Welcome home to Selangor FC - RGMC!

 A big welcome back to all readers of 'old-school' blogging! I've reclaimed this blog after more than a decade and decided to provide some lasting input on sports and musculoskeletal injuries.  

From my 13 year journey to the west (Doha, Qatar), I've decided to return home. You will see more about professional football, runners, swimmers, cyclists, musculoskeletal pain syndrome, and my favourite topic, shockwave therapy. Many thanks to Aspetar Hospital, National Sports Institute, National Sports Council, MASM, ISMST, AMSSM, and AFC for providing a platform of development for me. 

A big thank you for the management of Selangor Football Club for providing this avenue to continue to allow me to serve the footballers and members of the public. 

I am now available at RGMC in Section 5, Shah Alam, Selangor. Call us at 016-6251936 for appointments. The set up here has access for diagnostic, focal shockwave, injections, dietician, physiotherapy, strength and conditioning, etc. 
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Medical Coverage for Karatedo

Every time I am asked to assist in medical coverage of a martial event, I would ask for the assistance of hospital teams to ensure that the whole mechanism for emergency care is activated. During the 8th AKF, the organisers had the commitment of the Negeri Sembilan Health Department to ensure that the medical services offered during the 3 day competition was adequate and did not endanger the participants' lives.

The most important factors responsible for keeping the injury risks low were:-
1. The high standards of referreeing
2. The high fitness and skill levels of participants
3. Adequate rehydration in between bouts

Despite having a team for each 'tatami', we were busy with minor lacerations, bruises, contusions, muscle strains and mild joint sprains. We only had one participant who injured her neck, was immobilised using the hard cervical collar and long spinal board and transferred safely to the hospital. Two participants had mild concussion and were sent to hospital for further evaluation and observation for 24 hours. We only had to stitch up a bad laceration on an official who had fallen before the second day's competition. The Atomated External Defibrillator (AED) was available on stand-by in the event of patient collapse due to cardiac arrhythmias.

This is definitely a competition involving the whole team of referrees (rules and regulations), officials (traffic), doctors and paramedics, ambulance driver, registar-on-call and surgeon-on-call (immediate hospital care).

We still need qualified volunteers to provide a safer medical coverage during such sports events. You may contact me at draston@gmail.com.

Team Physician 'trouble' in Field Hockey

You are required to arrive at the game venue earlier than everyone else to prepare set up your things and prepare the drinks. Prior to that you make sure that your medication and taping inventory in your bags (and trolley) are updated and your water and ice supply is ready. Ensure that you identify yourself to the tournament medical officer (if available) and assess the availablity of medical assistance in case of emergency. For best practice, organisers need to have an emergency service crew and ambulance on standby for the match. They should also have an AED and spinal board ready for cervical fracture immobilisation and evacuation.

Once the athletes arrive, you give them their sports drink bottles, review the injury status (and any other medical condition), tape the joints and assist in stretching. We watch the athletes warm-up (and join in if possible, as you are required to run on the pitch in the event of injury) and do their sports-specific drills before the match. You have to have your rigid tape and powder ready in case some of the sticks needed minor adjustments for grip. You may also need to have self-adhesive tape (e.g. Powerflex or Coban) to hold the shin pads and support the wrists (also prevent sweat from wetting the sticks). You need to ensure that you have 4-5 bags of cube/crushed ice for injuries. Have your Ethyl Chloride spray, scissors, suture set, tubigrip, gauze, povidone iodine ointment and surgical spirit ready in case of cuts, abrasions, lacerations and contusions. The coach and manager will need you to give your injury status report prior to selection of the team.

During the match, you need to be watching the match at all times. Ensure that there is free flow of sports drinks and mineral water for athletes (and officials). Athletes coming in and out of the pitch are 'checked' to ensure that are rehydrating well and injury free. You need to assist them in RICE treatment if there are injuries. Assess the injury and give an immediate injury status report to the coach as he may need to return to play. The decision to play should be based on medical facts and not on the need to play. Clean and dress bleeding wounds immediately and you may need to suture the patient on site if you are able to get a relatively clean environment with your sterile equipment. (to be continued)

Volunteers needed for medical coverage

If you've got time, lots of guts, determination to learn, attention to detail and love for sporting activities, you're the person we are looking for.

I am recruiting volunteers from all walks of life to assist in medical coverage of training and competition involving club, state, national or international level athletes. We would need to have the volunteer familiarise with the safety protocols and tag along with more experienced volunteers before we launch you to head your own team. You do not necessarily need medical training as we will always have trained medical staff with you. Besides, trained medical staff also needs to know how to conduct themselves during sports injury, field emergencies and evacuation. You will have the assistance of the Malaysian Association of Sports Medicine members (you are welcome to be a member too!).

I can be contacted at draston@gmail.com or 019-2103787 (before 9pm).

Where is the medical team?

"Where is the medical team?" Shouted the spectators in the far side of the Cheras Badminton Stadium. The officials pointed to the table where the medical team was seated. There were three doctors watching the match although only one was officially on duty. The rest of the medical team consisting of a nurse, a medical assistant, a physiotherapist, an ambulance driver and 2 students were seated just behind the doctors.

Two of my doctor colleagues immediately ran up the stairs to reach the patient. But since they were not dressed in their uniform as I was, nobody could recognise them. The crowd was not helpful. They blocked the access route to the stands just to catch a better glance at the women's doubles finals match between China and Indonesia. I didnt have much of a choice. Everyone was gesturing to me to attend to the patient although I was the last doctor standing for the competition. I had to leave my post to run after my other colleagues.

True to my suspicion. The patient was an epileptic male who was poorly controlled on medication . He just had a tonic-clonic convulsion on the stands possibly due to the hot, humid and extremely noisy environment with every spectator banging away on the sponsored plastic air-balloons. There was not much we could do but to ensure that the patient was comfortable and did not choke on his own tongue or secretions. He was slightly dazed when we got to him and it took three men to carry him up the stairs and down the stairway into the medical room. We were relieved to see that he was better. His mother was not perturbed by the incident and wanted to return to the game immediately. She was not sure what medication the son was on. Neither could she tell us more about the condition. To our surprise, she refused our offer to take the son to the nearest hospital by ambulance. I informed my colleague that we could not have the patient return to the spectator stand without risking another episode that we may not be able to manage. Finally, the patient's mother relented and took the boy home.