NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Glasgow 2014 Commonwealth Games: NHSGGC and the Medical Services

Although the Commonwealth Games lasted only 11 days, planning has taken many years. One of the things spectators wouldn’t be aware of was the effort that had gone into planning the medical services for athletes, team officials and the other accredited people required to make the Games a success.

 

The medical services were based at the Polyclinic within the athlete village in Dalmarnock, with smaller satellites at the Edinburgh and Dundee villages set up for diving and shooting events respectively as well as a clinic at the Games Family Hotel. There were also medical teams for athletes at competition venues with crowd doctor and first aid support for the spectators. This was all complemented by the Scottish Ambulance Service.

 

The polyclinic was a multidisciplinary environment with medical and nursing staff covering emergency medicine, sports medicine and immediate care. Other services included imaging (with a mobile CT and MRI scanner, X-ray and ultrasound), optometry, dentistry, podiatry, physiotherapy, sports massage and pharmacy.

 

NHSGGC staff and contractors were involved in a variety of roles; Dr John MacLean, Chief Medical Officer for the Games, is a Glasgow GP; Dr Jonny Gordon, Deputy CMO, is an emergency medicine consultant at the Victoria Infirmary and Gerry McLaughlin, Polyclinic Manager is charge nurse for A&E at the Royal Alexandra Hospital.

 

Liz Mendl, General Manager of Glasgow 2014 Medical Services and Anti-doping convened a Medical Services Forum to help plan the services and ensure appropriate standards, training and referral procedures into the NHS were in place. The Forum also had a number of NHSGGC representatives including Gillian Penrice (Public Health), Angela Carson (optometry), Annmarie Sinclair (Diagnostics), Audrey Thompson (Pharmacy), Paul Ryan (primary care), Anne Harkness, (Director of Emergency Care and Medicine) and Louise Carroll (Civil Contingencies).

 

Reflections from NHSGGC Clyde-siders

We have asked a few of those working at Glasgow 2014 to share their personal experiences.

 

Jonny Gordon, Emergency Medicine Consultant at the Victoria, Glasgow 2014 Deputy Chief Medical Officer.

As a sporting spectacle the Commonwealth Games were simply fantastic, but they also cemented once again the reputation that Glasgow and Scotland have in delivering excellence in health care. GGC were an integral component in supporting G2014 Medical Services. One example of this was the flexibility shown in allowing senior EM clinicians to volunteer for the Immediate Care Area of the Polyclinic working alongside senior nurses and senior GPs.

 

Every shift was covered by at least one Emergency Medicine consultant local to Glasgow. This unprecedented cover was in place 24 hours a day for 25 days and involved 13 consultants. This ensured that not only were the athletes and team officials guaranteed to see a senior decision maker, but that the clinicians they saw were also familiar with the local arrangements for healthcare in Glasgow.

 

We didn’t expect to have many life-threatening emergencies to deal with, but the real benefit was that we had senior doctors in the Polyclinic who investigate less and refer less into hospital. This minimised impact on local services and the local population by preventing disruption of their services. Two to three consultants volunteered from each of the five hospitals within GGC to allow this to happen and we ensured only one consultant was away from their own unit at any time.

 

The integrated working of everyone in the Polyclinic was a joy and will be a lasting memory. We talk about legacy but perhaps one of the things we should look at in the NHS is how we can work better together between primary, secondary and specialist care as we were able to do in the Polyclinic.

Paul Ryan, Clinical Director in Glasgow City CHP, North East Sector and primary care clinical expert for Glasgow 2014.

A small group of GPs and nurses provided 24 hour cover to the Commonwealth Games Federation based at the Hilton Hotel and the wider Games family and Technical Officials based at satellite hotels.  A medical centre was established at the Hilton with a daily clinic for press and officials at the SECC.

 

The service was designed to deliver Primary Care services.  There were 135 attendances during the 16 days of operation. A variety of procedures were carried out including bandaging, wound dressings and anticoagulation monitoring. There were also dental infections, abrasions and isolated cases of gastroenteritis.  Many presentations were for mislaid medicines and it was apparent many countries use drugs less familiar to us which are commonly prescribed by trade names. We managed to decipher and issue appropriate prescriptions with the aid of search tools and some faxes from the home country. The lesson is to remind your patients to take a note of their medication when travelling abroad.

 

Whilst the work was not particularly onerous, there were some hospital admissions. The most surprising aspect was the number of delegates who attended the Games with serious underlying health problems and we played a role in allowing these people to support their teams in the competition. Overall the experience was a rewarding one.

