Medical assistance at competitions. The order of medical support of sports competitions. Distinctive signs of medical personnel
Medmoscow offers a wide range of medical services, among which “medical support by a doctor” occupies a due place. When organizing any mass events, whether it be sports competitions, corporate parties, holidays, celebrations, weddings, graduations, one cannot do without medical personnel who must be present at it. Our doctors regularly accompany such events. At the request of the customer, an ambulance paramedic, an ambulance doctor, a sports doctor, a traumatologist, a resuscitator can arrive at the facility. It all depends on the nature of the event.
Doctor on duty at public events
The doctor arrives at the venue in advance and prepares the place for duty. Throughout the event, the doctor controls the situation and monitors the participants. Constantly located in the area of accessibility, which allows you to provide medical care immediately. During the duty, the doctor is in constant contact with both the organizers and the participants of the action and is ready at any time to provide qualified assistance to the victim, carry out resuscitation measures, and, if necessary, call the ambulance team and send them to the nearest hospital. After the transfer of the victim to the EMS doctors, the doctor on duty continues medical support until the end of the agreed time. The software program can be developed in advance and agreed with the customer.
Office doctor duty at the enterprise
For large enterprises, it is very important that all employees are safe and can be sure that they will be provided with medical care at any time. This is exactly the service we provide. A specialized doctor is located in the office, where he has at hand everything necessary for the initial appointment of patients, as well as the provision of medical care. If necessary, the office doctor calls ambulance, which transports the victim to any hospital in Moscow and the region. In addition to providing assistance to office workers, the doctor conducts dispensary observation, makes reports for Rospotrebnadzor, selects the necessary documentation, and prepares lists of employees who must undergo an initial / periodic medical examination (in accordance with order No. 302N). Also, the office doctor can issue sick leave certificates, issue certificates to the pool, take samples with subsequent transfer to the laboratory.
Medmoscow doctors have all the necessary medical and diagnostic equipment, as well as medicines that will help provide emergency care and support vital functions until the ambulance arrives.
You can order a doctor via the Internet by e-mail: This e-mail address is being protected from spambots. You must have JavaScript enabled to view.
Plan:
Medical support competitions.
Anti-doping control
Gender control.
Sports and medical classification of disabled people
Competitions place extreme demands on the athlete's body. The medical support of the competitions is aimed at:
1. - maintaining the health of athletes;
2. - prevention of injuries and diseases;
3. - creation of the most favorable conditions for achieving sports results;
Medical support of the competition
Medical support of the competitions is carried out by the medical and physical education service and territorial medical and preventive healthcare institutions at the request of the organizers of the competitions.
The presence of a doctor is required:
1) at major competitions (starting from the district level);
2) at competitions in sports associated with an increased risk of injury (boxing, fencing, gymnastics, cycling and skiing, motorsport, etc.);
3) with a particularly large and long-term load ( race walking, marathon without, bike rides, etc.);
4) carried out in complicated environmental conditions (middle and high mountains, adverse climatic conditions, etc.).
Other types of competitions, as well as competitions in the system of mass physical culture and health work, can be served paramedical personnel.
Major competitions with big amount participants are served by a team of doctors, middle and junior medical staff under the leadership of the chief physician, who, as a deputy judge, is a member of the judiciary.
Medical support of competitions includes a number of issues. First of all, the correctness is checked admission participants - registration of the application, compliance with the age and qualifications of the established requirements (for which the doctor participates in the work of the credentials committee). Admission must be given no earlier than 10-15 days before the start of the competition; The signature of the doctor and the seal of the medical institution are placed next to the name of each participant in the competition. In doubtful cases, the doctor may conduct an additional examination of the athlete.
Warning and current sanitary control for the condition of the competition venues, accommodation and meals for participants is carried out in accordance with the current rules medical service competitions together with the local sanitary and epidemiological station (SES). Before the start of the competition, they get acquainted:
1) with sanitary and hygienic conditions and the epidemiological situation in the places where they are held;
2) with the sanitary and technical condition of sports facilities, inventory and equipment, ancillary facilities, showers, food places, first-aid posts, etc.;
3) carry out sanitary-chemical and bacteriological analysis of drinking and technical water.
During the competition, current control is carried out, “sanitary reconnaissance” is carried out along the routes of the tracks.
Observation of competitors for the purpose of prevention of diseases, injuries, overvoltage conducted in the form of a survey and sample surveys.
With 1) illness, injury, physical overstrain, weak physical fitness participants, 2) the absence of protective devices provided for by the rules. 3) non-compliance of clothing and footwear with the rules of the competition, 4) in case of a sudden threat to the health of athletes) a sharp deterioration in the weather) - the doctor has the right to prohibit the competition or remove individual participants from the competition.
To prevent sports injuries, it is necessary to pay special attention to: 1) the condition of the competition venues. 2) sports equipment and equipment, 3) clothes and shoes of participants, 4) fencing and protective devices. 5) rooms for rest, 6) the presence of a warm shower and other restorative means.
It is necessary to familiarize the participants in advance with the dangerous places of the competition tracks, to exclude oncoming traffic, the presence of spectators and vehicles directly on the tracks.
One of the most urgent tasks is rendering medical care for sick or injured competitors.
Special attention you should pay attention to the appropriate correction of the training regimen, nutrition, sleep, rest, the use of restorative agents.
Anti-doping control
An integral part of medical support at official all-Union and international competitions is anti-doping control.
According to the official definition of the International Olympic Committee (IOC), adopted in 1984, “doping is the intake or use of substances foreign to the body in any form or physiological substances in abnormal quantities and administered by abnormal methods to healthy people for the sole purpose of providing an artificial and dishonest increase in achievements in competitions."
The use of various stimulants in sports has a long history. The first mention of the use of stimulant drugs by athletes is recorded in Ancient Greece. Winner Olympic Games 668 BC, in the 200m race, he ate a specially prepared dish of fig fruits.
The use of doping began in the sport of a new and recent history before the rise of the modern Olympic movement. the mention of the intake of stimulants by athletes dates back to 1865, when swimmers were convicted of taking doping while swimming through the canals at competitions in Amsterdam.
The fight against doping in sports began in antiquity. According to the information that has come down to us, it began with the introduction of punishment for giving stimulants to racehorses. However, there was no anti-doping system either in the ancient world or in the Middle Ages.
The turning point for the Olympic Movement came in 1960. At the 1960 Olympic Games in Rome, on the day of their opening, the Danish cyclist Knut Enermark Jensen died. the official cause of death was sunstroke.
However, an autopsy showed that the athlete took a significant dose of amphetamine. this incident prompted the International Olympic Committee to establish its first medical commission, chaired by New Zealand surgeon Sir Arthur.
The decision against the use of doping and the creation of a medical commission was taken by the IOC in 1962, at a session in Moscow.
Since 1967, the medical commission has worked under the leadership of a member of the IOC Executive Committee, Prince Alexander de Merode (Belgium).
In 1964 random samples were taken from participants in the Tokyo Olympics in order to identify cases of stimulant use. Anti-doping control was carried out selectively in 1968 in Grenoble and Mexico City. Since 1972, doping control has become mandatory for all types of competitions Olympic program. Currently, no country has the right to host official international competitions if it does not have a doping control service.
Doping control is carried out by the relevant services of the host country under the supervision and guidance of the IOC Medical Commission or international federation for this sport.
Anti-doping control is the determination of the presence of doping in liquid biological media (blood, urine, saliva, etc.). Usually all details anti-doping control stipulated in the instructions sent by the Federations or National Olympic Committees.
Prior to the competition, all participating countries are sent a list of prohibited medicines considered doping. The composition of the anti-doping commission, the equipment on which the presence of doping will be determined, sampling methods, etc. are indicated.
Tests for the presence in the body of an athlete of pharmacological preparations classified as doping include: sampling of biological fluids (blood, urine, saliva, etc.), subsequent physical and chemical analysis at the venue of the competition or in one of the laboratories recognized by the international Medical Commission IOC, as well as other medical tests necessary for a full conclusion. The most frequently examined urine.
For detection of the fact of doping by the participants of the competition it is required to objectively prove the presence of a doping substance or its metabolite in a portion of urine collected after the competition in strict accordance with the rules: under the control of the personnel assigned to this; dividing the sample into two portions; sealing and coding samples in the presence of an athlete or his representative (the first sample is sent to the laboratory for analysis, the second is a control and is analyzed if doping is detected in the first sample).
The laboratory, accredited for control, conducts research using a complex of modern methods of chemical and toxicological analysis, which makes it possible to determine almost all substances and their metabolites known today. The result is considered positive if it is obtained simultaneously by several (at least two methods).
According to the current rules the winners of the competitions and athletes who took 2nd-4th places are subject to control. in sports games and team competition the choice of athletes for control is determined by lot. By decision of the medical commission, other participants in the competition may also be subject to control. It is advisable to investigate athletes in cases of development of syncope, unconsciousness, acute overexertion.
The use of doping drugs before the competition and during the competition for the purpose of treatment is also prohibited. Failure to appear at the control is regarded as doping.
Sanctions are imposed on the guilty athlete - deprivation of a medal in individual types competitions and the defeat of the team if any of its participants is found to have doping.
The decision on the appropriate sanctions - the disqualification of the athlete - is made by the refereeing commission. The terms of disqualification depend on the nature of the drug used. Athletes convicted of using anabolic steroids are subject to the most severe punishments.
To participate in competitions, children must obtain the opinion of a sports doctor.
This material will be relevant for course participants:
"Therapeutic exercise and sports medicine",
"Pediatrics",
"Therapy",
"General medical practice (family medicine)",
As well as students of advanced training courses and professional retraining in the direction "" and specialties "", "".
The demand to cancel the provisions of the Order of the Ministry of Health of March 1, 2016 No. 134n
On March 22, 2018, the Supreme Court of the Russian Federation considered the claim from the public organization "Traditional Karate". In this application, the organization demanded to invalidate certain provisions (including during the preparation and conduct of physical culture and sports events), including the procedure for a medical examination of persons wishing to undergo sports training, engage in physical culture and sports in organizations and (or) fulfill the standards of tests (tests) of the All-Russian physical culture and sports complex "Ready for work and defense" ( further Order ) . This procedure was approved by the order of the Ministry of Health Russian Federation dated March 1, 2016 N 134n.
The Ministry of Health of the Russian Federation and the Ministry of Justice of the Russian Federation were involved as defendants.
What do the disputed points 7, 9, 10 of the Procedure say?
Primary health care is provided only:
- in the medical center of the sports facility,
- in the office or department of sports medicine of a medical organization,
- medical and physical education dispensary.
Health care includes:
- primary pre-medical health care,
- primary specialized health care.
Who can provide primary specialized health care?
It can be provided by a sports medicine doctor in the following areas:
- general practitioner (local therapist),
- general practitioner (family medicine),
- pediatrician (district pediatrician).
Requirements for a medical organization
Such assistance can be provided by a medical organization of any organizational and legal form with a license that gives the right to perform work (provide services) in "therapeutic physical culture and sports medicine".
Individual entrepreneurs engaged in medical activities are equated to medical organizations
The sports medicine physician must:
- carry out diagnostics
- determine preventive, therapeutic, rehabilitative measures,
- carry out follow-up care,
- determine medical indications for referring persons to medical care in hospitals in emergency and (or) planned forms,
- carry out systematic monitoring of the health of persons involved in physical culture and sports (including in the preparation and conduct of physical culture and sports events),
- in the presence of medical indications, refer these persons for a consultation with other medical specialists.
What did the public organization not like in the Order of the Ministry of Health?
