OA

©2008 OA • 33 Sewall Street • Portland, ME 04102 • (207) 828-2100

Medical Drugs and Equipment for the Team Physician

Discussion

The decision about which medications and supplies to take to an athletic event can be difficult. Only some of the factors that must be considered are type and location of event, weather conditions, number of players, and their sex. The complexity increases when traveling internationally with a large team. In these situations, the team physician needs to function as a portable emergency room because it may not be possible to rely on the local medical community for care of an illness or injury. Preparing a medical kit of this magnitude can overwhelm even a well-experienced team physician because of the scope and amount of medications required. The initial costs and the costs to maintain and restock the kit can be staggering. Because it is assumed that the physicians traveling with the National Teams have strong backgrounds in orthopedics, these issues are not addressed. It is also assumed that the physicians are competent in performing basic life support. Because of space limitations and infrequent use, the medications and supplies necessary for advanced cardiac life support (ACLS) are not included.

The physicians with US Soccer were confronted with a multitude of potential problems when they traveled with the National Teams. Therefore, the Sports Medicine committee of US Soccer elected to develop standard medical kits for use when the National Teams travel internationally. These kits are maintained by US Soccer and are transported with the team equipment, minimizing the handling and customs problems. A unique feature of the US Soccer Medical Kit is its design based on a medical guide. This guide describes treatment options for many medical and emergent conditions encountered when traveling with a team. It is arranged in a cookbook fashion, using major body systems as categories. It includes information and warnings about medication dosing, common side effects, and drug interactions. It also identifies any medications in the kit that are subject to drug testing. All of the medications described in the medical guide are included in the medical kit.

The US Soccer Medical Kit is too big to be contained in a simple black bag. It is comprised of one large case and several smaller bags. The case is portable, lockable, waterproof, and virtually indestructible. It allows quick, easy access and protects the contents from damage. The bags contain large splints and bulky materials, such as casting supplies. The tropical kit contains IV solutions with set-up equipment and extra medications for traveler's diarrhea. A fanny pack, called the break-out kit, allows ready access to frequently-used medications. This is especially useful when the main kit is inaccessible, such as on a plane.

When the main case is first opened the contents appear to be in total chaos. However, there is a logical order to the location of the contents. The plastic bags on top contain medications and supplies grouped together for specific body systems (i.e., eye kit; ear, nose, and throat (ENT) kit; dental trauma kit; suture kit; creams/lotions; and dressing supplies). These are designed to allow access to all supplies and medications necessary to treat a specific problem, such as a laceration or epistaxis.

Under the plastic bags are the vials of medications. Each is labeled on the top and front, providing easy identification both in and out of the case. Also included on the label is the strength and expiration date of the medication. All medications are repackaged into uniformly-sized vials to conserve space. The medications are grouped by category (i.e., anti-inflammatories and antibiotics) starting on the left side of the case. Instruments (i.e., diagnostic kit and blood pressure cuff) and tall bottles of liquids are located on the right side. A copy of the medical guide and lists of all medications and supplies included in the kits are located under the foam in the lid of the case.

Standardizing the medical kits and providing a medical guide insures that all US Soccer National Teams are adequately covered from a medical standpoint when they travel. However, these kits and guides are not perfect. They cannot contain every medication or supply the physician may need to treat a medical condition. The medical guide deals only with medical and dental conditions.

It is helpful for every physician to customize the kits. Minor modifications in types or brands of medications can make the kits easier to use and the physician more comfortable. For example, if the physician treats traumatic epistaxis with a nasal pack of surgical patties soaked in a cocaine solution, it is necessary to include the cocaine since it is not part of the standard kit. It is also recommended that the physician include surgical gloves that fit and extra nonsteroidal anti-inflammatory medication. All physicians who use the US Soccer Medical Kits and Guide provide feedback so that the kit can be improved.

Table 12-1 is the list of medications and supplies included in the medical kits. These lists are divided into: (a) prescription medications, (b) non-prescription medications, (c) equipment/supplies, (d) tropical kit, and (e) break-out kit. The US Soccer Medical Guide follows the medications and supplies list.

This information about the US Soccer Medical Kits and Guide should help the team physician to devise and develop a personal black bag. With the kit and careful planning, the physician should be able to handle most medical and emergent conditions at sporting events and while traveling.

