Discussion: Medical certificate required

Thought this was interesting -- Looking into registering for the public races associated with WOC in France and noticed this:
Medical certificate: French legislation requires all competitors in orienteering events in France to present a medical certificate less than 12 months old testifying that “they do not suffer from any medical condition which makes it unsuitable for them to compete in orienteering events”.
(web site gives a link to a sample one can use)

Link

The registration page explains more and says national team members are excluded from this requirement.

Sample document (pdf)

The sample document just says:

Name of competitor, date of birth, "does not suffer from any medical condition which makes it unsuitable for him/her to compete in orienteering events." And then the doctor's signature info.

Hmmm... I wonder if doctors would let me compete in France? Would conditions that require you to carry an Epipen be considered a bad mix with orienteering?

When I got my medical certificate here (in France), the doctor checked:

blood pressure
whatever they check when they use a stethoscope and make you take deep breaths
I think he asked about family history of heart disease
he asked if I orienteered a lot and I said I was on the Canadian team.
he asked if there were any other concerns

I have heard that doctors can be more thorough though. My certificate is a fill in the blank sort of thing that says:

"Je soussigné, Docteur ---- certifie, après examen que Mme ---- presente, ce jour, une absence de signe clinique apparent contre-indiquant la pratique du sport suivant: course à pieds et course d'orientation, y compris en compétition"

"I, the undersigned, Doctor -, certify, after an examination, that Ms ---,today shows no clinical signs that counterindicate practising the following sports: running and orienteering, including competition"

So basically what the sample document says. You need a medical certificate to practise any sport in France and my club mates were completely shocked that we did not require one in Canada.

Getting the medical certificate in France cost €22, although I've heard it could cost more if the doctor does a very thorough exam.

I´ll go to Scotland instead...

in Scotland they do rec****

while visiting italy recently i tried to participate in a local meet. I was told I was not allowed, unless I was a member of the national federation. There are two levels of membership: recreational and competitive. One is requires a simple medical certificate, while the other requires a medical certificate that only a sports medicine doctor can issue (after tests such as EKG etc etc). The simple medical visit doesn't cost more than 10 Euro, while the sports medicine visit will cost at least 60 Euro. The membership to FISO will cost about 20 Euro. The cost of the local meet itself is between 3-5 Euro. Someone with membership of "recreational" is allowed only to do courses that are at most a Yellow or Orange course. For visitors such as myself, I would have been allowed to run a course had I been a member of USOF (or whatever country's federation). It's an insurance thing. At the time, I was not a member to any national federation, and in that case, I was told that I could run a course in a special category called "ghost category", in which for one Euro they sold me a map, no control card given, no name, no registration, "basically, you don't exist". I went to the start, told the starter that i was a ghost, he told me i was ready to go in 40 seconds, and I ran the course. I punched on the edge of the map. At the finish, I punched the last punch, but had no control card to hand in. I did not exist.

btw, this is not just for orienteering, but for all athletic events. To run a 10K in a local neighborhood, one must be a member of Federazione Atletica Leggera. For those big one-time events in which thousands show up, and that is the only event they might be doing in the span of a year, the registration page has a little checkbox that says "check here if you are a member of FIDAL. If not, a 2 Euro fee will be added as a one-day membership to FIDAL". In that event too, one must show up with a medical certificate on doctor's studio stationary.

This must be new? as we have run in the last two French 6-days without any such certificates, though we are members of USOF (oops - OUSA).

They tightened up in the last couple of years due to legal obligations. It isn't by choice.

This strikes me as a spectacularly counter-productive law - surely any health problems which are picked up by such a procedure are more than outweighed by the adverse health impacts of putting up such a barrier to participation in sport.

I'm not so sure it's that huge a barrier if you're French though (as opposed to a visiting foreigner). They just think it's a normal thing to do. When I got mine, I was able to get a doctor's appointment the same afternoon I called. Most people probably see a doctor once a year anyways. Plus they have universal healthcare here so it's not expensive.

I wasn't asked for a medical certificate at the Tyrol 6 Days in July (3 of the races were in Italy and run by FISO). What do France and Italy do about the thousands (maybe hundreds of thousands) of overseas visitors who go on cycling, mtb, or mountain walking trips? Noone I know has ever been asked to prove their fitness before booking a tour, or taking their bike into either country.

Competition is the issue. As long as it isn't timed/scored/ it is okay. It isn't entirely logical. One cannot run up classes either without special certs, so, say, a 50yo couldn't run M21 in a sprint without a special cert, even if it is a shorter distance than usual (and his orienteering cert allows him to run rogaines, say).

As cjross says, it's not that big of a deal to the French. And it may save a life or three occasionally. I know a former French team member had to give up competitive sports after a medical exam (thorough, because he was a team member) showed up some serious heart anomalies.

Please tell me there's nothing in the new US health care laws that will require anything like this.

I suspect this medical certificate is not a big deal in the 99% of the countries where health care is now treated as a right and not a privilege. I suspect also that the Europeans expect that as a member of a federation and allowed to compete you will have had at sometime to prove your fitness to compete.
You shake your heads at the requirement for a medical certificate. They probably shake their heads in wonder at the waivers our participants have to sign.
They say: show us you are fit to compete.
We say: you have a right to die on our courses but if you do you don't have the right to sue us or our successors.

in 2007 while i was in Romania I compete in National Champs ( as I hold that citizenship too)- and i was required to have a medical test done prior to event.. that was not the problem -- the problem is when someone over 60 - for instance - they want to compete in events, but the medical test might deny their chance - since they are.. not fit for competition-- now how you can get fit if you cannot compete/train etc ??.. just to have a test that cost xy euros - i would call it just another money grab. I like it more the way is in NA ( just a waiver )

Blair wrote...surely any health problems which are picked up by such a procedure are more than outweighed by the adverse health impacts of putting up such a barrier to participation in sport.