The Novosibirsk Regional Public Organization of Traditional Karate considered that the above paragraphs of Order No. 134n contradict:
- article 10 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation",
- article 10 of the Federal Law of December 4, 2007 N 329-FZ "On Physical Culture and Sports in the Russian Federation",
- clause 5.1.1 of the Regulations on the medical support of persons involved in physical culture and sports,
- sections 3 and 4 of the Program for medical examination of people involved in mass sports and physical education of the Order of the Ministry of Health of August 20, 2001 N 337.
Thus, the provisions of the Procedure (paragraphs 7, 9, 10) force athletes and trainees to undergo medical examinations and receive permits for a fee. In this situation, underage athletes of a public organization are deprived of the right to undergo free medical examinations at polyclinics at the place of attachment. Reason: lack of sports medicine doctors in the city's clinics.
Why can't a sports NGO organize free medical examinations??
In the city of Novosibirsk, it is still possible to undergo free medical examinations at a medical and physical education dispensary, but in order to get the right to send your pupils for free medical examinations, you must be an accredited organization under the Ministry of Physical Culture and Sports of the Novosibirsk Region.
In order to undergo medical examinations and obtain permits, the GNOVFD requires payment for medical services according to the price list.
Verification of compliance with the normative legal act of the Ministry of Health
By virtue of the Federal Law of December 4, 2007 N 329-FZ and the Regulations on the Ministry of Health of the Russian Federation, the procedure for organizing the provision of medical care to people involved in physical culture and sports is established by the federal executive body, that is, the Ministry of Health of the Russian Federation.
According to Art. 32 of Federal Law No. 323-FZ, only medical organizations can provide medical care. Medical assistance includes 4 types:
- primary Health Care,
- specialized, including high-tech, medical care,
- ambulance, including specialized ambulance, medical care,
- palliative care.
According to Art. 33 of Federal Law No. 323-FZ, primary health care consists of:
- primary pre-medical health care, which can be provided by a paramedic, obstetrician and other medical workers with a secondary medical education,
- primary medical care, which can be provided by general practitioners, pediatricians, general practitioners (family doctors),
- primary specialized health care that can be provided by medical specialists, including medical specialists of medical organizations providing specialized, including high-tech, medical care. Such assistance, in accordance with paragraphs 1 and 2 of part 3 of Art. 21, is provided on the basis of a referral from a district general practitioner, a district pediatrician, a general practitioner (family doctor), a paramedic, a specialist doctor, or on the basis of an independent application of a citizen.
Accordingly, paragraphs 7, 9 and 10 The procedure for organizing the provision of medical care to persons involved in physical culture and sports are in no way inconsistent with the provisions of the law.
What does paragraph 10 of the above legal act say?
By itself, paragraph 10 defines the list of job responsibilities of a sports medicine doctor and is fully consistent with the qualification requirements and official duties sports medicine doctor who are established United qualification handbook positions of managers, specialists and employees, approved by order of the Ministry of Health and Social Development of the Russian Federation of July 23, 2010 N 541n.
Requirements for the education of a physician in sports medicine:
The doctor must have a higher medical degree in the specialties "Medicine" or "Pediatrics" with postgraduate education (residency) in the specialty "Therapeutic physical education and sports medicine".
The second option for becoming a doctor in sports medicine is to take professional retraining courses. Prof. retraining in the direction "Therapeutic exercise and sports medicine" persons who have an internship / residency in the specialty can pass:
- "Neurology",
- "General practice (family medicine)",
- "Pediatrics",
- "Emergency",
- "Therapy",
- "Traumatology and Orthopedics".
According to the Order of June 15, 2017 No. 328n, specialty "C tomatology" is excluded from this list. Also, dentists cannot be trained in residency in the following specialties:
- "Manual Therapy"
- "Radiology",
- "Physiotherapy",
- "Functional diagnostics".
Supreme Court decision
As you can see, there are no direct prohibitions on receiving free medical care. And the plaintiff incorrectly interprets the substantive law. None of the above items prevents you from receiving free medical services.
Appendix 1 of the above Procedure establishes that a medical examination of this category of citizens (in this case minors) is carried out on the basis of the results of clinical examination or preventive medical examination.
But the following types of examination are carried out additionally for those persons who intend to go in for sports and physical culture in organizations:
- anthropometry,
- body type assessment
- level assessment physical development,
- assessment of the level of puberty,
- carrying out electrocardiography and carrying out functional (stress) tests.
In this case, such a medical examination can be carried out as part of the following medical measures:
- medical examination of certain groups of the adult population,
- clinical examination by state civil servants of the Russian Federation and municipal employees,
- medical examination of orphans staying in stationary institutions,
- medical examinations of minors, including upon admission to educational institutions and during the period of study in them (read more ""), as well as preventive medical examinations.
All this is regulated by the following Orders of the Ministry of Health:
- dated October 26, 2017 N 869n,
- dated December 14, 2009 N 984n,
- dated February 15, 2013 N 72n,
- dated April 11, 2013 N 216n,
- dated August 10, 2017 N 514n - on medical examinations of minors,
- dated December 6, 2012 N 1011n (paragraph 6).
According to the procedure for conducting preventive medical examinations of minors, which was approved by order of the Russian Ministry of Health of August 10, 2017 N 514n, a certain list of studies is carried out free of charge within the framework of state and territorial programs for guaranteeing free medical care.
Accordingly, the Supreme Court dismissed the claims.
In accordance with Article 37.1 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens of July 22, 1993 N 5487-1 (Bulletin of the Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1993, N 33, Art. 1318; Collection of Legislation of the Russian Federation, 2007, N 1, item 21; N 43, item 5084) I order:
Approve the procedure for providing medical care during physical culture and sports events in accordance with the annex.
Minister T. Golikova
Application
The procedure for providing medical care during physical culture and sports events
1. This procedure regulates the provision of medical care to persons involved in physical culture and sports, and other persons during physical culture and sports events ( sports competitions, educational and training events), physical culture and sports (including mass sports), as well as rehabilitation measures after intense physical exertion, diseases and injuries in athletes.
2. Provision of medical care to persons involved in physical culture and sports (including mass sports) includes:
dynamic observation (current medical observation, periodic medical examinations, in-depth medical examinations, medical and pedagogical observations) of the health of persons involved in physical culture and sports (including mass sports) and the issuance by specialists of an appropriate medical report on admission to physical culture and sports (including mass sports), sports competitions (hereinafter - admission);
provision of primary health care, specialized medical care during sports events (sports competitions, training events), physical culture and sports (including mass sports).
3. Provision of medical assistance during rehabilitation activities to athletes after intense physical exertion, after diseases and injuries, includes measures to increase and maintain sports (general and special) performance, rehabilitation measures to restore health.
4. Medical examination (examinations) for admission to physical education and participation in mass sports competitions is carried out in outpatient clinics, sports medicine departments (offices) of outpatient clinics, medical and sports dispensaries (centers of physical therapy and sports medicine) by a general practitioner (pediatrician), physiotherapy doctor, sports medicine doctor based on the results of medical examinations conducted in accordance with Appendix No. 1 to this Procedure.
5. Medical examination (examinations) and execution of a medical report on admission to sports and participation in sports competitions is carried out in the departments (offices) of sports medicine of outpatient clinics, medical and sports dispensaries (centers of physical therapy and sports medicine) by a doctor for medical physical education and a sports medicine doctor based on the results of staged (periodic) and in-depth medical examinations conducted as part of the provision of medical care during educational and training events.
6. The provision of primary health care and specialized medical care is carried out in accordance with the established standards of medical care in medical organizations, including medical and physical education dispensaries (centers of physical therapy and sports medicine).
7. Departments (offices) of sports medicine of outpatient clinics, medical and physical education dispensaries (centers of physical therapy and sports medicine, carry out their activities in accordance with annexes NN 2-7 to this Procedure.
8. Dispensary supervision of persons involved in physical culture and sports is carried out by departments (offices) of sports medicine of outpatient clinics, medical and sports dispensaries (centers of physical therapy and sports medicine).
I. Provision of medical assistance during physical culture and sports competitions
9. The provision of medical care during physical culture and sports competitions includes the provision of emergency and primary health care to participants in the competition: athletes, specialists working with athletes, organizers of competitions, spectators, personnel of sports facilities. When holding competitions at the international and federal levels, the current international standards for the provision of sports competitions are also taken into account.
10. The provision of medical care to athletes participating in the competition is carried out in order to maintain health and prevent injuries by the medical center of the sports facility, which operates in accordance with Annexes NN 8, 9 to this Procedure.
11. The organizers of sports competitions during their conduct provide for the solution of the following issues:
admission to competitions of athletes - participants in competitions;
assessment of competition and training venues;
the procedure for the involvement and coordination of medical organizations involved in the provision of primary health care and specialized medical care to participants in the competition;
provision of first and emergency medical care;
determination of places and ways of medical evacuation;
familiarization of medical personnel and representatives of teams (athletes) with the organization of medical care;
maintenance of medical and statistical forms of accounting and reporting on morbidity and injuries of participants in the competition;
preparation of the final statistical report on all cases of morbidity and injury of participants in the competition.
12. The provision of emergency medical care to athletes during physical culture and sports events is carried out by the mobile ambulance team.
13. For emergency evacuation of an athlete, unimpeded access of medical workers to the place of performance of athletes is provided.
14. When holding sports competitions with the participation of athletes with disabilities, appropriate conditions are provided for the provision of medical care to these categories of persons.
15. The provision of medical assistance during sports competitions includes the stages: preliminary, direct medical support for competitions and final.
At the preliminary stage, a medical committee (medical team) of the competition is created in order to allow athletes to compete, assess the readiness of sports facilities, and organize medical care during sports competitions. The medical personnel of the competitions have clear distinguishing signs on their clothes.
At the preliminary stage, the following are determined: the ways of evacuating the injured from the venues of the competitions to the medical center of the sports facility, the number and type of ambulance transport, working out the interaction with mobile ambulance teams to evacuate the injured to the medical organization, as well as actions in case of emergencies.
Prior to the start of the competition, the chief physician of the competition provides information to athletes, team representatives and officials about the occurrence of conditions that impede the conduct of the competition (impossibility to organize evacuation to a medical organization, impossibility to provide effective medical care in the medical center of the sports facility). The chief doctor of the competition may recommend to the chief judge of the competition the cancellation or postponement of the competition.
At the stage of direct medical support of competitions, the admission of athletes to competitions is determined, and medical assistance is provided to athletes according to medical indications.
The admission of an athlete to the competition is carried out by the medical committee (medical team) of the competition, which includes the chief doctor of the competition. Doctors participating in the work of the medical committee check the medical certificates provided by athletes (representatives of teams) on admission to participate in competitions, determine the compliance of the athlete’s age with the regulations on competitions. Athletes are not allowed to participate in competitions in the absence of a medical certificate or containing incomplete information.
The basis for the admission of an athlete to sports competitions on medical reports is an application with the mark "Admitted" opposite each athlete's name with the signature of a physiotherapy doctor or a sports medicine doctor and a certified personal seal, if there is a signature with the full name of the doctor at the end of the application, certified by the seal medical organization that admitted the athlete, which has a license to carry out medical activities, the list of works and services which includes physiotherapy exercises and sports medicine (it is possible medical certificate on admission to competitions, signed by a physiotherapy doctor or a sports medicine doctor and certified by the seal of a medical organization that meets the above requirements).
The provision of medical care in case of injuries to athletes during sports competitions is carried out by the medical personnel of the competition at the place of injury. In the event that the volume of medical care provided is insufficient or in the absence of an appropriate effect during medical measures, the victim is taken to the nearest medical center of the sports facility. If necessary, the victim is transported by an ambulance to a medical organization to provide him with specialized medical care.
All cases of medical care during sports competitions are recorded in the primary medical documentation: in the register of medical care provided at physical education classes and sports events; in a sports injury report.