Table 12-1

List of Medications Included in the U.S. Soccer Medical Kits

Prescription Drugs

Drug Generic Quantity
Augmentin amoxicillin, 500 mg;
clavulinic acid, 125 mg
50
Bactrim DS Caplets trimethoprim, 160 mg;
sulfamethoxazole, 800 mg
50
Benadryl injectable
50 mg/ml 1 cc
diphenhydramine 2
Cipro, 500 mg ciprofloxacin, 500 mg 50
Cleocin T-Gel, foil packs clindamycin 30
Compazine injectable, 10 mg/2 cc* prochlorperazine, 10 mg/2 cc 2 vials
Cortisporin otic suspension 10 cc** polymyxin B-neomycin-hydrocortisone 1 bottle
Decadron tabs 1.5 mg dexamethasone, 1.5 mg 100
Depo-Medrol, 40 mg/ml, 1 cc* methylprednisolone, 40 mg/ml, 1 cc 2 vials
Doxycycline 100 mg tablets doxycycline, 100 mg 50
Entex-LA* phenylpropanolamine HCI, 75 mg;
guaifenesin, 400 mg
50

 

Drug Generic Quantity
Epinephrine ampule 1:1000, 1 cc* epinephrine 2
Flagyl 250 mg tablets metronidazole, 250 mg 30
Flexeril 10 mg cyclobenzaprine, 10 mg 25
Halcion 0.25 mg tablets* triazolam, 0.25 mg 50
Hismanal 10 mg asternizole, 10 mg 50
Hydrocortisone cream 1% 1 oz** hydrocortisone cream 2
Indocin 25 mg indomethacin, 25 mg 30
Lidex cream 0.05% sample tubes** fluocinonide, 0.05% 50
Lidocaine 1% without epinephrine, 10 cc vial* lidocaine, 1%, without
epinephrine,10 cc
2 vials
Lidocaine 2% with epinephrine, 10 cc vial* lidocaine, 2%, with epinephrine,
10 cc
1 vial
Marcaine 0.5%-10 cc vial** bupivacaine 0.5% 1

 

Drug Generic Quantity
Monistat 3 suppositories miconazole 3
Morphine ampule, 10 mg/cc, 1 cc* morphine, 10 mg/cc, 1 cc 2
Motrin 800 mg caplets ibuprofen, 800 mg 30
Naprosyn 500 mg caplets naproxen, 500 mg 30
Nasalide nasal spray 25 ml** flunisolide, 25 ml 2
Neosporin ophthalmic ointment,1/8 oz tube polymyxin B-bacitracin-neosporin 2
Neosporin ophthalmicsolution, 10 ml bottle polymyxin B-bacitracin-neosporin 2
Nizoral cream 2% sample tubes ketoconazole 2% 50
PCE tabs 500 mg erythromycin, 500 mg 50
Pen-VEE K, 500 mg penicillin V, 500 mg 50
Pepcid, 40 mg famotidine, 40 mg 30
Procardia 10 mg nifedipine, 10 mg 12
Proventil inhaler-17 gm albuterol, 17 gm 2
Pyridium 200 mg tabs phenazopyridine 15
Rocephin, 1000 mg vial ceftriaxone, 1000 mg 1 vial
Silvadene cream 20 gm tube 1 % silver sulfadiazine 2
Silver nitrate sticks silver nitrate sticks 1 canister
Sulf-10 10% ophthalmic solution, 1 cc sulfacetamide 4
Tetracaine ophthalmic 0.5%, 1 cc** tetracaine ophthalmic 4
Tigan suppositories 200 mg* trimethabenzamide 5
Tylenol #3* codeine, 30 mg.;
acetaminophen, 300 mg
50
Tylox capsules* oxycodone, 5 mg;
acetaminophen, 500 mg
25
Valium injectable diazepam,
vial-5 mg/cc-2 cc*
5 mg/cc-2 cc 2 vials
Valium tabs, 5 mg* diazepam, 5 mg 20
Zovirax ointment 5%, 3 gm tube acyclovir 5% 1

*Substances are banned by USOC/NCAA.
**Substances that need written notification for testing officials.

Table 12-1 (continued)

Over- the-Counter Drugs

Item Generic Quantity
Advil 2-tablet packs ibuprofen 30
AlternaGEL, 5 oz aluminum hydroxide 1 bottle
Anbesol gel 0.25 oz benzocaine 1 tube
Aspirin, 325 mg, enteric acetylsalicylic acid, 325 mg, enteric 50
Benadryl 25 mg diphenhydramine, 25 mg 30
Benadryl cream 0.5 oz diphenhydramine I tube
Betadine ointment 1 oz povidone-iodine, 10% 1
Chapstick 10 gm lip balm   1 tube
Ex-Lax tabs phenolphthalein 18
Gaviscon tabs chewable alum. hydroxide, 80 mg;
mag. trisilicate, 20 mg
42 (1 box)
Hibidens 4 oz antimicrobial skin cleanser   1
Imodium caplets, 2 mg loperamide 24
Kaopectate tabs attapulgite 40
Mastisol dressing adhesive   2 amp
Mycitracin ointment polymyxin B-bacitracin-neomycin 30
Neo-Synephrine Nasal Spray 1%, 15 ml* phenylephrine 1 bottle
NIX 1 % Lotion permethrin 1 bottle
Pepto-Bismol tabs bismuth subsalicylate 30
Phillip's Milk of Magnesia tabs magnesium hydroxide 24
Pre-Sun 39 sunscreen 4 oz para-aminobenzoic acid 1
Robitussin DM, 8 oz bottle* guaifenesin, dextromethorpan 1
Saline, sterile, nonpreserved. 8 oz saline, sterile 2
Solarcaine spray 3 oz benzocaine 1 bottle
Tears Plus, 15 cc lubricant eye drops 2
Tinactin powder 1.5 oz tolnaftate 1
Tylenol Extra-Strength, 2-packs, gelcaps acetaminophen 50

*Substances are banned by USOC/NCAA.

