DIRE CONSEQUENCES for sports activity ‘sans’ medical check-up

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- By Lakna Paranamanna and Sarasi Paranamanna

Fitness report should be mandatory
Engaging in sports activities is a widely-accepted approach to stay fit but for some it may be a harbinger of death if they are not physically fit for the task. The recent death of a student who died while running 5000 metres at the school sports meet calls us to reconsider the methods used in schools before and while training students for physical activities. The tragic death of the girl is the second case of this type to be reported this year and on 31 January another 19-year-old student succumbed to the same fate while taking part in a cross country race.



The shocking deaths have attracted a high emotional response from the public, which has compelled the Education Ministry officials to make physical fitness tests mandatory in schools before the students engage in physical activities. Usually athletics are a group who are perceived to be healthier, but though it is rare, athletes and sportsmen also have the risk of sudden cardiac arrest or cardiovascular diseases while engaging in physical activities.

" Professor Arjuna De Silva, Director General of the Sports Medicine Institute said, these types of tragic events can be prevented by going through at least a basic physical examination before engaging in sports "

Professor Arjuna De Silva, Director General of the Sports Medicine Institute, said, these types of tragic events can be prevented by going through at least a basic physical examination before engaging in sports. However, highlighting the importance of getting an Electrocardiography (ECG) done, Prof De Silva said certain cardiovascular conditions cannot be detected through a basic medical check and an ECG would help the doctors to diagnose any cardiac abnormalities.
“Ideally if a student can get a basic medical checkup and an ECG report it will be best for the student’s health” he said. It was reported that the girl who died in Chilaw while running a cross country had an abnormality in the coronary artery since birth, which further validates the importance of obtaining an ECG report before engaging in physical activities.

He said, sports coaches and physical training instructors look through the basic physical examination for doctor’s advice on the health of the child and he added that according to internationally accepted standards the person who is to take part in a sport should go through a pre-participation physical evaluation where he/she is asked a series of questions about his/her medical history and physical condition.

According to Prof. De Silva the basic physical examination should include checking blood pressure, examination of the heart, lungs and abdomen and checking whether the child is anaemic (decrease of the quantity of haemoglobin in blood).

The internationally-accepted standards require the student to give details of his family’s medical history. The questionnaire should ask whether he /she is on prescribed or non prescribed drugs, whether there is a family history of heart disease, whether he/she experiences discomfort or pain in the chest when engaging in physical activities, whether anyone of the family had died for no apparent reason, whether he/ she has a heart infection or a heart murmur and whether he/she has passed out during exercises. In addition, this questionnaire includes questions about diet, skin infections, muscle injuries, fractures, asthma and allergies.

“Only if the medical history of the student and the physical evaluation is clear that the student should be allowed to engage in exercises”, said Prof De Silva.
 “If the event is long distance running, only children who are 15 and above can participate. If it is contact sports, protective gear must be used and warm up and stretching exercises are essential to prevent injuries during sports” he said.
Prof De Silva said, students should be gradually trained especially for events that require a lot of stamina, so that the student is physically and mentally prepared on the day of the race.

" According to Prof. De Silva the basic physical examination should include checking blood pressure, examination of the heart, lungs and abdomen and checking whether the child is anaemic (decrease of the quantity of haemoglobin in blood) "

“The coaches and students should be mindful of the students’ limits. Pushing yourself too much to a particular target cannot be done if you are not physically ready. If the child is required to run a long distance race suddenly, his/her heart might not be able to cope with the pressure. The parents also should not push the child too much” he said noting that young athletes are likely to continue the activity even if they feel an abnormality or a pain which might have deadly consequences sometimes.
“We have prepared certain guidelines for schools to follow. If schools are encouraging students to engage in sports, they, the school should have a first aid kit and a person who is skilled in administering first aid in case of an emergency. The school should have a method of transporting students in an emergency, which should ideally be a van and not a three-wheeler” he said.



Neglecting practice sessions has contributed greatly – Education Ministry
The Education Ministry claims that although a set of regulations had already been issued in 2007 concerning the selection of students for sports events of long duration, some of them may have been overlooked by school authorities and participating students, in their eagerness to be part of the event. Education Ministry Physical Education and Health Director, B. A. Abeyrathne said, the regulations issued on January 29, 2007 to all Provincial Education Directors, Zonal Education Directors and Principals carried the following guidelines to select students for inter-house sports meets and marathons:

• The fitness levels of students who participate in marathon events should be certified by a medical practitioner through a check-up
• All students who participate in semi-marathon or similar cross country races should be above 15 years of age  
• Only those who have attended required practice sessions should be allowed to participate in the events.

However Mr. Abeyrathne says, when considering the two recent incidents of student fatalities,   he believes the main contributing factor was the neglecting of training and failure to carry out the relevant medical check-ups.

“At present, students in most schools simply enroll themselves to participate in various sports events due to their enthusiasm, but neglect the practice sessions. Some tend to conceal their medical conditions for fear of not being allowed to participate in games. These flaws in the system require close attention,” he said.

