EMERGENCY FOR EVERY DOCTOR SYMPOSIUM - 2019

A. ANDI KURNIAWAN, MD
Dr. Andi Kurniawan, Sp.KO
Spesialis Kedokteran Olahraga

Pendidikan Dokter : Universitas Sebelas Maret Surakarta

Spesialis : Universitas Indonesia

Indonesia Sports Medicine Centre

IDI : Anggota
PDSKO : Anggota
PEROSI : Sekjen

Dokter Tim Indonesia Olympic London 2012

Dokter Tim INA Youth Olympic Games - Nanjing 2014
Dokter Tim INA Olympic Rio 2016
Dokter Tim INA Youth Olympic Games - Argentina 2018
Dokter Tim INA Asian Games - Jakarta Palembang 2018

Finisher Tokyo Marathon 2018

➤ EMERGENCY IN SPORTS
➤ SPORT RELATED SUDDEN DEATH
➤ EPIDEMIOLOGY : SUDDEN DEATH IN SPORTS
➤ SUDDEN CARDIAC ARREST
➤ SUDDEN DEATH PREVENTIONS

LIFE-THREATENING INJURIES IN SPORTS ACTIVITIES

SPORTS INJURIES
& SERIOUS
MEDICAL
PROBLEMS
CAN OCCUR AT ANY TIME
THE MOST SERIOUS INJURIES :
1. One fracture/dislocation
(weightlifting)
2. Three closed fractures (two sailing,
one football)
3. One open fracture (mountain bike)
4. One facial injury (hockey)
5. One head injury (sailing)
6. One suspected cervical spinal
injury (BMX)
French gymnast Samir Ait Said snapped his leg during a pommel horse landing in the first week of
the Rio Olympics
http://www.dailymail.co.uk/news/article-3750383/The-worst-injuries-Olympic-Games-
Rio.html#ixzz4SCvBEVIl
 Armenian weightlifter Andranik Karapetyan dislocated his elbow lifting 195kg (429lbs
http://www.dailymail.co.uk/news/article-3750383/The-worst-injuries-Olympic-Games-
Rio.html#ixzz4SCvBEVIl
Australian javelin thrower Kim Mickle dislocated her
right shoulder during a qualifying
http://www.dailymail.co.uk/news/article-3750383/
The-worst-injuries-Olympic-Games-
Rio.html#ixzz4SCydecL5
 French athlete Yohann Diniz appeared to have defecated himself during the race
http://www.dailymail.co.uk/news/article-3750383/The-worst-injuries-Olympic-Games-
Rio.html#ixzz4SCzHVhaJ
 He collapsed at one stage during the gruelling event

Read more: http://www.dailymail.co.uk/news/article-3750383/The-worst-injuries-Olympic-Games-

Rio.html#ixzz4SCzf76DU
Follow us: @MailOnline on Twitter | DailyMail on Facebook
 Diniz eventually finished the race in eighth place
http://www.dailymail.co.uk/news/article-3750383/The-worst-injuries-Olympic-Games-
Rio.html#ixzz4SCzHVhaJ
EMERGENCY IN SPORTS
Defined as an unexpected
serious occurrence that
may cause injuries that
require immediate
medical attention

Time becomes a critical

factor in an emergency,
there is no room for
indecision or error
 Non Young Older
Athlete
Athlete Athlete Athlete

SPORTS-RELATED
SUDDEN DEATHS Cardiac
Non
Cardiac Sports
Non
Endurance Endurance
Sports

LIFE-THREATENING INJURIES IN SPORTS ACTIVITIES

 EXERCISE IS MEDICINE - AMERICAN COLLEGE OF SPORTS MEDICINE

Many research studies have shown the benefits of regular EXERCISE.

Many studies show that 150 minutes per week of moderate intensity
EXERCISE is required to achieve these health benefits.

➤ Regular Exercise can decrease the risk of Mortality by 40%.

➤ Reduce mortality and the risk of recurrent breast cancer by
approximately 50%.
➤ Lower the risk of colon cancer by over 60%.
➤ Reduce the risk of developing of Alzheimer’s disease by
approximately 40%.
➤ Reduce the incidence of heart disease and high blood pressure
by approximately 40%.
➤ Lower the risk of stroke by 27%.
➤ Lower the risk of developing type II diabetes by 58%
➤ Sudden death in athletes is conventionally defined as an unexpected
and instantaneous death occurring during or immediately after (i.e.,
within 1–3 hours) exercise, due to any cause except violence.

