12th FINA World Swimming Championships (25m) 2014 Doha
A Blend of Medical Delivery, Drug Surveillance and Medical Science
By James Miller, MD FAAFP/Sports Medicine
168 Federations came to Doha, Qatar to compete, renew friendships, shatter World Records and share in the third FINA World Aquatics Convention. The World Aquatics Convention started these amazing championships with the following statement:
Our mission is to provide a platform for the global Aquatics family and business leaders to come together to network and share best practices, to encourage greater engagement in aquatic sports and elite performance across all FINA disciplines.
The Convention allowed a sharing of FINA’s commitment to aquatic excellence as well as renewing FINA’s dedication to a worldwide effort to safety in aquatics for all. A new programme was launched in an address by Dr. Julio C. Maglione, President of FINA on the final day which fits with FINA’s theme Water is our World.
FINA launched in Doha a special programme named ‘Swimming for All – Swimming for Life’ with the goal to teach children how to swim and to promote physical activity through swimming across the globe.
This initiative has far reaching implications when it comes to the health of the world’s youth regardless of their background or federation.
Dr. Margo Mountjoy (FINA Bureau Member, Liaison to the Sports Medicine Committee and prior SMC Chair) shared the FINA Sports Medicine Committee’s work on the FINA-Yakult Consensus Statement on Nutrition for the Aquatic Sports with the FINA Swimming Coaches Golden Clinic which attracted over 200 coaches from around the world. The partnering of the FINA SMC and coaches will provide an opportunity to decrease the incidence of illness and injury in our athletes. This serves everyone’s interests: improved training, healthier athletes, faster athletes and healthy role models for future champions. Dr. Mountjoy’s presentation to coaches is the first of hopefully many opportunities to share the ideas from the Sports Medicine Committee to the international coaches for the betterment of the athletes, their health and their performances.
Behind the Scenes
An integrated health care network was in place through the combined efforts of FINA joining with Aspetar and the National Sport Medicine Program (NSMP). Aspetar is a world leader in sports medicine research that is based in Doha, Qatar. They are the first specialised Orthopedic and Sport Medicine Hospital in the Gulf region. Their state of the art facilities and dedication to sports medicine care and research has attracted world leaders in clinical and research specific to sports medicine. Aspetar’s facility is surrounded by Aspire, which is the sports complex that attracts international events such as the 12th FINA World Swimming Championships (25m). Advanced planning was also in place to address the unlikely but real threat of Ebola Viral Disease, which was causing considerable suffering in three African countries in the months just prior to these Championships.
Behind the scenes, the medical set-up is always complex, but the championships in Doha presented added challenges with the large number of national federations competing. The FINA AXA Assistance medical insurance covered all accredited athletes. Medical clinics were in place for minor medical needs at most of the host hotels for the entirety of the warm-up and competition days, 24 hours a day.
In addition, Aspetar nurses and physicians staffed an inclusive medical clinic at the Hamad Aquatic Center. This clinic was open the entire time that the Aquatic Center was open. The Aspetar Hospital was available for more severe cases as arranged by the Local Organising Committee Sports Physicians.
If transport was required, ambulance service was coordinated through a joint effort with the Qatar Red Crescent and Hamad Medical Corporation for competition and non-competition venues.
Health Care during the Championships
The pre-event planning performed perfectly with access to care by all athletes.
Some countries brought their own health care teams which varied from single trainers to full service medical teams with trainers, medical coordinators and physicians who were quite well equipped with medical supplies. It is important to remember that all FINA World Championships provide each national federation with whatever medications they are and/or are not able to import into the country or do not have available that are medically necessary. In most cases, preliminary lists of all pharmaceuticals are sent in by national federations in advance for approval before the teams submit their stock for clearance into the country. This minimises delays clearing the medical team once they have arrived.
All levels of health care were provided to all teams either integrated with their own medical staff or completely provided by the Championship Medical staff noted above, since the majority of teams did not have all inclusive medical teams with them. In all there were 113 physician consultations and more consultations that did not require a physician. Of these 113 physician encounters, 79 were for illnesses and 34 for injuries.
Research for our Athletes’ Health
The Swimmers Heart Study was started in Doha under the Aspetar lead investigator Dr. Nathan Riding. The stated study goals and objectives were:
- To establish the prevalence of abnormal electrocardiograms in a cohort of elite swimmers participating in the 2014 FINA World Swimming Championships (25m).
- To undertake a needs analysis (infrastructure and financial) to ascertain the feasibility of implementing a pre-participation cardiovascular screening programme across all FINA events.
