Interassociation consensus recommendations for pitch-side emergency care and personal protective equipment for elite sport during the COVID-19 pandemic

Abstract

The COVID-19 pandemic has necessitated many novel responses in healthcare including sport and exercise medicine. The cessation of elite sport almost globally has had significant economic implications and resulted in pressure to resume sport in very controlled conditions. This includes protecting pitch-side medical staff and players from infection. The ongoing prevalence of SARS-CoV-2 and the desire to resume professional sport required urgent best practice guidelines to be developed so that sport could be resumed as safely as possible. This set of best practice recommendations assembles early evidence for managing SARS-CoV-2 and integrates expert opinion to provide a uniform and pragmatic approach to enhance on-field and pitch-side safety for the clinician and player. The nature of SARS-CoV-2 transmission creates new hazards during resuscitation and emergency care and procedures. Recommendations for the use and type of personal protective equipment during on-field or pitch-side emergency medical care is provided based on the clinical scenario and projected risk of viral transmission.

Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020

“… 21 Medical personnel stationed at the heat deck are advised to follow the recommended local infection control measures, such as donning personal protective equipment (eg, sleeves, apron, gloves and a medical grade face mask) and social distancing of medical personnel who are not assigned to treat EHS athletes. 22 Currently, bathing water has not been reported as a SARS-CoV-2 transmission medium 23 ; however, instruments (eg, cold water immersion tub and pole-less mesh stretcher) used during the EHS treatment procedure are not exempt from the risk of contamination. Therefore, where there is a known risk of coronavirus infection, local protocols must be followed and a more vigorous cleaning of these non-consumable items of equipment may be required.…”

End-to-end SARS-CoV-2 transmission risks in sport: Current evidence and practical recommendations

“…Reducing the duration and frequency of interactions can be effective, as clinical environments tend to be specialised and not easily relocated to optimise environmental conditions. National healthcare guidance on personal protective equipment (PPE) has been interpreted for the sporting setting, taking into account the sport-specific nature, including delivery of pitch-side medical care (Table 1), [84,85] with the recommendation that athlete patients also wear a face covering for the duration of review. [82] Safe and effective use of PPE is founded on good training to ensure it is worn correctly and the risk of self-contamination is minimised during application and removal (donning and doffing).…”

“…[8] Consequently, these situations require a higher level of mitigation, through increasing the standard of PPE, and also the need for a dedicated area to limit the exposure to bystanders, which must be subject to appropriate decontamination after use. [84] Establishing a sport-specific injury risk profile can help provide COVID-19 safe updates to emergency action plans and thus ensure adequate equipment is available to account for PPE availability and sanitisation protocols for equipment between uses. Emergency care poses the greatest challenge, due to the need for a rapid response and propensity for these scenarios to involve aerosol-generating procedures.…”

“…Depending on resource availability and staff familiarity with donning and doffing, organisations may wish to have staff already prepared in Level 3 PPE for high-risk settings in order to prevent any unnecessary delay in delivering prompt emergency care. [84,85] In circumstances where only Level 2 PPE is available, or there is a delay in donning Level 3 PPE, airway interventions beyond simple manoeuvres are not recommended. In cardiopulmonary resuscitation (CPR), chest compressions can be commenced in addition to the use of an automated external defibrillator, provided that a face covering is applied to the casualty which does not impede airflow (i.e.…”

“…[7,88] These factors determine the risk of infectious respiratory aerosol and droplet particles transferred from Table 1. Recommended Personal Protective Equipment (PPE) guidance for specific clinical situations that may be encountered in the sporting environment [84,85] Medical human-to-human. Outdoor team sports, which include a large number of prolonged close interactions, or encounters between athletes outdoors (e.g.…”