What's in a Sport Medicine Doctor’s Bag?
Sports medicine physicians have to be ready for anything whether they are covering a game, a mass participation event such as a marathon, or multi-sport events. They may even be providing EMS-like coverage for attendees of a game or concert. The level of competition may be youth leagues, community leagues, or recreational all the way up to professional. Preparation means having certain equipment, medications, and devices immediately available and ready access to EMS services and transportation to the hospital when required. In reviewing what a sports medicine physician (or any sideline physician) should have available, we will try to distinguish between what should be immediately available in their bag next to them and what needs to be readily available within a short walk or drive. Dr. Philda De Jager published an excellent review in Continuing Medical Education (2004) which we are going to try to summarize as well as supplement and update where appropriate.
The physician must consider the type of sport covered. Covering a marathon, where most pathology involves dehydration, heat related illness, or electrolyte abnormalities requires different preparation and consideration than covering a football game which generally consists of orthopedic injuries and concussions. Each sport has its own pattern of injuries and the astute provider will need to consider that as they build their tool kit for the specific sport or event.
The age of participants will determine certain anticipated injury patterns. For example, when covering youth soccer, you might expect more asthma attacks than an adult men’s soccer league. Conversely, adult athletes are more likely to suffer from serious exertional events such as acute coronary syndrome and exacerbation of other chronic medical conditions.
The provider will need to consider the location and infrastructure of the region where the event will be held. Is this a rural trail running marathon where road access is limited? Is it an urban event where traffic may be prohibitive for timely EMS transit? In international competition, what resources does the hosting country have available for your athletes? What is the treatment and evacuation plan of an injured athlete? Sports medicine physicians may have to alter or change what they carry based on the location and infrastructure available to them for the event.
Medical Bag. There is likely no “best” medical bag. Important considerations are organizational capacity, weight when fully stocked, and ease of carrying or transporting. Small, cushioned compartments to protect medical vials and see through compartments to find things quickly are helpful. Each compartment or container should be labeled or its contents should be quickly identifiable. One suggestion includes creating “kits” such as ones for medications or procedural supplies and further identifying by injury type such as to the eye, ear, skin, dentition, etc for quick and easy access. The bag should have a lock to prevent unsolicited access or removal of supplies without your knowledge. Shoulder straps or wheels and handle (similar to airplane luggage) may be helpful. Providers may consider wearing a smaller personal bag during the event such as a “fanny pack” for quick access to specific equipment or meds (and they will be awarded no style points for this decision).
Contents of the bag. The contents of the medical bag can be broken down into equipment, medications, and other non-medical items. These will be reviewed individually.
Medications. A sports medicine physician does not need to carry an entire pharmacy with them during travel or on the sideline, but they should know where these medications are readily available. In most cases, EMS will have the majority of the resuscitation drugs available to them. Your athletic trainer(s) will generally have some of the more common drugs athletes need or want. Keep in mind in international travel the provider may have to declare and secure certain medications (most likely opiates) based on the rules of the country.
Plan and prepare for your athletes with specific medical conditions. The sports medicine team physician must be aware of the medical needs of their athletes. They may have common conditions such as asthma or diabetes, actively treating a skin injury, or rehabilitating an orthopedic injury. Younger athletes may have more rare diseases such as cystic fibrosis or a developmental abnormality requiring unique medications or treatment. Older athletes may have chronic diseases, diagnosed or undiagnosed, that require closer monitoring and management.
Non-Medical Equipment. A pen and paper, a light source, and a cell phone should be readily available. There should be a list of both local emergency contacts as well as those for individual athletes and staff. You may need a prescription pad and documents of medical licensure. You should have a plan in place for concussion assessment and proper documenting material. Material for documentation should be readily available, this may be paper or digital depending on available resources.
Readily available reading material. The provider should have ready access to specific information appropriate to their sport, including world anti-doping agency (WADA) list of banned substances. They should have access to books, websites or apps that cover management of common medical emergencies.
Coordinating with your Athletic Trainer, Emergency Medical Services. Many of these medications and equipment need to be available to the sports medicine physician. They do not necessarily need to be packed and carried by the physician. Your athletic trainer will generally carry many of the common sideline medications and equipment required for the athletes. The EMS team, if available, will have most of the resuscitation equipment and medications. The job of the sports medicine physician is to know where these resources are and how to readily access them. In order to avoid redundancy and unnecessary burden, this can often be accomplished by coordinating with athletic training staff and emergency medical services.
Emergency Action Plan. All physicians should be familiar with (and/or create if one doesn’t exist) an emergency action plan for the event they are covering. This includes coordination with EMS and the host facility for both the athletes and the fans in attendance.