Breakout Kit

Item Generic Quantity
Advil, sample packets ibuprofen 20
Band-Aids, coverlet coverlet bandages 20
Benadryl, 25 mg diphenhydramine 10
Cipro, 500 mg ciprofloxacin 10
Dramamine tabs* dimenhydrinate 36
Epi-pen* insect sting emergency kit   1
Gaviscon chewable tabs alum. hydroxide, 80 mg;
mag. trisilicate, 20 mg
6
Imodium, 2 mg loperamide, 2 mg 20
Lidex, 0.05% cream, samples** fluocinonide 10 tubes
NTG, 1/150 gr nitroglycerin 1/150 gr 1 bottle
Sudafed tablets pseudoephedrine 48
Swiss Army knife, multi-purpose   1
Tylenol Extra-Strength packets acetaminophen 20
Tylenol No. 3* codeine, 30 mg; acetaminophen, 300 mg 10

*Substances are banned by USOC/NCAA.

**Substances that need written notification for testing officials.

Tropical Kit

Item Generic Quantity
Alcohol sponges   10
Angiocath, 18 gauge   2
Angiocath, 20 gauge   2
Copper wire, 12 gauge (to hang IV bag)   2 feet
D5 Ringer's lactate, 1000 cc bags   4 bags
Gauze sponges, 3 X 3   10
IV tubing, extension and spike   2 set-ups
Non-sterile gloves   2
Tape, Dermacel, 1"   1
Tape, Dermacel, 1/2"   1
Tourniquet, rubber   1
Bactrim DS double-strength trimethoprim, sulfamethoxazole 50
Cipro, 500 mg ciprofloxacin, 500 mg 300
Imodium AD caplets, 2 mg loperamide hydrochloride, 2 mg 100
Kaopectate tabs attapulgite 100
Pepto-Bismol tabs bismuth subsalicylate 60

 

Equipment

Item Quantity Item Quantity
Adaptic 3 X 3 5 Fluor-1 strip (ophthalmic) 5
Adhesive tape remover pads (Clinipad) 5 Forceps, angled, nasal 1
Alcohol sponges 20 Gauze sponges, 3 X 3 20
Alumafoarn finger splint, 3/4" 1 Gloves, latex medical, sterile 2 pairs
Band-Aids, coverlet, elasticized 30 Gloves, latex non-sterile 10
Blood pressure cuff 1 Inflatable forearm splint 1
Casting tape-Fiberglass-2" 4 Inflatable leg splint 1
Casting tape-Fiberglass-4" 4 Inventory list  
Cautery, battery-powered 1 Knee immobilizer 1
Cervical collar-soft 1 Medication envelopes 2" X 4" 50
Chux 5 Nasal speculum 1
Coban-4" 2 Nasopharyngeal tubes, adult 1
Cotton-tipped applicators-sterile 10 Nasostat hemostatic nasal balloon 1
Drape, barrier, sterile 2 Needle-18 gauge-1.25" 5
Drape, towel, fenestrated, sterile 2 Needle-22 gauge-1.25" 5
Dressing, Surgipad-5" X 91 2 Needle-27 gauge-1.25" 5
Eye patch sponges 4    

 

Equipment - continued

Item Quantity Item Quantity
Otoscope/ ophthalmoscope kit (Welch Allen) 1 Suture, 4-0 Silk 3
Plastic bags, heavy duty 5 Suture, 4-0 Vicryl 3
Pocket mask with unidirectional flow valve 1 Suture, 6-0 Ethilon 3
Razors, disposable 2 Syringe-12 cc 5
Reflex hammer 1 Syringe-3 cc w/attached 22-gauge needle 5
Scalpel, disposable, sterile #11 3 Syringe-35 cc 2
Scalpel, disposable, sterile #15 3 Tape measure 1
Scissors, bandage, all-purpose 1 Tape, Dermacel, 1" 1
Shoulder immobilizer, large 1 Tape, Dermacel, 1/2" 2
Steri-strips-I /4" X 4" packs 5 Tape, Elasticon, 2" 1
Sterile cottonoid (Codman) patties 1 package Telfa dressing, 3" X 4" 5
Stethoscope-Littman 1 Thermometer, oral 1
Stockinette, elastic-T X 36" 1 Tongue depressors, sterile 10
Stockinette, elastic-4" X 36" 1 Vaseline packing strip (nasal) 1/2" X 72" 1
Suture kit, sterile (5 pieces*) reusable 1 Velcro tourniquet 1
Suture, 0 Ethilon 2 Webril cast padding-2", 3", 4" 4 rolls each
Suture, 4-0 Ethilon 3    

*Suture kit contents:

1. Needle holder-4 314"
2. Iris scissors-4 112"
3. Suture forceps
4. Suture scissors
5. Mosquito clamp