➤ Sudden cardiac arrest (SCA) is instead defined as abrupt loss of

heart function in subjects with or without heart disease, mainly due
to a sudden and unexpected cessation in heartbeat, potentially leading
to SCD.
 SUDDEN DEATH IN SPORTS

Horrifying
ExtraOrdinary Tragic Incident Dramatic
Incident
 EPIDEMIOLOGY

2.4

➤ 2,3 / 100.000 athletes per year 1.8

(elite athletes ; 12 - 35 years old)
1.2
➤ 0.9 / 100.000 Non Athletes per
year. 0.6

0
CARDIOVASCULAR
Corrado D, Basso C, et al. Does sports activity enhance the risk of sudden death
in adolescent and young adult? J Am Coll Cardiol 2003; 42:1959-63
 EPIDEMIOLOGY

US National Registry of Sudden Death in Athletes (27 years period)

From 1,866 Sudden Deaths :
➤ 1,049 (56%) Cardiovascular
➤ 416 (22%) Blunt Trauma Injury
➤ 182 (10%) Miscellaneous :
➤ Heat Stroke (46)
➤ Pulmonary (35)
➤ Drugs (34)
➤ Others (67)
➤ 154 (8%) Unresolved Cases

Maron BJ, Doerer JJ, et al. sudden death in young competitive athletes -
analysis of 1866 death in US, 1980 - 2006. Circulation 2009 : 1085-92
 EPIDEMIOLOGY

From 1,049 Sudden Cardiac Death :

➤ 251 : Hypertrophic Cardiomyopathy
➤ 116 : Coronary Artery Diasease
➤ 57 : Possible HCM
➤ 41 : Myocarditis
➤ 30 : Arrhythmogenic RV Cardiomyophaty
➤ 24 : Mitral Valve Prolapse
➤ 19 : Aortic rupture
➤ 17 : Aortic Stenosis
➤ 68 : Others

Maron BJ, Doerer JJ, et al. sudden death in young competitive athletes -
analysis of 1866 death in US, 1980 - 2006. Circulation 2009 : 1085-92
 Hypertrophic Arrhythmogenic RV
Cardiomyopathy Cardiomyophaty

Coronary Artery Disease : CV abnormalities found in

80% Autopsy in Athletes > 35 years who died suddenly.
 YOUNG COMPETITIVE
ATHLETES

Family and Personal History

Physical Examination, 12-lead ECG

negative positive
findings findings

Further Examinations (echo,

ELIGIBLE for
stress test, 24-h Holter,
Competition
cardiac MRI, Angio/EMB, EPS)
no evidence of
cardiovascular disease
diagnosis of cardiovascular disease

Management According to
Established Protocols

Pre-Participation Cardiovascular
Screening Recommendation
SUDDEN DEATHS
IN MARATHON
ENDURANCE SPORTS
 3 CASES IN 2018
SUDDEN DEATHS

Laki-laki (50) Laki-laki (55) Laki-laki (23)

100 meter km ke 3 Menjelang Finish
menjelang finish Perlombaan 5K Full Marathon
CHANGE FROM “ELITE SPORTS EVENT” TO “A MASS RECREATIONAL LEISURE EVENT”

COMPETING IS MORE IMPORTANT THAN WINNING

 FEMALE RUNNER

Early days of marathon, only Male

competitive elite athletes were allowed
to run.
1980 : only 10% of marathon runners.
Today : 60 % of the marathon runners.

State of the Sport - Part III: U.S. Race Trends. Running USA. July 9, 2014. Available at: http://www.runningusa.org/2014-state-of-the-sport-part-III-us-race-
trends. Accessed November 14, 2014.
 Figure 2 : Increasing Numbers of U.S. Athletes Complete Running Races

State of the Sport - Part III: U.S. Race Trends. Running USA. July 9, 2014. Available at: http://www.runningusa.org/2014-state-of-the-sport-part-III-us-race-
trends. Accessed November 14, 2014.
 FINISHING TIME

• The average finishing time of running a

marathon has dramatically increased.

• Female : slightly above 5 hour.

