Injury Prevention and Emergencies in Sport
The prevention framework
van Mechelen's sequence: establish the extent (incidence, severity), establish aetiology and mechanism, introduce preventive measures, then re-evaluate by repeating step one. Effective programmes are multifactorial and neuromuscular: the FIFA 11+ reduces lower-limb injuries through strength, plyometric, balance and landing-control exercises performed as a warm-up. Protective equipment works when it fits and is worn; rules and playing surfaces matter too.
On-field emergencies
Use a structured approach: danger, response, airway, breathing, circulation, then a secondary survey. Sudden cardiac arrest is the highest priority - start CPR immediately and defibrillate as early as possible, since every minute of delay reduces survival. Commotio cordis is ventricular fibrillation from a blunt precordial blow during the vulnerable phase of repolarisation and is treated identically.
Suspected spinal injury: immobilise in the position found, use a coordinated log roll or lift, and remember that helmet and shoulder pads must be removed together or not at all in American football.
Concussion: remove from play, no same-day return, use SCAT6, and follow a graduated six-step return-to-sport protocol with at least 24 hours per step after an initial 24–48 hours of relative rest.
Anaphylaxis: intramuscular adrenaline 0.5 mg (0.01 mg/kg) into the anterolateral thigh, repeated after 5 minutes if needed. Exertional heat stroke: cold-water immersion. Avulsed tooth: replant or store in milk or saline and do not scrub the root.
Traps: "when in doubt, sit them out"; grade-based concussion return tables are obsolete; the pitch-side team must rehearse an emergency action plan before the event.
Anti-Doping and Team/Event Medicine
The anti-doping framework
The World Anti-Doping Code is applied through the Prohibited List, which covers substances prohibited at all times (S0–S5: anabolic agents, peptide hormones, beta-2 agonists, hormone and metabolic modulators, diuretics), substances prohibited in-competition (S6–S9: stimulants, narcotics, cannabinoids, glucocorticoids) and P1 beta-blockers (prohibited in archery and shooting, and in some other precision sports under specific federation rules). M1–M3 cover prohibited methods, including blood manipulation, chemical and physical manipulation, and gene doping.
Strict liability is the central principle: the athlete is responsible for whatever is found in their sample, whether or not there was intent. No-fault does not excuse the anti-doping rule violation but can reduce the sanction.
Therapeutic use exemptions are needed when a prohibited substance is required for genuine medical treatment; obtain them in advance, with retroactive application reserved for emergencies and defined circumstances.
Anti-doping rule violations include presence, use, evasion, tampering, whereabouts failures (three in 12 months), trafficking, administration and complicity.
Practically: check every medicine against the list, check supplements (contamination is common and the athlete carries the risk), and remember intravenous infusions are prohibited in-competition above 100 mL per 12 hours.
Event and team medicine
Event planning requires a rehearsed emergency action plan, medical coverage matched to the sport and crowd, clear communication, and agreed transfer pathways to hospital. The team physician's duties include pre-participation assessment, illness and injury management, and confidentiality; the athlete's health overrides the result.
Traps: inhaled salbutamol is permitted only within the dose limit (1600 µg/24 h) and needs a TUE above it; beta-blockers are prohibited in-competition in shooting and archery.