"Schools have taken measures individually to station doctors and first-aid groups during events, but these are only a handful. I know that some schools have arranged for parents who are medical practitioners to be present during practice sessions on a voluntary basis. However, rural schools experience hardships in having a medic present during school sporting events due to the limited resources available "

He said several programmes are currently being planned to be implemented in schools countrywide, to ensure the safety of student athletes and sport enthusiasts. “We have planned a fitness development project which would monitor the physical conditions of students every term. A report card will be maintained based on the data collected and would be handed over to the students at the end of each term, similar to that of an academic performance report card. Those who have performed well would also receive a certificate.”  Mr. Abeyrathne expressed his disappointment with regard to the discontinuance of the morning physical education programme, in most schools. “This practice has been abandoned by most schools as it is considered a disruption to the morning academic activities. But we have decided to impress the importance of continuing the programme to every school principal, to enable students to engage in some form of physical activity daily,” he said. “Participation in sports should not be discouraged, but it is necessary to ensure relevant precautionary actions are not overlooked as a result of over-enthusiasm.”

Presence of medics at sports events
Experts say, the presence of medics during a sports event would increase the probability of securing the life of the casualty. However, the present regulations pertaining to school physical education programmes have not yet made the presence of medics during school level sporting events obligatory, while most schools do not even equip themselves with a properly trained first-aid group.

 “Schools have taken measures individually to station doctors and first-aid groups during events, but these are only a handful. I know that some schools have arranged for parents who are medical practitioners to be present during practice sessions on a voluntary basis. However, rural schools experience hardships in having a medic present during school sporting events due to the limited resources available,” Mr. Abeyrathne said acknowledging the need for the presence of first-aid groups and medics during sporting events, who would be able to provide quick responses to the casualties.

Nutrition training is important – Nutritionist
“Athletes and sports enthusiasts should note that nutrition training is as important as physical training for better performance,” Sri Lanka Nutritionists’ Association President Dr. Renuka Silva said. He said, due to the present trend of lifestyles, most students are used to skipping breakfast which is not a healthy habit to develop. “The timing of food consumption is important and it is vital for those engaged in sports to train themselves to a meal plan,” he said.
Speaking on general nutrition requirements of a sportsman or a sportswoman, Dr. Silva commented on certain myths surrounding the topic. “It is often considered that an athlete requires a higher intake of protein than an average individual. But in reality, an athlete’s main nutrition requirement would be carbohydrates, to generate the necessary energy,” he said, adding that consuming carbohydrate-rich food including rice, bread, yams and wheat-based products would generate energy and help battle fatigue or inability to perform for long durations.

" It is often considered that an athlete requires a higher intake of protein than an average individual. But in reality, an athlete’s main nutrition requirement would be carbohydrates, to generate the necessary energy "

He said fluid intake should also be well thought-out and not neglected. “Irrespective of the nature of the sporting activity, be it cycling, a marathon or any other event of lengthy duration, the participants should consume carbohydrate based drinks.” He said they should not be confused with energy drinks available in the market as the caffeine boost only provides a temporary stimulation to the body.
Prof De Silva said the most convenient and healthiest option is to consume a solution mixed with lemon juice, water, sugar and salt. “Salt intake is important for an athlete as it would help maintain the necessary sodium levels and prevent cramps, and fluid intake would prevent dehydration, which would lead to a fatal heat stroke if the condition is worsened.”  
He advised sports enthusiasts to refrain from consuming over-the-counter protein supplements, as food would provide sufficient levels for body functions.


Importance of first-aid knowledge for students
The St. John’s Association for Sri Lanka Brigade Coordinating officer and trainer B. A. Cooray, said it is vital for students to be equipped with knowledge on first-aid as it would not only increase the possibility of securing the casualty’s life but would also help avoid further deterioration of the condition.  “Currently, there is no regulation which makes it compulsory for every school to be equipped with a first-aid team. It is most unfortunate and the authorities’ attention should be shed on this issue,” he said.

" Currently, there is no regulation which makes it compulsory for every school to be equipped with a first-aid team. It is most unfortunate and the authorities’ attention should be shed on this issue "

Mr. Cooray said it is important to follow these first-aid steps during any accident, until proper medical attention is provided:
Check for pulse, breathing, consciousness of the patient and if conscious, proceed to give commands to check how they respond.  Bring the casualty to the recovery position as it would help him/her breathe easily.   If he/she is not breathing, take immediate steps to provide Cardiopulmonary resuscitation (CPR).
If the casualty has fainted - the cause is lack of oxygen. Hence raise the casualty’s lower body so that the head is placed on a lower level and the blood flow to the brain is increased. Upon resuscitation, provide a sugar-based drink to increase glucose levels.


Absence of data concerning school-level athletes

Even in the wake of two student fatalities, the Education Ministry is still not aware of the number of student fatalities and of those injured during the past few years. The data should ideally be in place for the preparation of efficient policy frameworks concerning various issues related to school level sports education. An official of the Education Ministry said they are still in the process of accumulating the data and  are planning to compile it once the information has been submitted from all districts.

" The data should ideally be in place for the preparation of efficient policy frameworks "