Like everyone, athletes are at risk of medical emergencies, from allergic reactions to broken bones. Unlike everyone, however, athletes in the USADA testing pools are subject to anti-doping rules that prohibit the use of certain substances and methods, some of which may be necessary in the case of a medical emergency.
Fortunately, the rules account for emergency situations and ensure that athletes can receive life-saving care without the threat of anti-doping consequences. The World Anti-Doping Agency’s International Standard for Therapeutic Use Exemptions (ISTUE) includes the ability to file for a retroactive Therapeutic Use Exemption (TUE), which allows athletes to receive emergency care first and foremost, and secure anti-doping permissions after the fact. In the event of a medical emergency, the athlete’s health and wellbeing is always the top priority and athletes should NEVER delay care based on anti-doping responsibilities.
So, what qualifies as emergency care? Are there differences for in-competition and out-of-competition care? Here is a quick breakdown.
Emergency Care: Out-of-Competition
Emergency medical care occurs when illness, either diagnosed or undiagnosed, or injury creates a need for immediate treatment that cannot wait without risking life-threatening consequences. This care is often provided in an Emergency Room (ER) or urgent care clinic, but it can also be performed wherever an emergency occurs by certified medical personnel (e.g., paramedics), as well as by athletes themselves or Athlete Support Personnel (ASP) (e.g., coaches, trainers, parents, teammates, etc.).
Most substances and methods used for emergency treatment are not prohibited out-of-competition, so a TUE is often not required. Even so, it is best practice for athletes subject to anti-doping rules and testing to check the given medications on Global DRO after the fact. Athletes can also submit a TUE Pre-Check Form to USADA with a summary of the circumstances of use, and we will advise if you need a TUE. If you do need to file for a retroactive TUE after use, you may submit a TUE application (be sure to check the ‘retroactive’ box) with all the associated medical evidence documented by the treating medical provider.
Emergency Care: In-Competition
If an emergency arises during the in-competition period, the priority should once again be the athlete’s life and health. The athlete can investigate the need and file for a TUE as soon as practical after their condition improves enough to be released from the hospital or they are in an otherwise stable condition.
Athletes may first submit a TUE Pre-Check Form summarizing the circumstances of use/treatment and USADA will advise if a TUE is required along with all the necessary documentation required. If the athlete is treated by medical personnel, it will be necessary to either get copies of the medical notes taken during the emergency or get the contact information from the treating providers/facility with a reference number (if applicable) to inquire later about getting copies of any paperwork.
In-competition medical emergencies requiring a retroactive TUE could be as simple as the use of an EpiPen autoinjector for an episode of anaphylaxis (e.g., after a bee sting). In this case, there may not be any formal medical documentation. Instead, athletes need to complete a TUE application, submit an athlete testimonial outlining the circumstances. and obtain a clinical note from the relevant primary care provider confirming the diagnosis along with a valid prescription for the EpiPen.
Other in-competition medical emergencies may be more complicated. For example, an athlete could receive a glucocorticoid injection (e.g., Kenalog, Triamcinolone, etc.) from a team doctor during the in-competition period for an injury. This situation can be tricky because there is a question of athlete health and safety and whether the injection of the glucocorticoid enhances performance beyond a return to the athlete’s normal health. In this case, after the treatment, the athlete would need to collect all medical information regarding the diagnosis and treatment of the injury and submit a retroactive TUE request to USADA.
The receipt of an IV infusion is another example of emergency medical care that might occur in-competition and may require a TUE. There are rules about the substances and volumes that can be administered via IV, so it’s important that athletes and ASP be familiar with those restrictions. More information on the IV infusion rules is available here.
While a great deal of emphasis for a retroactive TUE is based on the medical evidence provided, the athlete’s testimonial letter surrounding the circumstances of treatment will also be taken into consideration.
You can refer to USADA’s TUE Policy for more information or contact USADA’s Drug Reference Line at drugreference@USADA.org or call (719) 785-2000, option 2.
In addition to educating athletes and offering real-time support, USADA offers resources and tutorials for athlete support personnel, including health professionals and coaches.