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The Prehospital Olympics

I’ve never really felt the urge to write a blog, but the result of a tweet I sent last night around the medical care at the Olympic Games, has empowered me to justify the tweet I sent.
The tweet caused a variety of responses from lots of different levels of practitioner on Twitter.
Some were objecting to my use of Anglo Saxon to get across my surprise, and disgust at the level of care, and others felt that my accusations of sub standard care were completely unjustified.
As a bit of background we are 3 days into the greatest sporting event, that only happens every 4 years. The honour of hosting the games is often just as, if not more competitive than the Olympians themselves.
In the first 3 days there have been 3 traumatic injuries that were treated by staff at the scene. In every one of the cases the treatment has been sub standard to what one would expect for members of the public, let alone elite athletes, who dedicate their whole lives for the honour of representing their county at their chosen event.
The incidents were a gymnastics fall, and then 2 cycle accidents. The gymnastics incident resulted in the casualty receiving sub standard immobilisation of both their C spine, and obvious,serious fracture. The casualty was then dropped on the stretcher. The first cycling incident resulted in a cyclist crashing at speed, with a high index of suspicion of injuries due to the mechanism.
Unconfirmed times are suggesting that She was lay unconscious on Her own for in excess of 3mins. The casualty that generated my tweet, and hence this blog, was another cycling incident where a cyclist was again subject to sub standard immobilisation of Her C spine, and a completely wrong placement of a pelvic binder.
The tweets I received back after questioning the poor medical response ranged widely including advice that instead of criticising them, that I should get on a plane and fly out there and sort it out. Other tweets suggested that I was being unfair on the teams, and that it wasn’t their fault that they didn’t have good gear, or gold standard guidelines.
Others said that mine were wise words from someone who had probably never had their practice televised internationally, and never made any mistakes.
My response was that surely elite athletes should be treated by elite medics?
Also that basic anatomical correct placing of an immobilisation device, and initial casualty care wasn’t really an advanced skill?
The purpose of my tweet really wasn’t to upset anyone, and I subsequently deleted it. Anyone that knows me, will tell you that I am passionate about patients receiving gold standard pre hospital care.
My issue is that if you compare the olympics and the way we have witnessed medical care to Formula 1 for example, it is left badly lacking. Multiple F1 races are ran throughout the year in all corners of the globe. Their medical team is second to none. They practice and simulate not till they get it right, but until they can’t get it wrong.
The drivers are afforded gold standard care, whichever circuit they race at, anywhere on the globe.
So if F1 can do this multiple times in a year, why can’t the IOC adopt the same approach for the once every 4 years, that they put on the Olympic Games.
It may not be the fault of the teams, but the IOC should have a better delivery of medical care at their event.
If I was on TV in front of an audience of millions, providing medical care, I would ensure that I was absolutely on top of my game, delivering gold standard care. What we have seen so far, doesn’t require marginal gains, or a bit of polishing, it is fundamentally poor, bordering on dangerous care.
Not even basics done well. And at this level surely we can expect more than basics done well.
So in summary: sorry if I’ve upset anyone by bringing to you’re attention the sub standard medical care that we have witnessed over the first 3 days of competition, I personally would expect much more from the Firefighters, Police officers and offshore medics that I train, so I’m struggling to make excuses for the medical teams in Rio.
I however make no apologies for having very high standards that I uphold aggressively with passion, for the good of the patient.
It may the fault of the IOC, for not having a robust F1esque system in place, but please “don’t hate the player, hate the game”
Phil Keating

Peer reviewed by IOC (not)

2 Comments Post a comment
  1. Grant Jonsson #

    Caroline…The “care” this patient received is not just marginally poor, it evidences malpractice. Since the patient turned out to be OK I guess we can joke about it at least a bit without being too terribly crass. The abdominal binder, which was surely intended to be a pelvic binder, isn’t even fastened correctly. Forget the fact that it is in the wrong place. And then there is the head block. Don’t want to get into any arguments about the use of head blocks, rigid cervical collars, or backboards, but — I’ve never seen a head block under the knee before. You might say, “Well, yes, but it was being used to elevate the possibly injured knee.” OK, but, it’s the wrong knee, so that argument doesn’t stand up. And then there are the little things. Any first day EMT-basic would have at least put all three cot belts in place, but the upper one, which would go across the chest, or in this case the upper abdomen, is dangling off the side of the cot.

    This is horrible patient care. If this patient had been transported to the Level One trauma center my service uses then I, as the lead medic, would have quite possibly had my license suspended on the spot after one of the faculty physicians contacted my medical director, which would have happened very quickly. If this is the level of care provided by the host country then I think the various teams should have brought their own EMS teams and team physicians.

    For anyone who wants to say “Well, would you have done better in an internationally televised event” the answer is YES. For anyone who wants to say “Have you ever made a mistake” the answer is YES, but not one this egregious. For anyone who wants to say “Well, they are doing the best they can”, I can only say then the “best they can” is simply not good enough. I’m sure they are wonderful people, but their medical skills leave a lot to be desired.

    August 10, 2016
  2. Graeme Wright #

    One thing that struck me when viewing recent photos and footage from the incidents at the games was that I actually haven’t seen any of responders with gloves (nitriles) on.

    I’m from Australia, so I’m not sure if the general stance on this differs globally, but I’d kind of been under the impression that it was a fairly stock standard part of PPE these days for EMS. i.e. If I had a dollar for every time I’ve heard “Scene Safety, BSI” from US services over the years, then I’d be doing pretty well indeed.

    Thanks for the article, and I certainly agree that we owe it to all to provide the absolute best level of service we can. For these athletes in particular though, the levels of effort made in facilitating and protecting their chances for long term recovery will have an especially large impact on their ability to continue doing what they strive to as professional athletes.

    August 11, 2016

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