 

Emma Sheppard, a Glasgow GP, worked in the Polyclinic in the athlete village. She writes:

The polyclinic experience has been fascinating. Working directly with practitioners such as public health doctors, physio and emergency doctors has helped mutual understanding of roles. Having a common goal and a willingness to succeed allowed improvements to be made to systems with enviable speed. There was the luxury of minutes rather than months waiting times for patients to see dentists, orthopaedics or physio. Direct work with pharmacists and those with previous experience has helped in understanding anti doping regulations.

 

The number of people travelling many miles to come to Scotland meant many of us had an impetus to update our knowledge on the management of fever in the returning traveller.

 

Highlights were driving the patient retrieval buggy round the athlete village and celebrity spotting as we were sited right on the village green.

 

Sean MacBride-Stewart, a pharmacist with the Central Prescribing Team also took part.

What struck me most was the scale of the planning to ensure the athletes could perform at their peak. Some of the teams did this from their own staff, but for the smaller teams the healthcare needs were mainly met by the volunteer health professionals. 

 

In pharmacy we dispensed over 2,000 prescriptions and providing advice for a variety of minor ailments. For me it also meant asking a colleague to take over counselling a patient because she could explain in French the three times and four times daily dosing of the analgesics that had been dispensed to a non-English speaking athlete.

 

Being located in the reception area of the Polyclinic also meant dealing with the unusual; working with physiotherapy the replacement of the rubber bungs (actually called ferrules) of the walking sticks of a power lifter. Locating all the healthcare professionals together in the Polyclinic made it easy to iron out problems as they cropped up, and there was a real willingness from everyone there to work that way.

 

Fiona Love, Practice Nurse in East Renfrewshire was also based in the Polyclinic and says:

I was working towards the end of the Games when demand was lower since most people had already competed. Most of the interactions were for relatively minor injuries or conditions and, unlike a typical GP practice population, the patient group did not have significant co-morbidities. However, patient interaction is the driving force of my Practice Nurse role and similarly with the Games patient group. For me, the value of my volunteering was an increased awareness and respect for the roles of my medical colleagues. Within the polyclinic we had emergency nurse practitioners, emergency medical consultants, pharmacists, dentists, podiatrists, optometrists, physiotherapists, sports medicine practitioners to mention but a few!

 

The essence of the Commonwealth Games experience was one of teamwork, with an attitude of determination to help the athletes and teams and make Glasgow 2014 a fulfilling experience one.

 

Angela Carson, Gartnavel General, led the eycare services

The remit was to provide eyecare to athletes and officials who needed urgent support to be visually fit to fulfil their Games role. Routine eyecare was not available. Criteria for referral were ocular injury, red / painful eye, sudden loss of vision, broken spectacles, broken or lost contact lenses. There were 485 clinical encounters and we supplied 262 pairs of spectacles plus one pair each of swimming and squash goggles and shooting spectacles.

 

The most frequent presentation was dry eye (44%) and fortunately, only one ocular emergency was trauma to a corneal graft. This patient was referred to Gartnavel General Ophthalmology department. He was likely to require further surgery once home.

We also treated two cases of keratoconus, a progressive, non-inflammatory corneal thinning which causes high astigmatism and myopia which does not correct well with spectacles. Both athletes had left their lenses at home and were very visually impaired as a result. Fortunately, we had some of the latest equipment which allowed us to produce a map of their corneal topgraphy and provide lenses. The athletes said the lenses were more comfortable and enhanced their vision to such an extent that they were overcome with gratitude.

 

Anne Harkness, ECMS Director, writes about other support to Glasgow 2014 from NHSGGC: 

Staff throughout NHS Greater Glasgow and Clyde played an important role both in supporting colleagues to volunteer and in treating those patients who needed more specialist care.  Services had been planned jointly from the start and it was these close working relationships that helped make the Games medical services such a success.

 

30 athletes and 14 officials from 19 countries were referred to the NHS. Very few people needed admitted to hospital and most only stayed for a day or so. Some patients needed a specialist out-patient appointment, with the most frequent requests for ENT and orthopaedics referral. Only 10 of the Games Family attended Emergency Departments. Of course Glasgow was very busy during the Games and a number of visitors and Clyde-siders came to Emergency Departments.

 

Staff can be proud of the way they supported the Games and the city and they all played a part in helping making the event such a success.

 

Thanks to Liz Mendl, General Manager, Medical Services and Anti-doping for permission to publish and to the Commonwealth Games Federation who own clinical data.