In all cases of providing medical assistance to athletes, information is brought to the head doctor of the competition, and information about cases of hospitalization of athletes is received immediately.
All complaints about the provision of medical care during sports competitions are submitted in writing to the chief doctor of the competition.
On final stage providing medical care during sports competitions, the chief doctor of the competition draws up a report that is sent to the chief judge of the competition, to the executive authority of the constituent entity of the Russian Federation in the field of healthcare, to the medical and sports dispensary of the constituent entity of the Russian Federation. The report contains the following information: the number of participants in the competition, characteristics of the conditions and venues of the competition, the number of requests for medical care, the number of hospitalized, the reasons for hospitalization, the types of medical care provided, the results.
16. The composition of the medical committee (medical team) includes specialists in physical therapy and sports medicine: a doctor in physical therapy or a doctor in sports medicine (hereinafter referred to as specialists in physical therapy and sports medicine), who operates in accordance with annexes NN 2, 10, 11 to this Order.
The medical committee (medical team) of the competition organizes work depending on the number of participants in the competition, the type of sport, the specifics of the competition, the conditions for holding the competition, as well as the number of predicted applications for medical reasons (morbidity and sports injuries, types of alleged nosological forms of diseases). The recommended staffing standards of the medical committee (medical team) during physical culture and sports events are determined in accordance with Appendix No. 12 to this Procedure.
The chief doctor of competitions during physical culture and sports events carries out his activities in accordance with Appendix No. 13 to this Procedure.
II. Provision of medical assistance during training training process
17. The provision of medical care during training activities includes: admission to sports and sports competitions, conducting in-depth medical examinations (hereinafter referred to as IMO) of athletes, conducting ongoing medical monitoring of athletes and staged (periodic) medical examinations of athletes, conducting medical pedagogical observations (hereinafter referred to as VPN) for athletes.
18. The provision of medical care during educational and training activities is carried out in order to increase the effectiveness of the educational and training process, the functional capabilities of the body of athletes.
19. In-depth medical examinations of athletes are carried out in outpatient clinics, sports medicine departments (offices) of outpatient clinics, medical and physical education clinics (centers of physical therapy and sports medicine).
20. In-depth medical examinations for athletes of the national teams of the Russian Federation and their reserve staff, as well as for athletes with disabilities (Paralympians, Deaflympics) are carried out according to separate UMO programs.
21. The results of examinations and observations are drawn up in the form of conclusions and protocols and are used in the work of doctors, teachers, trainers and other specialists.
22. The issue of admission to sports is accepted on the basis of an examination of the athlete, provided that there are no morphological and functional abnormalities that, with an increase in the intensity of basal metabolic processes, lead to life-threatening violations of body functions or morphological deviations from the norm.
III. In-depth medical examination of athletes
23. An in-depth medical examination (hereinafter referred to as the IME) of an athlete is carried out in order to obtain the most complete and comprehensive information about the physical development, assessment of the state of health, the functional state of the athlete's body and his performance. physical performance, for which an athlete examination program is drawn up, including:
morphometric examination;
conducting a general clinical examination;
conducting laboratory and instrumental examination;
Assessment of the level of puberty;
research and evaluation of psychophysiological and psychoemotional status;
assessment of the impact of increased physical activity on the function of organs and body systems;
identification of borderline conditions as risk factors for the occurrence of pathology (including a threat to life) during sports;
identification of diseases (including chronic ones in remission) and pathological conditions that are contraindications to sports;
predicting the state of health during regular classes with increased physical activity;
determining the expediency of classes chosen view sports, taking into account the established state of health and the identified functional changes;
24. Based on the results of the ULV, the adequacy of the load on the athlete’s body, the compliance of the load with the functional capabilities of the athlete’s body, the correctness of the load application regimen are assessed in order to allow him to go in for sports and participate in competitions.
25. UMO of athletes is carried out at all stages many years of preparation athletes: sports and health-improving stage, stage initial training, educational and training stage (stage of sports specialization), stage of improvement of sportsmanship, stage of higher sportsmanship.
26. Admission to classes at the sports and recreation stage is carried out on the basis of a conclusion on the state of health from specialists in physical therapy and sports medicine of the departments (offices) of sports medicine of outpatient clinics, medical and sports dispensaries (centers of physical therapy and sports medicine) (Appendix N 1 to this Order).
Stage of initial training (from 1 year to 3 years of sports):
Enrollment in initial training groups (1st year of study) is carried out on the basis of a conclusion on the state of health from specialists in physiotherapy exercises and sports medicine of the departments (offices) of sports medicine of outpatient clinics, medical and physical education dispensaries (centers of exercise therapy and sports medicine) .
EMU involved in groups of initial training (2nd and 3rd year of study) is carried out in the departments (offices) of sports medicine of outpatient clinics, medical and physical education dispensaries (centers of physical therapy and sports medicine).
Educational and training stage (3-5 years of sports):
ULV of those enrolled in training groups is carried out at least twice a year by specialists in physical therapy and sports medicine of the departments (offices) of sports medicine of outpatient clinics, medical and physical education dispensaries (centers of physical therapy and sports medicine).
ULV is carried out on the basis of a program that includes a unified list of types and volumes of medical research. Types and volumes of medical studies of the UMO program are determined taking into account complaints, anamnesis of life, sports anamnesis, age, orientation of the training process, sport, skill level of an athlete.
Stages sports improvement and the stage of higher sportsmanship (5 or more years of playing sports):
UMO of those involved in sports improvement groups and groups of higher sportsmanship is carried out at least twice a year by specialists in physical therapy and sports medicine of the sports medicine departments of outpatient clinics, medical and physical education dispensaries (centers of physical therapy and sports medicine).
27. The UMO program is compiled depending on the stages of training of athletes.
First stage: the program of the first stage is carried out in accordance with Appendix No. 1 to this procedure.
Second phase:
collecting an anamnesis of life;
assessment of the level of physical development;
At this stage, the following are determined:
a) age group taking into account age morphology and physiology:
before school age 4 - 6 years;
junior school age 6 - 11 years;
middle school period 11 - 14 years;
senior school period 14 - 18 years;
youth age 12 - 15 years;
junior age 18 - 21 years.
b) compliance with the age limits for admission to a certain sport.
c) the presence of diseases and pathological conditions that prevent admission to sports.
d) determination of risk factors for the occurrence of pathological conditions (including a threat to life).
e) the level of physical development, taking into account the characteristics that reflect the processes of growth, formation and maturity of certain body systems.
f) the level of puberty, taking into account biological age and assessed by the degree of development of secondary sexual characteristics.
Third stage:
collecting an anamnesis of life;
assessment of the level of physical development, assessment of the level of puberty;
examination by specialist doctors (pediatrician (by age), orthopedic traumatologist, surgeon, neurologist, otorhinolaryngologist, ophthalmologist, cardiologist, psychiatrist, doctors of other specialties for medical reasons);
study of electrophysiological parameters: ECG, EEG, EMG (in violation of muscle function);
ECHO-cardiographic study;
X-ray examinations of organs chest;
clinical and biochemical blood and urine tests;
consultative examination by a sports medicine doctor or a physiotherapy doctor.
At this stage, the following are determined:
c) the level of puberty;
Fourth and fifth stages:
examination of specialists in physical therapy and sports medicine (taking a life history; collecting a sports history; external examination; physical development assessment; health assessment; medical recommendations for correcting the educational and training process; admission to the training process and competitions);
examination by specialist doctors: (pediatrician (by age), neurologist, surgeon, traumatologist-orthopedist, otorhinolaryngologist, ophthalmologist, dentist, obstetrician-gynecologist, urologist, cardiologist; dermatovenereologist);
spirography;
electrophysiological studies (electrocardiography, including with stress tests; daily monitoring of heart rate and blood pressure(for medical reasons);
determination of physical performance when testing on a bicycle ergometer (test PWC170), or a treadmill, or using the Harvard step test;
laboratory tests, including a clinical blood test, a clinical urinalysis, other tests (for medical reasons);
biomechanical studies: plantography, stabilometry (according to medical indications), dynamography, etc.;
x-ray studies (for medical reasons);
ultrasound examinations: echocardiography, incl. with stress tests; ultrasound internal organs; duplex scanning of cerebral vessels, ultrasound (according to medical indications); echoencephalography (for medical reasons);
study of psycho-emotional status;
examination and research by medical specialists (according to medical indications);
other specialized functional studies (for medical reasons), including: computed tomography (CT), magnetic resonance imaging (MRI), electroneuromyography (ENMG), cardiointervalography (CIG), rheovasography; electroencephalography; study of reaction speed; rhythmocardiography.
These steps determine:
a) the presence of diseases and pathological conditions that prevent admission to sports;
c) the degree of development of secondary sexual characteristics;
d) features of physical development at the time of the examination;
e) change in the parameters of physical development depending on the direction of the training process, sportsmanship and the stage of the training process;
f) level functional state organism;
The examination data are entered into the medical control card of the athlete and the athlete or into the medical control card of the athlete's dispensary observation.
IV. In-depth medical examination of athletes of the national teams of the Russian Federation and their reserve staff
28. UMO athletes of the national teams of the Russian Federation and their reserve staff are held in medical organizations.
29. UMO for athletes of the national teams of the Russian Federation and their reserve staff is carried out in order to obtain the most complete and comprehensive information about physical development, assessment of the state of health, the functional state of the athlete's body and indicators of his physical performance.
30. Based on the results of the ULV, the adequacy of the load on the athlete’s body, the compliance of the load with the functional capabilities of the athlete’s body, the correctness of the load application regimen are assessed in order to allow him to go in for sports and participate in competitions.
31. The tasks of the UMO of athletes of the national teams of the Russian Federation and their reserve staff:
determination of risk factors for the occurrence of pathological conditions (including a threat to life);
determination of the level of reserve capabilities of the athlete's body, taking into account the stage of preparation;
conclusion on the admission of an athlete for health reasons and other medical criteria to training sessions and competitions;
the appointment of individual rehabilitation and recovery measures, justified by the identified features of health, functional state, indicators of the body's adaptation to stress.
32. Conducting ULV includes the main program and additional studies and consultations of specialists in addition to the main program, as well as a laboratory program (basic and additional for medical reasons).
33. The UMO program is unified in relation to five groups of sports: cyclic; speed-power; combat sports; sport games; complex coordination.
34. The choice and configuration of examination methods are determined by the individual characteristics of the body of athletes, the presence of chronic, recurrent diseases and a number of other risk factors, the specifics of sports, stages of preparation, additional indications during the examination by individual specialists.
35. Conducting ULV includes the main program:
Consultation of a sports medicine doctor or physiotherapy doctor:
collecting an anamnesis of life;
collection of sports history;
anthropometric surveys;
external examination;
carrying out functional tests;
assessment of physical development;
health assessment;
ultrasound examination of the heart (echocardiography, dopplercardiography) at rest, after exercise - for medical reasons; Ultrasound of the joints - for medical reasons;
rheoencephalography, rheovasography, rheohepatography - according to indications;
electroencephalography according to indications;
For athletes of certain sports, for medical reasons, additional research methods are carried out:
audiometry;
vestibulometry;
study of visual fields;
examination of the fundus and measurement of intraocular pressure;
carrying out coordination;
carrying out a load ergospirometric test: determining the trend of lactic acid in a direct way (excluding the method of express assessment and assessment of the lactate threshold according to oxygen consumption and CO2 curves).
36. Conducting ULV includes additional studies and consultations of specialists over and above the main program of ULV. If there are medical indications, to clarify the diagnosis and prescribe appropriate recommendations for treatment and rehabilitation measures within the framework of the UMO, additional instrumental, laboratory studies and specialist consultations are carried out, including:
computed tomography;
gastroduadenoskopiya;
consultations of specialists, including a psychiatrist, endocrinologist, etc.;
other necessary research and expert advice.