(average)

• Male : 4 hour and 45 minutes

WORLD’S
FASTEST
MARATHONERS Eliud Kipchoge run 2:01:39
(2018 Berlin Marathon)

2:00:25 run at
Nike’s Breaking2 marathon
May 2017
HUMAN RUNNING MACHINE

CHASSIS& MUSCOLOSKELETAL&SYSTEM&(Muscle,&Bone,&Joint)&

FUEL&TANK& ENERGY&SYSTEM&(Carbohydrate,&&&Fat&Stores)&

ENGINE& CARDIOVASCULAR&SYSTEM&(Heart&&&Blood&Vessels)&

RADIATOR& COOLING&SYSTEM&(Skin&and&Lungs)&
 SUDDEN DEATH IN MARATHON INCIDENCE

PARTICIPANT SUDDEN DEATH

EVENT YEAR
(% FEMALE) CASE (FEMALE)

Marine Corps and

Twin Cities marathons 1976-1994 221 318 (18) 4 (1) 1 : 60.000
(1)

London Marathon (2) 1981-2006 650 000 (17) 8 (0) 1 : 80.000

US Marathon (3) 1975-2004 3 292 268 (19) 26 (7) 1 : 126.000

US Marathon (4) 2000-2010 10.900.000 (59) 59 (8) 1 : 184.000

(1) Maron BJ, Poliac LC, Roberts WO. Risk for sudden cardiac death associated
with marathon running. J Am Coll Cardiol. 1996;28:428-431
(2) Tunstall Pedoe DS. Marathon cardiac deaths: the London experience. Sports
Med. 2007;37:448-450
(3) Redelmeier DA, Greenwald JA. Competing risks of mortality with marathons:
retrospective analysis. BMJ. 2007;335:1275-1277
(4) Jonathan H. Kim, M.D., Rajeev Malhotra, M.D., George Chiampas, D.O., et al. Cardiac Arrest during Long-Distance Running Races. New
England Journal of Medicine 366(2):130-40
 @dokandi

KEMATIAN MENDADAK
DI MARATHON

84% Men Marathon Runners have a

higher risk

Average age

42+13 Runner's Sudden Death Incident

at the Even Marathon

th
26 Sudden death occurs mostly in
km 40-42 (42% of cases)
mile
New England Journal of Medicine 2012
A prospective and comprehensive national survey was
performed throughout France from 2005 to 2010,
involving subjects 10 to 75 years of age
Case detection for sports-related sudden death : 4.6
cases per million population per year
Circulation.
820 : sports-related sudden deaths
2011;124:672–681
 DISTRIBUTION BY AGE
SPORTS-RELATED SUDDEN DEATHS (SDS)

Overall population
Competitive athletes

Sports-Related Sudden Death in the General Population,

Circulation. 2011; Volume: 124 : 6, Pages: 672-681
Redelmeier DA, Greenwald JA. Competing risks of mortality with marathons:
retrospective analysis. BMJ. 2007;335:1275-1277.
 Emergency Medical Treatment, and Cause of Cardiac Arrest

Non-Survivors and Survivors

Non-Survivors Survivors
n : 23 n:8

Time to initiation 5.2±4.0 1.5±1.4

of CPR minutes minutes

Time to emergency 7.7±6.7 3.9±2.7

medical service minutes minutes
arrival

Redelmeier DA, Greenwald JA. Competing risks of mortality with marathons:

retrospective analysis. BMJ. 2007;335:1275-1277.
P R E V E N T I O N

SUDDEN DEATH 

IN MARATHON EVENT
 RACE
MANAGEMENT
KOMUNITAS
PELARI

TEMPAT LAYANAN
MELIBATKAN
 KESEHATAN
KERJASAMA
 Rumah Sakit, Clinic, dll

KEPOLISIAN BANYAK

PIHAK

Ikatan Dokter Indonesia

PEMERINTAH
Kemenkes, Dinkes, dll
PB. PASI

PIHAK2 YANG HARUS TERLIBAT DALAM USAHA PENCEGAHAN KEJADIAN

KEMATIAN DI MARATHON

Membuat REGULASI bagaimana
Penyelenggaraan RACE LARI yang
memperhatikan Aspek Kesehatan
dan Keselamatan.
KEPOLISIAN
REPUBLIK
INDONESIA
Tidak Memberikan IJIN untuk
pelaksanaan “RACE” apabila aspek2
keselamatan dan kesehatan tidak
sesuai dengan Standard Yang
Berlaku.

