1. Caring for the Olympic Athlete Kristine Karlson MD DHMC 1992 Olympian US Rowing Team Physician 1997- Olympic Team Physician 2008

2. Who am I (and why am I talking about this)? Not an athlete in high school Tried some new things in college Worked out pretty well…

3. My Career Spread medical school to 5 years Intern year in family medicine split into 2 years 3 world championship gold medals 5 th in 1992 Olympics Retired from rowing, finished residency But Olympics called again

4. Tried out for 1996 Olympics, 2 nd (earns trip home) Sports medicine fellowship Started at DHMC in 1997

5. Current practice: Half family medicine, primary care ages birth to 94 Half non-operative orthopedics Dartmouth College training room clinic Travel with US rowing team

6. Elite Athlete Care

7. Elite Athlete Issues Drug testing and drug/supplement use Public health concerns Acute illness and infectious disease Accidents/injuries

8. Travelling with Athletes Positives Part of elite group Watch events up close as insider Meet interesting people Interesting locations “Free” vacation USA gear Improvising care

9. Travelling with Athletes Negatives On call 24/7 Demands for inappropriate care Hard decisions Boring “Interesting” locations Improvising care Vacation time used up Babysitting adults

10. The Medical Kit Antibiotics NSAIDs Wound care Ortho ENT/eye/GI Gyn Misc.

11. Drug Testing Issues WADA Prohibited list Therapeutic use exemptions http://www.wada-ama.org/en/ As much as possible done before leaving the US Asthma testing if needed NO supplements!

12. Doping Control

13. Public Health Officer Food Anderson Br. J. Sports Med. 1996;30;347- 348 – Salmonella at 1996 Junior Worlds Water Safety Bikes Walking

14. Unusual Care in Unusual Locations “Now” care – gyn exam at 11 PM, earache overnight Pressure to use antibiotics for URI Lower threshold to use antibiotics Close followup Care of team staff and family members

15. Improvising/ “Other Duties”

16. Boring/ Down Time

17. Babysitting Adults Pre-event safety Post competition party

18. Seeing other Cultures

19. Beijing 2008 Staff 32 athletic trainers 16 physicians (some ortho, some not) 1 chiropractor 1 massage therapist

20. Beijing 2008 Staff Each sport assigned ATC Some sports shared ATC, many shared physician Usually ATC and physician known to the sport and athletes, not always

21. How did we get there? USOC volunteer medical program Emphasis on staff who have worked with elite sports Selected/ sanctioned by NGB 2 weeks volunteer at training center “Minor” trip(s) International games such as Pan Am’s

22. USOC Medical Volunteers http://www.teamusa.org/medical/volunt eers http://www.teamusa.org/medical/volunt eers 5 years experience, 2 years with team Preferred to have worked with NGB US citizen, malpractice insurance, no criminal background, letters of reference, etc

23. USOC Medical Staffing Training centers Resident athletes Camps Staff at training centers ATC’s Fellows Local MD’s Volunteers

24. USOC Training Centers Colorado Springs Largest and “home” for USOC Chula Vista CA Field sports, rowing, canoe/kayak Lake Placid NY Winter sports

25. Beijing 2008 Anticipated issues Heat Pollution GI illness

26. Beijing 2008 Village medical clinic USA medical clinic Always staffed (one ATC always slept there, MD on call) First contact with ATC ATC may involve MD BNU Training Center USOC staff, training partners, spares

27. Beijing 2008 Medical clinic Lots of rub downs Some rehab for athletes with injuries who were still able to compete Wound and illness care Heat, ice, modalities

28. Beijing 2008 At the Venues Depended on set-up Team room vs sidelines ATC always present, physician during competition and maybe during training

29. Beijing 2008 Emergency services Staff responsible for knowing plan If transported, go with athlete

30. Beijing 2008 Cases seen Buttock blister URI Mild diarrhea Fever Asthma Tooth pain/ vaginal yeast infection Diverticulitis Knee effusion Foreign body foot Shin abrasion Allergic reaction Post race collapse

31. Beijing 2008 Worst case for Team USA was wrestler hospitalized for kidney failure after dehydrating to make weight Stress fracture Plantar fascia rupture