37. Clinical laboratory diagnostics within the framework of ULV is carried out in order to obtain the most complete and comprehensive information about the health and functional state of the athlete's body for the timely detection of prepathological and pathological abnormalities, diagnosis, treatment, and effective management of the training process. Laboratory studies within the UMO include basic and additional laboratory programs.
ULV core laboratory program: the mandatory scope of laboratory tests performed under the ULV for each athlete: urinalysis; clinical blood test on an automatic analyzer with smear microscopy, counting of platelets and reticulocytes and determination of ESR; state of the immune system (subpopulations of lymphocytes: CD3+ (CD4+, CD8+), CD16+, CD19+, IgM, IgA, IgG, IgE, Phagocytosis); functional activity of the pituitary gland (STG, Prolactin, TSH, Cortisol, Testosterone); The state of the thyroid gland (Thyroxine free, AT-TPO, Glucose, Cross Laps); Calcium ionized; Magnesium; Phosphorus; Alkaline phosphatase; Iron; ALT; ACT; Bilirubin total/straight; Urea; Creatinine; total protein; Albumen; Myoglobin; Serotonin; Histamine; lactate; Uric acid; Lipase; GGT (gamma-glutamyl transferase); MB-CPK (cardiac creatine phosphokinase) activity; MB-CPK (cardiac creatine phosphokinase) quantitative analysis; Acid phofatase; LDH (lactate dehydrogenase); Cholesterol; HDL cholesterol fraction; LDL cholesterol fraction; SNP cholesterol fraction; triglycerides; CPK; Antibodies to HIV 1/2; Antibodies to chlamydia trachomatis IgA; Antibodies to chlamydia trachomatis IgG; Anti-HCV with confirmatory test and the following additional tests for anti-HCV positive: HCV RNA, HCV genotype; Antibodies to the causative agent of syphilis (total antibodies); HbsAg antigen with confirmatory test and the following additional tests if Hbs positive: Hbe, anti-Hbe, anti-HBs, anti-Hbcor-IgM, HBV DNA; Chlamydia trachomatis DNA (biological material - epithelial scraping of the urethra/cervical canal); DNA of the causative agent of gonorrhea (biological material - epithelial scraping of the urethra / cervical canal); DNA of the causative agent of trichomoniasis (biological material - epithelial scraping of the urethra / cervical canal); blood type, Rh factor and AT to Rh factor.
Additional ULV laboratory program: one or more studies from the list of additional ULV laboratory tests prescribed by doctors according to indications, in addition to the main ULV laboratory program: indicators of the functional state of the pituitary-gonadal system; indicators of the functional state of the pituitary-thyroid system; indicators of the functional state of the pancreas (assessment of diabetes); indicators of bone tissue metabolism; indicators of the functional state of the pituitary-adrenal system; catecholamines, precursors and derivatives; growth factors; prenatal diagnosis; tumor markers; extended study of the immune status; allergy testing; individual allergens; peptic ulcer; deployed biochemical research blood; lipid spectrum; individual indicators of lipid metabolism; electrolytes and minerals; iron metabolism, hematopoiesis; red blood formula; leukocyte formula; reticulocytes; hemostasis; biochemical studies of urine; urolithiasis disease; clinical examination of urine; androgenic status; helminthic invasions; infectious diseases; immunofluorescent methods (smears); enzyme immunoassay and serological methods; DNA research (PCR diagnostics); bacteriological methods.
38. Based on the results of the UMO, the information received is analyzed and a unified individual conclusion is prepared for each athlete and for the national team as a whole.
39. All data on the results of ULV are entered into the medical control card of the athlete's dispensary observation or into the electronic medical record of the athlete.
V. In-depth medical examination of athletes of the Paralympic and Deaflympics national teams of the Russian Federation and their reserve staff
40. UMO of athletes of the Paralympic and Deaflympic combined teams of the Russian Federation and their reserve staff is held in federal healthcare institutions.
41. UMO for athletes of the Paralympic and Deaflympics national teams of the Russian Federation and their reserve staff is carried out in order to obtain the most complete and comprehensive information about physical development, assessment of the state of health, the functional state of the athlete’s body and indicators of his physical performance, about the most functionally involved physiological systems body of an athlete with disabilities.
42. Based on the results of the ULV, the adequacy of the load on the athlete’s body, the compliance of the load with the functional capabilities of the athlete’s body, the correctness of the load application regimen are assessed in order to allow him to go in for sports and participate in competitions.
43. The tasks of the UMO of athletes of the Paralympic and Deaflympic national teams of the Russian Federation and their reserve staff:
determination of the presence of diseases and pathological conditions that prevent admission to sports, limit sports performance;
determination of risk factors for the occurrence of pathological conditions (including a threat to life);
diagnostics of the athlete's physical development and its changes during the training cycle, depending on the direction of the training process and sportsmanship;
assessment of the level of the functional state of the body, taking into account risk factors, data on the state of health, development of recommendations for correcting individual training plans;
assessment and analysis of the cause of disability, the functional state of the body, macromorphological parameters of the athlete;
determination of the classification group, taking into account the classification used;
assessment and analysis of the cause of hearing loss, assessment of speech skills, assessment of the possibility of using sign language, selection of a hearing aid if necessary (for deaf athletes);
complex diagnostics and assessment of physical performance, determination of the level of reserve capabilities of the athlete's body, taking into account the nature and degree of disability and the stages of training;
forecast for the development of the main physical qualities: speed, endurance, strength, agility, flexibility at the current stage of the training process;
conclusion on the admission of an athlete for health reasons, the assigned classification and other medical criteria for training sessions and competitions;
the appointment of individual rehabilitation and recovery measures, justified by the identified features of health, functional state, indicators of the body's adaptation to stress.
44. Conducting ULV includes the main ULV program and additional studies and consultations of specialists in addition to the main ULV program, as well as the ULV laboratory program (basic and additional for medical reasons).
45. The choice and configuration of examination methods are determined by the individual characteristics of the body of athletes, the presence of chronic, recurrent diseases and a number of other risk factors, the specifics of sports, stages of preparation, additional medical indications during the examination by individual specialists.
46. Conducting ULV includes the main program:
Consultation of specialists in physical therapy and sports medicine:
collecting an anamnesis of life;
collection of sports history;
anthropometric surveys;
external examination;
carrying out functional tests;
assessment of physical development;
health assessment;
admission to the training process and competitions;
analysis of the information received with a unified individual conclusion for each athlete and for the national team as a whole.
Consultations of specialist doctors: cardiologist, therapist, surgeon, pediatrician (by age), traumatologist-orthopedist, neurologist, dentist, otorhinolaryngologist, ophthalmologist, obstetrician-gynecologist, dermatovenereologist, medical psychologist, urologist, endocrinologist (for medical reasons). If necessary, doctors of other specialties are involved.
Functional diagnostic studies:
chest x-ray once a year;
radiography of various departments of the musculoskeletal system (according to medical indications);
ECG study at rest in standard leads;
computer spirography with the study of volume and speed parameters of vernal respiration (including using functional tests and diagnostic pharmacological tests);
Ultrasound of internal organs (liver, biliary tract, kidneys, pancreas, spleen, prostate, pelvic organs and mammary glands, thyroid gland);
ultrasound examination of the heart (echocardiography, dopplercardiography) at rest, after exercise - for medical reasons;
Ultrasound of the joints - for medical reasons;
rheoencephalography, rheovasography, rheohepatography - according to medical indications;
electroencephalography for medical reasons;
a set of methods for studying the neuromuscular apparatus - electroneuromyoreflexography with magnetic stimulation (according to medical indications);
testing physical performance and tolerance to physical activity with gas analysis: bicycle ergometric test, running on a treadmill with submaximal (PWC170) or maximum loads (until giving up work);
special load tests according to the direction of the training process and the type of sports affiliation - is determined by the stages of preparation, the specifics of sports.
For athletes of certain sports, for medical reasons, additional medical examination programs are carried out, unified in relation to Deaflympics and Paralympic athletes, which include the following examination methods:
ultrasound examination of the lower or upper limbs(UZDG) - POD;
additional examinations by a neurologist: Ashforth test for assessing muscle tone, for assessing muscle strength - the scale of the Committee of Medical Research, the VAS scale (visual analog scale) - for assessing pain - POD;
testing: the Hamilton test determines the level of depression, the scale for assessing the level of reactive and personal anxiety Ch.D. Spielberg and Yu.L. Khanina - PODA, Paralympic athletes with visual impairment;
load test for power simulator with simultaneous registration of force, speed and power muscle contractions and ECG - POD;
in-depth examination by an ophthalmologist: electroretinography, study of visual evoked potentials, ultrasound biometrics - Paralympic athletes with visual impairment;
MRI of the brain - Paralympic athletes with visual impairment;
a full-fledged stress test (in the absence of contraindications from a sports doctor and an ophthalmologist) - ergospirography / PWC170 - Paralympic athletes with visual impairment;
in-depth examination by a neurologist: testing on one of the selected scales: to assess neurological functions - the Canadian neurological scale, the scale of the American Spinal Injury Association, the international classification of cerebral palsy, to assess the safety of cognitive processes - the NINDS-AIREN, MMSE scales; quality of life - SF-36; for rate motor activity Tinetti scale, UPDRS-III, Rivermead, Frechai test; to assess muscle tone - Ashforth test - Paralympic athletes with cerebral palsy;
ultrasound examination (dopplerography of cerebral vessels) - Paralympic athletes with cerebral palsy;
rheoencephalography - Paralympians with cerebral palsy;
in-depth examination by an audiologist-otorhinolaryngologist: collecting an auditory history, assessing hearing perception, determining hearing thresholds for air and bone conduction, assessing the qualitative and quantitative characteristics of hearing loss, assessing sign language skills, general communication skills - deaflympians;
carrying out a load ergospirometric test: determination of the trend of lactic acid in a direct way (excluding the method of express assessment and assessment of the lactate threshold according to the curves of oxygen consumption and CO2) - Deaflympics of cyclic sports.
47. Conducting ULV includes additional research and expert advice over and above the main ULV program. In the presence of medical indications, in order to clarify the diagnosis and prescribe appropriate recommendations for treatment and rehabilitation measures within the framework of UMO, additional instrumental, laboratory studies and specialist consultations are carried out, including:
magnetic resonance imaging;
computed tomography;
gastroduadenoskopiya;
evaluating the strength of the muscles of the limbs, identifying hidden joint damage, determining the angular velocity of contraction of individual muscle groups when testing in the isokinetic mode and the rate of contraction of 30 and 60 degrees per minute for any limb;
determination of the mobility and strength of the muscles of the spine, including mandatory testing of various parts of the spine in a three-dimensional assessment system;
cytochemical analysis of the activity of mitochondrial enzymes of lymphocytes to determine the "mitochondrial index";
consultations of medical specialists, including a psychiatrist, an endocrinologist;
other necessary studies and consultations of medical specialists.
48. Clinical laboratory diagnostics within the framework of ULV is carried out in order to obtain the most complete and comprehensive information about the health and functional state of the athlete's body for the timely detection of prepathological and pathological abnormalities, diagnosis, treatment, and effective management of the training process. Laboratory studies within the UMO include basic and additional laboratory programs.