Mendorong Pemerintah
IKATAN DOKTER untuk membuat Regulasi
tentang Penyelenggaraan
INDONESIA RACE LARI yang sesuai
dengan standard
international
PERHIMPUNAN Memberikan Pelatihan dan
Edukasi kepada Pelari
DOKTER SPESIALIS tentang Risiko Kesehatan
KEDOKTERAN olahraga lari.
OLAHRAGA Memberikan Pelatihan dan
Edukasi tentang
penanganan
PERHIMPUNAN Kegawatdaruratan di Bidang
Olahraga
DOKTER SPESIALIS
ANESTESIOLOGI
 DEFINISI PELARI KEREN :
TERHADAP DIRI SENDIRI
Mau dan Bisa mendengar keluhan tubuhnya
sendiri

Tau “LIMIT” tubuhnya sendiri

Bisa melakukan “RECOVERY” yang baik

Menjalankan Program Latihan Yang Benar

Melakukan Cek Kesehatan secara Rutin

minimal 1 tahun sekali
 DEFINISI PELARI KEREN :
TERHADAP ORANG LAIN
Mau & bisa “Menegur” dan “Mengingatkan” teman
untuk tidak memaksakan diri

Tidak Memprovokasi Oranglain

Menjadi Motivator Yang “Realistis”

Saling Memberikan Informasi yang BENAR

Tahu dan Bisa Melakukan “PERTOLONGAN

PERTAMA” apabila ada terjadi kasus gawatdarurat.
 KOMUNITAS LARI YANG KEREN :
Saling mensupport satu sama lain dan tidak saling
berkompetisi

Saling Mengingatkan Satu Sama Lain

Saat Latihan Bersama memperhatikan aspek kesehatan dan
keselamatan

Saling Memberikan Informasi yang BENAR

Anggota komunitasnya mempunyai kemampuan Basic

Life Support and Emergency Skill
 Melakukan Melakukan Edukasi
Usaha Untuk Kepada Peserta
Screening
Peserta
dengan Baik

Rasio Petugas
Medis & Pelari
sesuai standard

RACE

Memiliki Emergency
MANAGEMENT
Plan yang baik ORGANIZER Race Medical Director :
dokter spesialis yang
kompeten

Personel Medis
Memberikan
yang bertugas
Layanan Medis
mempunyai skill
Menyediakan Yang sesuai Dengan
dan keterampilan
Equipment Standard
di bidang
Medis Yang sesuai International
“emergency in
sports” Dengan Standard
International
FIFA MEDICAL BAG
 Football Players
Collapses

Non-Contact
Contact Collapse
Collapse

Responsive Non-Responsive Non-Responsive Responsive

Team Physician or Delegated
Official to Decide Further
Management Off The Field
Assume
Sudden Cardiac Team Physician or Delegated
Official to Decide Further
Unresponsive + Absent/abnormal breathing Management Off The Field
Ignore seizure-like movement
Ignore pulse check

Enter Field with AED/defibrillator

AED/Defibrillator available AED not immediately available

Assess Cardiac Assess Cardiac Administer ONE Precordial Thump

Rhythm Ventricular Rhythm Non- Start Compression - Only CPR
Fibrillation Ventricular Fibrillation Push Hard - Push Fast
Allow for complete chest recoil
AED-Shock as advised by the AED OR Manual Defibrilator
Shock ONCE
ResumeStart Compression-Only CPR , Push Hard-Push Fast
Allow for Complete Chest Recoil AED/Defibrillator available
AKLI FAIRUS - Persiraja Banda Aceh
 Sports injuries & serious medical problems
can occur at any time.

A mistake in the initial management of an

injury can prolong the time for rehab and
can potentially create a life-threatening
situation for the athlete.

TAKE HOME Be properly equipped and trained for any

medical crisis “TRAINED TO CONSIDER
MESSAGE WORST CASE SCENARIO”

Everyone is at risk for a medical emergency :

athletes, coaches, students, fans, and
officials.

Emergency Medical Response is the central

element of a multi Sports Event.