Caring for the Olympic
Athlete
Kristine Karlson MD
DHMC
1992 Olympian
US Rowing Team Physician 1997Olympic Team Physician 2008
Who am I (and why am I
talking about this)?
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Not an athlete in high school
Tried some new things in college
Worked out pretty well…
My Career
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Spread medical school to 5 years
Intern year in family medicine split into
2 years
3 world championship gold medals
5th in 1992 Olympics
Retired from rowing, finished residency
But Olympics called again
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Tried out for 1996 Olympics, 2nd (earns
trip home)
Sports medicine fellowship
Started at DHMC in 1997
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Current practice:
Half family medicine, primary care ages
birth to 94
Half non-operative orthopedics
Dartmouth College training room clinic
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Travel with US rowing team
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Elite Athlete Care
Elite Athlete Issues
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Drug testing and
drug/supplement
use
Public health
concerns
Acute illness and
infectious disease
Accidents/injuries
Travelling with Athletes
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Positives
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Part of elite group
Watch events up close as insider
Meet interesting people
Interesting locations
“Free” vacation
USA gear
Improvising care
Travelling with Athletes
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Negatives
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On call 24/7
Demands for inappropriate care
Hard decisions
Boring
“Interesting” locations
Improvising care
Vacation time used up
Babysitting adults
The Medical Kit
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Antibiotics
NSAIDs
Wound care
Ortho
ENT/eye/GI
Gyn
Misc.
Drug Testing Issues
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WADA
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http://www.wada-ama.org/en/
As much as possible done before
leaving the US
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Prohibited list
Therapeutic use exemptions
Asthma testing if needed
NO supplements!
Doping Control
Public Health Officer
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Food
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Anderson Br. J. Sports Med. 1996;30;347348 – Salmonella at 1996 Junior Worlds
Water
Safety
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Bikes
Walking
Unusual Care in Unusual
Locations
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“Now” care – gyn exam at 11 PM,
earache overnight
Pressure to use antibiotics for URI
Lower threshold to use antibiotics
Close followup
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Care of team staff and family members
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Improvising/ “Other Duties”
Boring/ Down Time
Babysitting Adults
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Pre-event safety
Post competition party
Seeing other Cultures
Beijing 2008 Staff
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32 athletic trainers
16 physicians (some ortho, some not)
1 chiropractor
1 massage therapist
Beijing 2008 Staff
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Each sport assigned ATC
Some sports shared ATC, many shared
physician
Usually ATC and physician known to the
sport and athletes, not always
How did we get there?
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USOC volunteer medical program
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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
USOC Medical Volunteers
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http://www.teamusa.org/medical/volunt
eers
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5 years experience, 2 years with team
Preferred to have worked with NGB
US citizen, malpractice insurance, no
criminal background, letters of reference,
etc
USOC Medical Staffing
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Training centers
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Resident athletes
Camps
Staff at training centers
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ATC’s
Fellows
Local MD’s
Volunteers
USOC Training Centers
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Colorado Springs
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Chula Vista CA
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Largest and “home” for USOC
Field sports, rowing, canoe/kayak
Lake Placid NY
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Winter sports
Beijing 2008
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Anticipated issues
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Heat
Pollution
GI illness
Beijing 2008
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Village medical clinic
USA medical clinic
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Always staffed (one ATC always slept
there, MD on call)
First contact with ATC
ATC may involve MD
BNU Training Center
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USOC staff, training partners, spares
Beijing 2008
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Medical clinic
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Lots of rub downs
Some rehab for athletes with injuries who
were still able to compete
Wound and illness care
Heat, ice, modalities
Beijing 2008
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At the Venues
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Depended on set-up
Team room vs sidelines
ATC always present, physician during
competition and maybe during training
Beijing 2008
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Emergency services
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Staff responsible for knowing plan
If transported, go with athlete
Beijing 2008
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Cases seen
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Buttock blister
URI
Mild diarrhea
Fever
Asthma
Tooth pain/ vaginal
yeast infection
Diverticulitis
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Knee effusion
Foreign body foot
Shin abrasion
Allergic reaction
Post race collapse
Beijing 2008
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Worst case for Team USA was wrestler
hospitalized for kidney failure after
dehydrating to make weight
Stress fracture
Plantar fascia rupture