ULV core laboratory program: the mandatory scope of laboratory tests performed under the ULV for each athlete: Complete urinalysis; Clinical blood test on an automatic analyzer with smear miroscopy, platelet and reticulocyte count and ESR determination; The state of the immune system (Subpopulations of lymphocytes: CD3+ (CD4+, CD8+), CD16+, CD19+, IgM, IgA, IgG, IgE, Phagocytosis); Functional activity of the pituitary gland (STG, Prolactin, TSH, Cortisol, Testosterone); The state of the thyroid gland (Thyroxine free, AT-TPO, Glucose, Cross Laps); Calcium ionized; Magnesium; Phosphorus; Alkaline phosphatase; Iron; ALT; ACT; Bilirubin total/straight; Urea; Creatinine; total protein; Albumen; Myoglobin; Serotonin; Histamine; lactate; Uric acid; Lipase; GGT (gamma-glutamyl transferase); MB-CPK (cardiac creatine phosphokinase) activity; MB-CPK (cardiac creatine phosphokinase) quantitative analysis; Acid phofatase; LDH (lactate dehydrogenase); Cholesterol; HDL cholesterol fraction; LDL cholesterol fraction; SNP cholesterol fraction; triglycerides; CPK; Antibodies to HIV 1/2; Antibodies to chlamydia trachomatis IgA; Antibodies to chlamydia trachomatis IgG; Anti-HCV with confirmatory test and the following additional tests for anti-HCV positive: HCV RNA, HCV genotype; Antibodies to the causative agent of syphilis (total antibodies); HbsAg - antigen with a confirmatory test and the following additional tests with a positive result for Hbs: Hbe, anti-Hbe, anti-HBs, anti-Hbcor-IgM, HBV DNA; Chlamydia trachomatis DNA (biological material - epithelial scraping of the urethra/cervical canal); DNA of the causative agent of gonorrhea (biological material - epithelial scraping of the urethra / cervical canal); DNA of the causative agent of trichomoniasis (biological material - epithelial scraping of the urethra / cervical canal); Blood type, Rh factor and AT to Rh factor.
Additional ULV laboratory program: one or more studies from the list of additional ULV laboratory tests prescribed by doctors for medical reasons, in addition to the main ULV laboratory program: indicators of the functional state of the pituitary-gonadal system; indicators of the functional state of the pituitary-thyroid system; indicators of the functional state of the pancreas (diabetes assessment); indicators of bone tissue metabolism; indicators of the functional state of the pituitary-adrenal system; catecholamines, precursors and derivatives; growth factors; prenatal diagnosis; tumor markers; extended study of the immune status; allergy testing; individual allergens; peptic ulcer; detailed biochemical blood tests; lipid spectrum; individual indicators of lipid metabolism; electrolytes and minerals; iron metabolism, hematopoiesis; red blood formula; leukocyte formula; reticulocytes; hemostasis; biochemical studies of urine; urolithiasis disease; clinical examination of urine; androgenic status; helminthic invasions; infectious diseases; immunofluorescent methods (smears); enzyme immunoassay and serological methods; DNA research (PCR diagnostics); bacteriological methods.
49. Based on the results of the UMO, the information received is analyzed and a unified individual conclusion is prepared for each athlete and for the national team as a whole.
50. All data on the results of ULV are entered into the medical control card of the athlete's dispensary observation or into the electronic medical record of the athlete.
VI. Current medical observations and periodic medical examinations (examinations) of athletes
52. Tasks of TMP:
individualization and improvement of the efficiency of the process of preparation and recovery measures;
determining the level of functional readiness (mainly the degree of severity of delayed post-load changes in the functional state of the leading organs and systems), making corrections in individual plans health-informed training;
determining the athlete's admission for health reasons to training sessions and competitions;
53. TMN is carried out by specialists in physical therapy and sports medicine.
54. In the course of TMT, regardless of the specifics of the training loads performed, the functional state is assessed: the central nervous system (CNS); autonomic nervous system; of cardio-vascular system; musculoskeletal system.
55. When performing loads aimed at developing endurance, the following are controlled: morphological and biochemical composition of blood; acid-base state of the blood; urine composition.
56. When performing speed-strength loads, the functional state of the neuromuscular system is controlled.
57. When performing complex coordination loads, the following are controlled: the functional state of the neuromuscular apparatus; functional state of analyzers (motor, vestibular (results of rotational tests), visual).
58. The conclusion based on the results of TMN includes: a comprehensive analysis of the examination of athletes, on the basis of which they evaluate: the level of functional state and general performance; the level of urgent and delayed training effect of physical activity; conclusion on the conducted TMN of athletes and preparation of relevant documentation.
59. On the basis of the conclusion, individual recommendations are made: on the correction of the training process; on therapeutic and preventive measures; on the use of selective methods for restoring the functions of individual systems; for the correction of the plan of medical and biological support.
60. A staged (periodic) medical examination of athletes (hereinafter - EA) is carried out at various stages sports training, as well as after short-term mild illnesses. During the competition period, it can be carried out in a reduced volume, taking into account the need and the tasks set.
61. The main purpose of EE is to assess, upon admission to physical culture and sports, the state of health, the level of physical development, the functional capabilities of body systems and general physical performance.
62. Depending on the specifics of each sport, as well as taking into account the individual characteristics of the athlete, an EA program is drawn up, according to which EA is carried out at least 4 times a year, depending on the number of training stages during the annual cycle.
63. In the process of EA, the level of health, physical performance and fitness of athletes is determined after the completion of a certain stage of training.
64. Registered: general physical performance; functionality of the leading body systems for the chosen sport; special performance.
65. Specialists in physical therapy and sports medicine, on the basis of medical records, the health status of the athlete and the recommendations of the coach and team doctor, determine the procedure and level of examination depending on the sport, the level of sportsmanship, the health status and physical development of the athlete.
66. To the leading functional systems that determine the level sports achievements, relate:
systems responsible for maintaining homeostasis; the cardiovascular system, respiratory system; central nervous system; neuromuscular apparatus, when performing cyclic work of high and submaximal power;
cardiovascular system, respiratory system; endocrine system; the central nervous system, when performing cyclic work of moderate power;
central nervous system; neuromuscular apparatus; sensory systems, when performing acyclic exercises of various types.
67. After the examinations, an individual conclusion is issued, which includes information about the state of health, physical development, physical performance, examinations, and admission to further sports.
68. If a pathology is detected, the athlete receives recommendations for further examination and rehabilitation or is sent to a medical organization.
VII. Medical and pedagogical observations of persons involved in physical culture and sports
69. Medical-pedagogical observations (hereinafter referred to as MTS) of persons involved in physical culture and sports consist in the joint control by specialists in physical therapy and sports medicine and a coach over the progress of the training process of an athlete or the exercise of an athlete.
70. In the process of PT, specialists in physical therapy and sports medicine determine the functional characteristics of the body of an athlete or athlete, the characteristics of reactions during various periods of training, before, during and after the competition, during the recovery period.
71. VPN are carried out:
in the process of training athletes to determine the level of readiness and evaluate the effectiveness of the adopted training methodology;
when organizing classes with children and adolescents in order to determine right system classes;
if it is necessary to resolve the issue of the possibility of early sports specialization.
72. On the basis of the data of the WPT, specialists in physical therapy and sports medicine assess the degree of compliance of the training process with the level of the health status of an athlete or athlete, his physical development and fitness, and give recommendations on the regimen and methodology of training.
73. The purpose of carrying out the PT is to determine the level of adaptation of an athlete (athlete) to physical loads in conditions sports training and development of individualized plans to restore or improve performance based on current observations.
74. Tasks of the VPN:
sanitary and hygienic assessment of places for sports and physical education in accordance with the requirements: air temperature and humidity, illumination and size of the room, equipment;
identification of the compliance of the lesson with the established hygienic and physiological standards;
study of the influence of training and competitive loads on the body of a sportsman or athlete;
assessment of the organization and methods of training;
determination of the functional state and fitness of an athlete;
prevention of sports injuries;
sanitary and educational work with athletes (athletes) (explanations are given on the daily routine, the rational use of hardening factors, the importance of athlete's self-control, balanced nutrition).
75. PTs are held at physical education classes in preschool institutions, schools, secondary and higher professional educational institutions at least 2 times a year, training in youth sports schools ah, at the training camp according to the plan drawn up by the physiotherapy and sports medicine specialists and the coach.
76. VPN is carried out by specialists with appropriate training and certificates in the specialty " physiotherapy and sports medicine", nurses working in the departments of sports medicine of the VFD (centers of physical therapy and sports medicine) according to a plan agreed with specialists in physical therapy and sports medicine. sports medicine departments of sports medicine of municipal and regional WFD.
77. VPN are carried out in several stages:
Stage 1: determination of conditions in the places of training (temperature, air humidity, condition of the places of employment, sports equipment, clothes and shoes of those involved, the availability of the necessary protective equipment), assessment of the correctness of the recruitment of groups of students (age, gender, health, level of preparedness);
Stage 2: studying the plan of the lesson, the volume and intensity of the load, the sequence of exercises, the nature of the introductory and final parts, timing the work of the subjects;
Stage 3: study of the initial state, reaction to the load and the course of the recovery processes of the examined athlete or athlete;
Stage 4: drawing up a "physiological" curve training session, reflecting a different degree of impact on the body, and schemes for constructing classes;
Stage 5: analysis of the obtained data of medical and pedagogical observations with a trainer (teacher) to make the necessary adjustments to the training plan (classes). Determining the timing of repeated and additional examinations (if there are deviations in the state of health).
78. On the basis of the conducted research, medical recommendations are drawn up on the regimen of training (classes).
79. The medical opinion is discussed with the coaches (teachers), as well as with the athlete (athlete). Specialists in physical therapy and sports medicine promptly inform the coach (teacher) about all the changes that have occurred in the state of the athlete (athlete).
80. Based on the results, the coach, together with specialists in physical therapy and sports medicine, plans the training process, participates in the preparation of long-term and current training plans (sessions), paying attention to ensuring an individual approach. According to the results of current observations, appropriate adjustments are made to the plans of the training process.
VIII. Provision of medical care during rehabilitation measures after intense physical exertion in sports, after illnesses and injuries in athletes
81. The purpose of recovery measures after intense physical exertion is to maintain and improve the functional state and athletic form of an athlete in any given period of time, who trains in accordance with the cycle of the training process and competes in accordance with calendar plan competitions at various levels.
82. A coach, a team doctor, a clinical pharmacologist, a biomechanic, a physiotherapist, a massage therapist, a dietitian, a reflexologist, a medical psychologist, specialists in medical profiles, in accordance with medical indications.
83. To carry out rehabilitation measures after intense physical exertion, the possibilities of a medical center of a sports facility, a medical and physical education dispensary, a center for physical therapy and sports medicine, and a rehabilitation department of a medical organization are used.
84. The provision of medical care during rehabilitation measures after intense physical exertion in sports, after illnesses and injuries in athletes is carried out taking into account the determination of the volume and nature of diagnostic and rehabilitation measures and depends on the nature, extent of damage, the timing of the disease and the stage of sports training.
85. Diagnosis of the consequences of injuries and diseases in athletes includes, along with clinical, instrumental and laboratory methods, an assessment of dysfunction of the affected organ or system, including using instrumental methods of functional diagnostics, biomechanical examination in terms of changes in general and special performance, changes in function an athlete who has suffered as a result of an illness or injury relevant to the implementation of sports activities.
86. A necessary condition for the recovery of an athlete in case of diseases and injuries is adequate to his functional status and taking into account the specifics of the sport, the motor regime and other types of physical activity at all stages of recovery. To implement this condition, a individual program rehabilitation of an athlete, which takes into account the clinical course of the disease or injury, functional status and sport.