It is well known that there are a small number of athletes that die suddenly and unexpectedly of cardiac causes, usually without warning symptoms. While these deaths are extremely unusual, the both FINA and the FINA Sports Medicine Committee feel understanding the aquatic athletes heart to be of extreme importance. In addition, the aquatic athlete heart undergoes compensatory changes in response to extensive training, just like all other muscles in the body. The first question is what types of changes occur because of elite athletic training? The second is are there any types of changes or pre-existing conditions that could have a negative effect on the athlete while they are competing or later in life? The last question would be: are there any other medical issues never thought of regarding the aquatic athlete heart? Many countries already engage in similar testing of their elite athletes (such as Italy, Belgium, Israel, United Kingdom, Qatar, United States of America and others) but the diversity of athletes at the 12th FINA World Swimming Championships (25m) offered a unique opportunity to expand the world’s understanding as it pertains to swimmers of all backgrounds, which had never been done to date. It would also assure that the techniques, questions and methods were completely uniform regardless of the athletes’ background or federation.
Aspetar collaborated with FINA to start this project. Random athletes 18 years old or over from all countries were selected for testing. Members of the Aspetar staff and members of the FINA Sports Medicine Committee went to all federations during warm-up and finals sessions to present “The Swimmers Heart Study” to them as well as to answer any questions they may have had. Frequently asked questions included reassurance as to anonymity of the athlete and country identity as the protocol for any positive screening test.
Once selected, the athletes reported to the testing site following the conclusion of all their events for the Championship. (so as to no way interfere with the performance outcome of the athletes selected). Their first responsibility was to sign a consent form to have the testing done as well as their data anonymously being entered into the Swimmers Heart Study data record. Athlete participation was completely voluntary.
Next, each selected athlete who had consented to participation would complete a personal medical history as well as a detailed family history. They then had a heart exam performed by an Aspetar Cardiologist as well as an electrocardiogram (ECG). If there were suspicious findings to any aspect of the testing (history, heart exam or ECG) the athlete would have further evaluation by an Aspetar Cardiologist as well as FINA’s invited cardiologist from the IOC, Dr. Antonio Pellicio. An Echocardiogram could be performed immediately on site if that was required for further evaluation. Any positive studies were directed by Prof. Pelliccian to guide the athlete’s case management with their individual federation medical liaison.
If an athlete wanted to be tested but was not in the selected pool of chosen athletes they could also participate completely free to the athlete or their federation. However, non-designated athletes’ data was not entered into the study since their participation was not random.
The goal is to expand this study to future World Championships to increase the numbers of athletes in the study as well as to expand research into the other aquatic disciplines.
The Ebola virus was not encountered, but the planning was essential.
Message therapy services were available for all teams in a large room next to the warm-up pools. These areas were heavily utilised throughout the Championships.
A unique offering was set up for athletes in Doha. A work-out facility, complete with cardio, weights and stretching areas was also adjacent to the warm-up pool. Every athlete prepares differently for their ultimate performance, so this welcome addition took that into account.
Doping control involved random testing selection performed before the day’s events. The major exception was the requirement that all World Records be tested. All events were subject to testing. As always, once an athlete is selected they are assigned a chaperone who must keep them in visual contact until all testing is successfully completed and the athlete is released. The athlete may be in warm-down, message, awards or participating in The Swimmer Heart Study but they are under full surveillance the entire time until their sample requirements are met.
Conclusion and the Future
The 12th FINA World Swimming Championships saw 4 individual and 3 relay Men’s World Records fall, while the Women set 10 new individual and 5 relay World Records. In addition, there was one new Mixed Relay World Record. The grand total was 23 new World Records. A lot goes into such swimming quality including training, facilities, athlete commitment to excellence. Qatar’s commitment to medical excellence and supporting the World’s elite athletes from all federations is just a part but an important part of these stunning statistics. FINA’s ongoing commitment to medical research to protect our greatest asset, our athletes, by preventative programmes and world class medical coverage at events was truly evident in Doha. Expanding the interaction of the SMC into the Coaches Golden Clinic is another example of this collaborative effort.
An extension of this collaboration will come to realisation at the 13th FINA World Swimming Championships (25m) in Windsor, Canada. The 18th FINA World Sports Medicine Congress will be moved to coordinate with the World Convention and the Championships combining all three for the first time. Once again, this provides the entire FINA Aquatic family to expand the network of opportunity and knowledge for the enhancement of athlete health, safety and ultimately performance.