olympic Games, response to mass casualties is a routine part of any medical plan. Hence, the terrorist attacks did not prompt the SLOC to make major changes to its medical plan, Borncamp says. Security plans in place before September 11 also accounted for the possibility of a terrorist attack, and the SLOC's plan did not require a major security overhaul. (See "Sports Venues Get Security Upgrades")

Lisa Schnirring

Field Notes

What's New in Olympic Drug Testing?
The Olympic Analytical Laboratory at the University of California, Los Angeles (UCLA) will make its temporary home in Salt Lake City during the 2002 Winter Olympic Games. Ginny Borncamp, medical services director for the Salt Lake Organizing Committee, says the UCLA lab made history when it received International Organization for Standardization (ISO) certification. "That's the first time ever for a temporary lab," she says. "They had zero discrepancies." The UCLA lab is the only drug testing facility in the US that is accredited by the International Olympic Committee.

About 350 volunteers have been recruited to assist drug testing efforts, Borncamp says. Most athletes will have been tested before arriving in Salt Lake City. During the games, the first three finishers in each event along with one randomly chosen athlete must be tested upon completion of their event. All athletes in endurance sports will be tested for erythropoietin (EPO) use. Currently, athletes undergo a two-step blood then urine test. According to a press release from the World Anti-Doping Agency (WADA), a simplified test to detect EPO is under development and is designed to enable the agency to perform out-of-competition testing for the substance.

In June 2001, the IOC and WADA released a new list of prohibited substances and methods that are in effect for the 2002 Winter Games. The new list:

• Defines blood doping as a prohibited method,
• Requires athletes who have sought authorization to use beta 2 agonists to submit clinical proof that they need the medications (see "IOC Asks Athletes for Asthma Proof: Request Raises Complex Issues"),
• Permits the use of formoterol and salmeterol as long as prenotification and clinical proof is given,
• Allows sports federations to require athletes to seek preauthorization for local or intra-articular glucocorticosteroid injections, and
• Expands the banned drug example list to include bupropion, a stimulant, and aromatase inhibitors, hormonal agents.

IOC Awards Sports Science Honor to Saltin
The International Olympic Committee (IOC) Medical Commission in December announced that its 2002 IOC Olympic Prize in Sport Sciences will go to Bengt Saltin, MD, who is known for his groundbreaking research on the role of physical activity in disease prevention and recovery. Saltin, director of the Copenhagen Muscle Research Centre at the University of Copenhagen, will receive his monetary prize (offered by Pfizer, Inc), a diploma, and an Olympic medal during the 2002 Olympic Winter Games in Salt Lake City.

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