87. The rehabilitation program for an athlete is compiled jointly by specialist doctors (taking into account the nature of the pathology): specialists in physical therapy and sports medicine, a functional diagnostics doctor, a physiotherapist (for medical reasons), a chiropractor (for medical reasons), a reflexologist (for medical reasons). indications), a psychotherapist (for medical indications), an occupational pathologist (for medical indications), an orthopedic traumatologist (for medical indications) and an athlete coach. To assess the functional status in the recovery process, doctors-specialists in laboratory diagnostics, radiation and ultrasound diagnostics can be involved.
Appendix N 1 to the Order
Regulations on the organization of medical examination (examination) of persons involved in physical culture and mass sports
1. The purpose of a medical examination (examination) for admission to physical culture and participation in mass sports competitions is to determine the state of health of an athlete, assess the level of his physical development and functional capabilities in order to allow him to engage in mass sports and physical culture.
2. Tasks of medical examination (examination) for admission to mass sports and physical culture:
assessment of the level of physical development;
determination of the level of general fitness;
identification of borderline conditions as risk factors for the occurrence of pathology (including a threat to life) during physical education;
identification of diseases (including chronic in remission) and pathological conditions that are contraindications to physical education;
determining the expediency of practicing a chosen type of physical culture, taking into account the established state of health and the identified functional changes;
3. The examination of persons involved in physical culture and mass sports is carried out on the basis of the program, the types and scope of medical examinations are determined taking into account:
age;
collection of anamnesis of life and sports anamnesis;
level of physical development;
the level of puberty (for children and young men);
examinations by specialist doctors: traumatologist-orthopedist, surgeon, neurologist, otorhinolaryngologist, ophthalmologist, cardiologist, obstetrician-gynecologist and other specialist doctors in accordance with medical indications;
studies of electrophysiological parameters (ECG, including those with stress tests);
ECHO-cardiographic studies, including with a load;
radiographic studies of the chest;
clinical blood and urine tests;
examination of specialists in physiotherapy exercises and sports medicine.
4. Based on the results of a medical examination (examination), specialists in physical therapy and sports medicine draw up a medical report, where the functional state is assessed as insufficient, satisfactory, quite satisfactory or good.
5. On the basis of a medical report, specialists in physiotherapy exercises and sports medicine determine belonging to a functional group:
Group 1 - physical education classes without restrictions and participation in competitions are possible,
Group 2 - physical training is possible with minor restrictions on physical activity without participation in competitions,
Group 3 - physical training is possible with significant restrictions on physical activity,
Group 4 - classes in therapeutic physical culture are possible.
6. Based on the results of the medical examination (examination) of the athlete, recommendations are given on the need for additional examination. Persons assigned to groups 3 and 4 are subject to additional examination at least once every 3 months.
7. The results of a medical examination (examination) are entered into the medical control card of an athlete and an athlete or into the medical control card of an athlete's dispensary observation.
Appendix N 2 to the Procedure
Regulations on the organization of the activities of a doctor in sports medicine
1. This Regulation regulates the issues of organizing the activities of a doctor in sports medicine.
2. A specialist is appointed to the position of a sports medicine doctor who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 N 415n (registered by the Ministry of Justice of Russia on July 9, 2009, registration N 14292), majoring in exercise therapy and sports medicine.
3. A sports medicine doctor carries out his activities in the medical center of the sports facility, the department (office) of sports medicine of medical and physical education dispensaries or other medical organizations and sports teams and clubs.
4. A sports medicine doctor during physical culture and sports competitions reports to the head doctor of the competition.
5. During the competition, a sports medicine doctor provides medical assistance to athletes and other participants in the competition in accordance with the established standards of medical care.
6. A sports medicine doctor performs the following functions:
access to classes and competitions;
organization and implementation of medical control over the health of persons involved in physical culture and sports;
study and analysis of deviations in the state of health, the level and causes of morbidity and sports injuries among people involved in sports and physical culture, the development and implementation of measures for prevention and treatment;
organization and implementation of therapeutic and preventive measures to restore and improve sports performance and rehabilitation after illnesses and injuries using rehabilitation methods and means, as well as using pharmacotherapy;
analysis of the results of the examination in order to draw up a program of rehabilitation or correction of the training process;
maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by the legislation of the Russian Federation;
observance of ethical norms and rules of conduct of a sports doctor within the framework of professional autonomy when making all decisions of a medical nature relating to the health, safety and legitimate interests of an athlete.
Appendix N 3 to the Procedure
Regulations on the organization of the activities of the department (office) of sports medicine
1. This Regulation governs the organization of the activities of the department (office) of sports medicine of a medical organization (hereinafter referred to as the Department).
2. The department of sports medicine is created as part of a medical and physical education dispensary (center for sports medicine and physiotherapy exercises) or other medical organization to provide medical care to people involved in physical culture and sports.
The Department of Sports Medicine is a structural subdivision of outpatient clinics, medical and physical education dispensaries (centers of exercise therapy and sports medicine).
3. The structure and staffing of the medical personnel of the Department are established by its head based on the volume of medical and diagnostic work carried out and the number of the population served.
4. The department of sports medicine is managed by the head of the department, who is appointed to the position and dismissed from the position by the head of the medical organization in which it was created.
5. The department coordinates its activities with physical culture and sports institutions/organizations, educational and other professional institutions and organizations, as well as with other departments of the organization in which it was created.
6. The Department of Sports Medicine performs the following tasks and functions:
medical support for people involved in physical culture and sports;
prevention of diseases and injuries, incl. with disability in athletes in connection with sports;
health improvement of children and youth at stages physical education, increasing the effectiveness of the use of physical culture for the preservation and restoration of public health;
conducting medical examinations of athletes and persons assigned to the department, including an in-depth medical examination (including an initial examination before the start of sports), milestone (periodic) medical examinations, pre-competitive examinations, current examinations, additional medical examinations;
carrying out urgent medical control, including medical and pedagogical supervision;
examination of sports ability to work;
control over the medical support of training sessions in institutions and organizations of physical culture and sports orientation, including preventive sanitary supervision;
medical support for people involved in sports at training camps in sports and recreation camps;
provision of primary health care, including emergency medical care to athletes in life-threatening conditions and their referral for hospitalization;
conducting consultations with the population of various age groups with the preparation of recommendations for wellness motor modes hardening, the use of means and methods of physical culture and sports in order to form health among different age groups of the population;
implementation of consultations of students of educational institutions in order to determine the medical group for physical education;
carrying out activities for the early detection of diseases associated with the possible adverse effects of excessive physical exertion on the body of those involved, especially children and young men,
analysis of the activities of the department and the development of measures to improve it;
making proposals for optimizing and improving the efficiency of medical support for people involved in physical culture and sports, introducing new medical and diagnostic technologies into practice;
assessment of the quality of medical care, development and implementation of measures to improve the diagnostic and treatment process;
maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by the legislation of the Russian Federation.
7. The department can be used as a clinical base for educational institutions of secondary, higher and additional professional education, as well as scientific organizations.
8. The department coordinates its activities with sports, educational, public and other organizations in order to optimize their activities.
Appendix N 4 to the Procedure
Regulations on the organization of the activities of the organizational and methodological department (office) of the medical and sports dispensary, the center of physical therapy and sports medicine
1. This regulation governs the organization of the activities of the organizational and methodological department (office) (hereinafter referred to as the Department) of the medical and physical education dispensary (center for physical therapy and sports medicine).
2. The department is a structural subdivision of the medical and sports dispensary (the center of physical therapy and sports medicine).
3. The department is headed by a head appointed to and dismissed by the head of the organization in whose structure it was created.
4. The structure and staffing of the medical personnel of the Department are established by its head based on the volume of ongoing medical and diagnostic work and the number of people served.
5. The department performs the following tasks and functions:
conducting, together with other departments and specialists, an analysis of the activities of the Dispensary (Center) and medical organizations of the administrative territory for medical support of people involved in physical culture and sports; the use of means and methods of physical therapy for the purpose of rehabilitation of sick and disabled people, as well as work to attract the population to physical education and make appropriate proposals;
studying the activities of preschool, educational, physical culture and sports and other organizations and departments on issues within the competence, developing and participating in the implementation of comprehensive measures to improve the health of various groups of the population using the means and methods of physical culture, including medical;
organizing and assessing the completeness and timeliness of medical examination, treatment and rehabilitation of attached contingents, the validity of admission for medical reasons to classes and competitions in sports and physical education;
coordination of work carried out in the administrative territory for the training, retraining and advanced training of specialists in sports medicine, physiotherapy exercises and medical massage;
organization of conferences, meetings, seminars of specialists and sanitary and educational work on the profile of activity;
ensuring control over the introduction of modern methods of examination, treatment and rehabilitation of athletes, as well as sick and disabled people using means and methods of physical therapy;
participation in the analysis of statistical reports of medical organizations of the administrative territory in the field of "sports medicine";
formation and updating of the library of medical literature, including scientific and methodological literature, as well as the legislative and regulatory framework in the area of activity and providing the opportunity for their study by specialists;
interaction with medical, sports, educational, public and professional organizations in the field of activity.
6. The department maintains accounting and reporting documentation, provides reports on activities in the prescribed manner, collects data for registers, the maintenance of which is provided for by the legislation of the Russian Federation.
Appendix N 5 to the Procedure
Regulations on the organization of the activities of a medical and physical education dispensary (center for physical therapy and sports medicine)
1. This Regulation governs the organization of the activities of a medical and physical education dispensary (center for physical therapy and sports medicine) (hereinafter referred to as the VFD).
2. VFD is created to provide primary health care and / or specialized medical care to people involved in physical culture and sports.
3. The structure and staffing of medical personnel of the VFD are established by its head based on the volume of treatment and diagnostic work carried out and the number of people served, taking into account the recommended structure and staffing standards of medical personnel.
4. WFD coordinates activities in the field of work with medical, sports, educational, public and other organizations in order to optimize the ongoing activities.
5. WFD provides medical support for people involved in physical culture and sports, organizational and methodological management of the activities of institutions/organizations, units that provide medical support for people involved in physical culture and sports, as well as using methods of physical therapy in the rehabilitation treatment of various age groups of the population.
6. The management of the WFD is carried out by the chief physician, who is appointed to the post and dismissed from the post by the health management body.
7. VFD performs the following tasks and functions:
medical support for people involved in sports and physical culture;
prevention of diseases and injuries, including disability among athletes in connection with playing sports;
health improvement of children and youth at the stages of physical education;
increasing the effectiveness of the use of physical culture, incl. physiotherapy exercises to preserve and restore the health of the population;
conducting medical examinations of persons assigned to the WFD, including: in-depth medical examination (including primary examination before the start of sports), milestone medical examinations, pre-competitive examinations, current examinations, additional medical examinations;
carrying out urgent control, including medical and pedagogical supervision;
implementation of dispensary monitoring of the health status of athletes, timely examination, treatment and recovery;
conducting an examination of sports ability to work, temporary disability, sending athletes for medical and social examination;
participation in the medical and pedagogical selection of persons when enrolling in institutions and organizations of a sports orientation, holding consultations on the choice of the type of sports specialization based on the data obtained as a result of examination and testing;
medical rehabilitation of the attached contingent;
control over the medical support of training sessions in institutions and organizations of the physical culture and sports profile; including preventive sanitary supervision;
medical support for people involved in sports at training camps, in sports camps;
conducting medical and sanitary support for sports competitions, sports events;
providing medical assistance to athletes in life-threatening conditions, sending them to hospitalization;
consultative reception of the population of various age groups with the issuance of recommendations on health-improving motor regimes, hardening, the use of means and methods of physical culture and sports in order to form health among various age groups of the population;
implementation of methodological guidance in matters of medical support for classes in the discipline "Physical Education" in educational institutions of various levels with a focus on the organization of classes with persons assigned to a special medical group for health reasons;
organizational and methodological guidance and medical control over the activities of medical and physical education dispensaries (departments, offices), medical centers of institutions and organizations of a physical culture and sports profile, departments (offices) of physiotherapy exercises of medical organizations that carry out medical rehabilitation, including rehabilitation treatment of patients, disabled people , persons affected by other adverse factors;
consulting students of educational institutions in order to determine the medical group for physical education in difficult cases;
analysis of physical development, health status, morbidity and injuries of people involved in sports, development and implementation of therapeutic and preventive measures to prevent injuries, morbidity, states of overstrain and overtraining when playing sports;
taking measures for the early detection of diseases associated with the possible adverse effects of excessive physical exertion on the body of those involved, especially children and young men;
studying the influence of physical culture and sports on health and physical development;
analysis of the activities of the institution and development of measures to improve it;
carrying out sanitary and educational work on the formation healthy lifestyle life, improvement of various age groups of the population by means of physical culture and sports;
organization and holding of seminars, meetings on the issues of medical control over people involved in physical culture and sports, preservation and strengthening of their health by means of physical culture, including physiotherapy exercises, for employees of medical, educational institutions of various levels, organizations and institutions of a physical culture and sports profile ; participation in the work of professional associations of specialists in sports medicine and rehabilitation of sick and disabled people;
making proposals for optimizing and improving the efficiency of medical support for people involved in physical culture and sports, introducing new medical and diagnostic technologies into practice;
assessment of the quality of medical care, development and implementation of measures to improve the diagnostic and treatment process.
8. VFD can be used as a clinical base for educational institutions of secondary, higher and additional professional education, as well as scientific organizations.
9. In the structure of the VFD, which is under the authority of the executive authority in the field of health care of a constituent entity of the Russian Federation with a population of over 500 thousand inhabitants, it is recommended to provide:
Department of Sports Medicine for Adults
Department of Sports Medicine for Children and Youth
Department of Sports Medicine Paralympic and Deaflympic Sports
Department of Functional Diagnostics
Department of Sports Biomechanics
Department of Endoscopy
Department of Radiation Methods of Diagnostics (radiography, computed and magnetic resonance imaging, sonography)
Department of Laboratory Diagnostics (Department of General Clinical Research Methods, Biochemical Diagnostic Methods, Immunological)
Department of Physiotherapy
Day hospital
Hospital of therapeutic and surgical profile
Department of sports orthotics
Laboratory for increasing functional reserves
Sports nutrition department
Department of Manual Correction Methods
Department of Prevention
Telemedicine Center
Scientific and organizational department
Organizational and methodological department
Editorial and publishing department
Administrative and economic divisions
Food unit.
10. In the structure of the VFD, which is under the jurisdiction of a municipality with a population of less than 500 thousand inhabitants, it is recommended to provide for:
Department of medical control for adults
Department of medical control for children and youths
Department of physical therapy for adults
Department of physiotherapy exercises for children and youths
Department of Sports Medicine
Department of Physiotherapy
Department of Functional and Laboratory Diagnostics
Prevention cabinet
Telemedicine cabinet
Day hospital
Organizational and methodological office
Administrative and economic divisions.
Appendix N 6 to the Procedure
Standard for equipping a medical and physical education dispensary, a center for physical therapy and sports medicine
I. Diagnostic equipment:
A set of equipment for examination by medical specialists
A set of equipment for functional diagnostics
Set of equipment for endoscopic diagnostics
Set of equipment for biomechanical testing
Set of equipment for electroneurophysiological diagnostics
Set of equipment for laboratory diagnostics
Set of equipment for radiation diagnostics
Set of equipment for ultrasound diagnostics
Set of equipment for neuropsychological diagnostics
II. Medical equipment
Set of equipment for sports orthotics
Equipment for individual therapeutic gymnastics rooms
Equipment for group therapeutic gymnastics halls
Gym equipment
Equipment for mechanotherapy rooms (including robotic)
Equipment for postural therapy and manipulations on the spine
Equipment for training with biofeedback
Equipment for hydrokinesitherapy
Ergotherapy equipment
Equipment for the development of fine motor skills
Equipment for the recovery of special sports skills
Equipment for the use of natural and preformed factors of nature (electrotherapy, microwave therapy, phototherapy, cryo-heat therapy, magnetotherapy, halotherapy, mechanical action, inhalation, hydrotherapy, for dry carbon dioxide baths)
Massage equipment
Reflexology equipment
Equipment for psychotherapy
Orthosis set
Crutches, medical canes, walkers
III. Other equipment
Office equipment (system unit, monitor, printers, scanners, keyboard, etc.)
telemedicine center
TVs
Equipment for creating a unified information network
Appendix N 7 to the Order
Recommended staffing standards for medical personnel of medical and physical education dispensaries, centers for physical therapy and sports medicine, departments (offices), methodological rooms of medical institutions
Medical staff
1. The positions of doctors in sports medicine are established at the rate of 1 position for:
a) 200 Honored Masters of Sports, Masters of Sports of International Class, Masters of Sports, Candidates for Master of Sports, 1st category athletes, school students Olympic reserve, schools of higher sportsmanship, boarding schools of the Olympic profile, colleges of the Olympic reserve;
b) 400 students of specialized children's and youth sports schools of the Olympic reserve, children's and youth sports schools, Paralympic training centers, centers of physical culture, sports and health;
c) 2,000 people involved in sports in physical culture and sports institutions, and other institutions and organizations of various organizational and legal forms of ownership;
d) 250 thousand people of the urban population living on the territory of the dispensary (center);
e) 250,000 people living in the districts of the region, living on the territory of the dispensary (center).
2. The positions of doctors in physical therapy are established at the rate of 1 position for:
a) 4 positions of sports medicine doctors, relying in accordance with subparagraphs "a", "b", "c", "d", "e" of paragraph 1 of this section;
b) 125 thousand people of the urban population living in the territory of the dispensary (center).
If other medical institutions (subdivisions) of the city (urban administrative district) are attached to the dispensary (center) to provide appropriate medical care, the positions of doctors in physical therapy, which are due to these institutions according to the staffing standards in force for them, may be introduced into its staff.
3. Positions of doctors: traumatologists-orthopedists, surgeons, ophthalmologists, neurologists, obstetricians-gynecologists, otolaryngologists, cardiologists, therapists, pediatricians, dermatovenereologists, manual therapy, nutritionists, dentists, endocrinologists, urologists, psychotherapists are established at the rate of 1 position of all these specialists per 2000 Honored Masters of Sports, Masters of Sports of International Class, Masters of Sports, Candidates for Master of Sports, Athletes of the 1st Category, Students of Olympic Reserve Schools, Schools of Higher Sportsmanship, Olympic Boarding Schools, Olympic Reserve Colleges, Students of Specialized Children and Youth Sports Schools of the Olympic reserve, youth sports schools, Paralympic training centers, centers of physical culture, sports and health.
4. The positions of doctors: in physiotherapy exercises, in sports medicine, doctors and methodologists in physiotherapy exercises and sports medicine to provide advisory assistance, organizational and methodological work and service for national teams and leading athletes are established in the staff of one of the medical and physical education dispensaries (centers) city, regional, regional, republican subordination at the rate of 1 position per 100 thousand of the population attached to the indicated dispensary (center) for these types of assistance.
5. The positions of laboratory doctors are established at the rate of 1 position for 5 positions of sports medicine doctors.
6. The positions of radiologists are established at the rate of 1 position for 20 positions of sports medicine doctors.
7. The positions of physiotherapists are established at the rate of 1 position for 5 positions of sports medicine doctors.
8. The positions of doctors of functional diagnostics are established at the rate of 1 position for 2 positions of doctors in sports medicine.
9. The positions of heads of departments are established depending on the number of positions of doctors provided for the dispensary (center) according to these staffing standards.
a) head of the sports medicine department:
from 3 to 6 positions of doctors in children's sports medicine - instead of one medical position;
from 6.5 to 10 positions of doctors in sports medicine - instead of 0.5 positions of a doctor;
more than 10 positions of doctors in sports medicine - in addition to the indicated positions.
Two of these departments for providing medical care to the adult population or two children's departments with the establishment of the position of the head in each of them are organized in dispensaries (centers), which are entitled to more than 20 corresponding medical positions;
b) the position of the head of the department of physical therapy:
from 3 to 7 positions of doctors in physiotherapy exercises - instead of 1 medical position;
from 7.5 positions of doctors in physiotherapy exercises - instead of 0.5 positions of a doctor.
10. The position of the head of the X-ray, physiotherapy room, laboratory is established instead of 1 position of a doctor of the corresponding specialty.
In cases where less than 1 position of a doctor of the corresponding specialty is established in the office, laboratory, the position of the head is not introduced.
11. The position of the head of the organizational and methodological office is established in one of the dispensaries (centers) of the district subordination.
Nursing staff
12. The positions of nurses in medical offices are established at the rate of 1 position for:
a) one position of a doctor: in physical therapy, in sports medicine, surgeon, traumatologist-orthopedist, ophthalmologist, otorhinolaryngologist, obstetrician-gynecologist, urologist;
b) two positions of a doctor: neurologist, dentist, endocrinologist, psychotherapist.
13. The positions of laboratory assistants are established at the rate of 1 position for 4 positions of doctors in physiotherapy exercises, sports medicine.
14. The positions of radiologists are established according to the positions of radiologists.
15. The positions of nurses in the office of functional diagnostics and electrocardiography are established according to the positions of doctors of functional diagnostics, but not less than 1 position in the presence of an equipped office.
16. Positions of physiotherapy nurses are established at the rate of 1 position per 2000 conditional physiotherapy units per year.
17. The positions of instructors (methodologists) in physical therapy are established at the rate of 1 position for 2 positions of doctors in physical therapy, in sports medicine, provided for in accordance with subparagraphs "a", "b", "c", "d", "e "Clause 1 of this section.
If other medical organizations (divisions) of the municipal (city) level are attached to the dispensary (center) to provide appropriate assistance, the positions of instructors in physical therapy, which are due to these institutions according to the staffing standards in force for them, may be introduced into its staff.
18. The positions of massage nurses are established at the rate of 1 position for 1 position of doctors in physiotherapy exercises, in sports medicine.
19. The positions of medical statisticians are established depending on the number of medical positions assigned to the dispensary: from 7 to 15 - 0.5 positions, more than 15 - 1 position.
In dispensaries (centers), where, in accordance with these and staff standards, the position of the head of the organizational and methodological office is established, 1 additional position of medical statistician may be introduced.
20. The positions of medical registrars are established at the rate of 1 position for 8 positions of physiotherapy doctors, sports medicine doctors and other outpatient doctors.
21. The positions of senior nurses of departments and housewives of departments are established according to the positions of heads of departments.
22. The position of the chief nurse of a dispensary (center) is established in each dispensary (center).
Junior medical staff
23. The positions of nurses are established at the rate of 1 position for:
a) two positions of a doctor in physical therapy;
b) one position of a doctor: surgeon, traumatologist-orthopedist, obstetrician-gynecologist, urologist;
c) one position of a nurse for balneo- and physiotherapy;
d) two positions of physiotherapy nurses, except for those provided for in subparagraph "c" of this paragraph;
e) four positions of laboratory doctors and laboratory assistants;
f) three positions of doctors: in sports medicine, ophthalmologists, otorhinolaryngologists, neurologists, dentists, endocrinologists;
g) X-ray room. If there are 0.5 positions of a radiologist in the staff of the office, 0.5 positions of a nurse are introduced;
h) registry.
24. The position of a cleaner-washer is established at the rate of 1 position for 1 treatment pool.
25. The position of a medical disinfector is set at the rate of 0.5 positions for 1 therapeutic pool or 2 baths for underwater massage.
Appendix N 8 to the Procedure
Regulations on the organization of the activities of the medical center of the sports facility
1. This provision determines the organization of the activities of the medical center of the sports facility.
3. The First Aid Center provides primary health care to participants in competitions and athletes, including at the stages of medical evacuation before the arrival of an ambulance, and measures are taken to prevent and reduce morbidity and injuries at the time of the competition.
4. The number of First Aid Posts is determined by the expected volume of medical care, based on the type of sport, the number of athletes and other participants in the competition, the expected types of diseases and injuries.
5. The first-aid post is organized in the places of training and in the places of direct competitions, contains premises for the reception of a specialist doctor, treatment and massage rooms, and is also adapted to provide medical care to people with disabilities.
6. The first-aid post performs the following functions:
provision of primary health care for diseases and injuries to athletes and other participants in the competition;
provision of specialized medical care to athletes in the field of "physiotherapy and sports medicine" (assessment and correction of the functional state of the athlete, taping, massage);
if it is impossible to provide medical assistance to athletes and other participants in the competition, sending them, in accordance with medical indications, to a medical organization to provide specialized medical care to the injured;
conducting additional medical examinations of athletes in those sports where this is regulated by the rules of the competition;
participation in the organization of medical evacuation and transportation of victims to the relevant medical organizations;
participation in the organization of anti-epidemic measures at the competition venues.
7. The number of medical personnel of the First Aid Center is established by the chief physician of the competition, taking into account the recommended staffing standards for medical personnel during physical culture and sports events (Appendix N 12 to the Procedure for the provision of medical care during physical culture and sports events, approved by this order).
8. The first-aid post is equipped with medicines and equipment in accordance with the standard for equipping a medical post for a sports facility (Appendix N 9 to the Procedure for the provision of medical care during physical culture and sports events, approved by this order).
9. The first-aid post is provided with communication with the chief doctor of the competition, the ambulance service, assigned medical organizations participating in the medical support of the competition.
10. The first-aid post submits reports on its activities to the chief doctor of the competition, and also maintains accounting and reporting documentation provided for by law.
Appendix N 9 to the Procedure
Appendix N 10 to the Procedure
Regulations on the organization of the work of a doctor in physical therapy
1. This Regulation regulates the organization of the activities of a doctor in physical therapy.
2. A specialist who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of health care, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 N 415n (registered by the Ministry of Justice of Russia on July 9, 2009, registration N 14292), majoring in exercise therapy and sports medicine.
3. A physiotherapist carries out his activities in the medical center of the sports facility, the department (office) of sports medicine of medical and physical education dispensaries or other medical organizations and sports teams and clubs.
4. Physician for physical therapy during physical culture and sports competitions is subordinate to the chief doctor of the competition.
5. During the competitions, the doctor for physical therapy provides medical assistance to athletes and other participants in the competitions in accordance with the established standards of medical care.
6. Physiotherapist performs the following functions:
the implementation of the admission of athletes to classes and competitions;
conducting dynamic monitoring (current medical monitoring, periodic medical examinations, in-depth medical examinations, medical and pedagogical observations) of the health of persons involved in physical culture and sports (including mass sports);
monitoring the health status of athletes;
determining the possibility of further participation in competitions of an injured athlete, taking into account the priority of protecting the health of athletes and their safety;
assessment of the compliance of competition venues with sanitary and hygienic standards;
evaluation and organization during competitions rational nutrition in accordance with the level of physical activity and sports;
organization of a psychological assessment service during physical education and sports and psychological support during competitions;
analysis of the results of the survey, in order to draw up a program of rehabilitation or correction of the training process;
participation in the assessment of the evacuation routes for athletes injured during the competition, the organization of the stages of providing emergency medical care to athletes;
first aid for injuries and life-threatening conditions (disorders of cardiac and respiratory activity, dysfunctions associated with weather conditions, hypovolemia, collapse);
control over the use by the medical personnel of the competition of medicines and methods related to the list of prohibited by the Anti-Doping Code of the World Anti-Doping Agency, if they are used for vital medical reasons;
informing the organizing committee of the competition about the state of health of the participants in the competition at all stages of the competition, about the use of prohibited substances;
coordination of the work of middle and junior medical personnel in organizing and providing medical care to athletes in all places of their accommodation (places of training, warm-up, collection, participation in the competition, rest, accommodation, meals);
study and analysis of deviations in the state of health, the level and causes of morbidity and sports injuries among people involved in physical culture, sports, tourism, the development and implementation of measures for their prevention and treatment, the introduction of new comprehensive methods for the diagnosis, treatment and rehabilitation of people involved in physical education and sports;
organization and implementation of therapeutic and preventive measures to restore and improve sports performance and rehabilitation after injuries and diseases;
introduction of modern methods of diagnostics, treatment and rehabilitation of people involved in physical culture and sports;
making proposals on improving the organization and methodology of the work of medical personnel;
participation in the work of conferences, congresses, meetings on the profile of activity;
maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by the legislation of the Russian Federation /
Appendix N 11 to the Order
Appendix N 12 to the Procedure
Appendix N 13 to the Procedure
Regulations on the organization of the activities of the chief doctor of competitions during physical culture and sports competitions
1. These Regulations govern the activities of the chief doctor of competitions during physical culture and sports competitions.
2. The chief physician of the competition is appointed a specialist who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 N 415n (registered by the Ministry of Justice of Russia on July 9, 2009, registration N 14292 ), in the specialty "physiotherapy and sports medicine" or "public health and healthcare organization".
3. The chief physician of the competition is subordinate to the chief referee of the competition.
4. The chief physician of the competition performs the following functions:
organizes the provision of medical care during sports competitions;
determines the number of medical personnel of the competition, the schedule of his work on sports facilities during training and competitions;
determines the list of medical organizations involved in the provision of medical care during physical culture and sports competitions;
determines the required number and composition of ambulance teams, the order of their work;
supervises the activities of the medical staff of the competition;
assesses the sanitary and hygienic condition of the competition and training venues;
organizes the work of medical premises and their logistics and drug support;
carries out the organization of work on the collection and removal of medical waste in accordance with sanitary norms and rules;
provides information on the organization of medical care during physical culture and sports competitions to athletes, team representatives;
considers complaints about the provision of medical care during physical culture and sports competitions;
removes the athlete from participation in the competition for medical reasons (by decision of the medical committee (medical team);
organizes the maintenance of accounting and reporting documentation, the provision of reports on the provision of medical care during sports competitions, sends them to the chief judge of the competition, to the territorial health management body, to the territorial medical and sports dispensary.
Strategic plans for the development of physical culture and sports in Russia provide for the introduction of a number of innovations in the field of training athletes of various classes. This includes the medical care of athletes, including those with limited movement at any level.
What does medical coverage include?
Medical support is understood as a set of interrelated programs, requirements for the quality of service and medical control of the family over athletes and athletes. Legislative documents provide that medical care is provided by specialists responsible for organizing sports and physical culture:
- mid-level medical staff controls health, fills in individual cards;
- doctors assess the compliance of the expected load with health indicators;
- physiotherapists carry out preventive measures, if necessary, deal with injuries, carry out rehabilitation;
- specialists work to support health by methods inherent in sports and physical education.
Summing up, we can say that medical support is a series of measures that are aimed at maintaining the health of athletes, preventing sports injuries and related occupational diseases.
Diversity of medical provision
Providing athletes with a certain package of services to support their health, carrying out preventive measures to prevent occupational diseases and injuries, involves examination according to certain schedules. At the same time, athletes are provided with the necessary medicines, dietary supplements, orthopedic products.
In general, the following types of medical support are distinguished:
Examination of athletes
According to the current Labor Code, the conclusion of contracts between a sports institution and a person who wants to practice the chosen sport is preceded by a thorough examination of the candidate. The purpose of such measures is to establish how health corresponds to the physical activity that a person claims.
The examination is carried out in the conditions of outpatient clinics or clinics, offices in sports facilities, specialized dispensary clinics. The results are recorded in a special athlete's passport. Provided that the candidate fully complies with the requirements, the employer undertakes to monitor the health of the athlete in dynamics. It includes a number of measures.
Scheduled examination
Such medical care is an activity carried out with a certain regularity in order to monitor health and its adaptation to training loads. According to the indications, adjustments to the recommendations for training are developed. Ongoing monitoring allows you to determine whether a particular athlete needs an adjustment in biomedical support.
Periodic medical examinations
According to the Labor Code, any athlete is required to undergo annual examinations. In addition, the specifics of some sports, the characteristics of each sportsman dictate the need for an examination more often than the legislative deadlines.
In-depth medical examination
Advanced health care is a set of activities aimed at controlling health. It is carried out at all stages of the preparation of athletes:
- health;
- primary;
- educational;
- training;
- specialization training;
- improvements.
Research evidence allows you to determine how tolerable workouts correspond to the physical capabilities of the person involved in the sports group.
Observations of doctors and teachers
Trainings are specially organized, where the coach and the doctor determine the body's response to training loads. The reaction of the organism at competitions and in the recovery period is considered.
Recovery after training, illness
The training load of athletes is much higher than that of a person in ordinary life. That is why measures to restore strength and emotional state are of great importance. Their strict observance allows maintaining and improving the functionality of an athlete, regardless of the stage of training or competition.
Mass sports competitions
The medical support of the competition is aimed at maintaining health and preventing injury. Particular attention is paid to athletes with limited movements.
The provision of medical care at competitions consists of several stages:
- preliminary;
- proper medical care;
- final.
Preliminary preparation of medical support
Preliminary preparation involves planning and preparing evacuation routes for injured athletes in advance, determining the possible number of special vehicles. Attention is paid to such an aspect as establishing a clear communication with the local ambulance station in case the injury turns out to be significant. If none of the preliminary preparation requirements can be met, the sports doctor addresses the Chief Referee with a proposal to postpone the date of the competition.
Medical support of the competition
Medical support for sports competitions – a set of measures to determine the athlete's eligibility. The sports committee checks the conclusion on admission, establishes the conformity of the age of the participant with the requirements of the competition regulations.
The lists of participants are marked "Admitted" or "Not admitted". It is obligatory to have a doctor's signature with a mandatory transcript and certification with a seal (exclusively personal).
If an injury occurs during the competition, it will be recorded in the Medical Care Record. It is designed and conducted as described .
The final stage of medical support
At the final stage, the sports chief physician draws up a report, certifies it with a personal seal and a signature with a transcript, sends it to the chief judge, to the specialized power structures of the subject of the Russian Federation where the competitions were held.
The following information is included in the document:
- how many people participated in the competition;
- description and map of the venue, conditions provided;
- how often participants turned to doctors for help;
- the number of people in traumatology and a description of the reasons;
- types of first aid that were provided before the arrival of the ambulance team.
Medical support for sporting events includes drawing up a plan for the location of places for first aid. All participants should be advised where they can get medical advice if needed.
As a rule, each team has medical staff. At competitions, team doctors, most often, are near coaching staff. If they are not directly at the training itself, then they are located in the first-aid post.
The general medical center should contain the most complete package of medicines, dressings, necessary equipment, tools, inventory that will provide assistance at any level.
Small medical centers are necessarily organized in places of training, training zones.
The catering cannot be ignored. This issue is handled by the organizers of the event. Meals are provided and free access to drinks. They should not contain caffeine. Drinking is available in any place where the participants of the competition stay.
Safe competition
The responsibilities of the organizing committee include the creation of all safety conditions in places where participants sporting event will receive medical attention. It is important that not only athletes, but also physicians, be brought to the attention of instructions on the medical provision of sports facilities.
In particular, this document assumes that on the eve of the competition, all structures that will be involved are inspected. If any malfunctions or violations of integrity are detected, an act on this is drawn up and a replacement is made. This is done to eliminate and reduce the likelihood of injury.