Similar to the arguments that are raised by the anti cycle helmet campaigners, heh heh. But in your country and my country they are compulsory and most of us think nothing of it.

The problem is that the "certificate" looks like a money grabbing scam of no value. Serious issues are most unlikely to be picked up by the sort of examinations described. And putting barriers such as this up to exercise is going to be counter productive to general public health.

The issue of running and heart health is a whole different subject but this is a good starting point.

for example:
Research has shown that in those people who have some sort of undetected heart disease, the risk of sudden death during exercise is massively reduced by regular exercise training. However, these people are more likely to have a heart attack while they exercise than while they are at rest.

In the United States these very rudimentary medical exams are required for children in public schools who participate in sports. They are a money maker for physicians, but some physicians fear that signing these papers may expose them to financial risk if the child suffers any kind of adverse event during sports.

They say: show us you are fit to compete.
We say: you have a right to die on our courses but if you do you don't have the right to sue us or our successors.

My preference is certainly the latter. Let ME decide if I'm fit enough to compete. I know what kind of training I've been doing, and whether I'm up (physically) for the challenge. Why should I need to jump through any hoops?

But if I'm wrong and I'm not fit enough, or if I really was fit enough but "things happen" and I have a heart attack that may have been totally unpredictable, then don't let my heirs sue the people who were good enough to put on the meet.

Why should I need to jump through any hoops?

Because you don't live in a vacuum. You live in a society. And there may be an adverse effect to the society if your heirs are remotely successful in suing the good event organizers; lawyers in general laugh at waivers.

There is a very successful trail running series now in its 10th year in the Bay Area. In about 2004, someone with known and serious heart issues died on the course. A good lawyer could have lawyered out a fairly reasonable argument of neglect on behalf of the organizers regardless of the known state of health; there was no cellphone coverage on the course (in Palo Alto, City of the Future of all places) and no emergency plan, so the response was quite bungled. Maybe a speedier response would have saved the guy, maybe not. Fortunately the heirs weren't suehappy, and the series lives on. It may not have, and we may not have had a trail run somewhere closeby in the past 6 years. This is the adverse effect to society.

Substitute trail running for orienteering or rogaining... we're fortunate with small numbers. Were the numbers higher, we'd face this issue regularly.

And it's not like the line of thinking I just used is inconceivable in the American society. The direct medical-certificate approach may be, but many race organizers consider the issue seriously. At most if not all 100-milers, you will be required to complete a detailed medical history questionnaire. That's self-reported; still hands-off. However, at least at the Western States, if you list something interesting, you'll get a phone call from one of the friendly event doctors. The event cares about the health of its participants, and whether it has to spend nonprofit money to defend itself in court. Regardless of the lawyerly issues, to protect the health of one of your fellow athletes is a worthwhile goal in itself, no?

I have orienteered in France for the last couple of years. Fortunately, I have a physician friend who was willing to sign his name and place his stamp on the form. He did nothing except sign the form, telling me if I can train, I can compete. Most of the French meets I went to wanted to see the certificate, but several didn't bother. Without a certificate, one can do a non-timed simple course, but not compete in your age group.

My physician here in the states basically says the same thing. You don't need a stress EKG test if you can compete in the hills here in the Bay Area. There is nothing that a stress test is going to show if you are asymptomatic training. That does not mean I may not drop dead at the next event (or training run) because of an arrhytmia or unforseen coronary artery disease, but the stress test probably wouldn't pick that up anyway. The important thing is if you have symptoms, e.g. chest pain, angina, severe shortness of breath, then you should probably see a physician, but the yield of an expensive stress test or echocardiogram for an asymptomatic person is virtually nil. Listen to your body.

Yeah, common sense and responsibility for your own actions. Oh so rare...

I have a close Italian friend who was a very good M21 runner for some years. He got heart surgery after some illness being discovered in one of the yearly health checks (those that include stress EKG). I do sign waivers here in the US, but I keep doing the yearly health check in Italy when I'm there (for about $60,00). Chances something being discovered are low, but surely grater that only signing a piece of paper.

RLShadow's comments brought back some horrible memories from being an organizer at the pre-event to the 2005 World Masters in Alberta. This is a story that makes me at least a little bit sympathetic to the French "prove you are fit to compete" approach.

I was meet organizer. An elderly competitor who was traveling with a large group started her race but did not arrive at the finish. After a few hours it became clear that one very strong possibility was that she had died somewhere on the course. In any case we organized a search with all available volunteers, including many youth. After we sent them off I almost immediately regretted sending them out, imagining the trauma it could possibly have caused to anyone that might discover a dead body (especially if it is a kid).

Luckily the woman was found alive, wandering along the local highways (we now understand that the first thing in a search plan is to start driving along the roads!). There were two comments that I overheard during this ordeal that made me pretty upset:

1 "We told her she shouldn't go out - her mind is not clear enough". As an organizer, why should I have to suffer through this agony because someone who isn't thinking clearly decides they can go out orienteering?
2. "She would love to die while orienteering" - well, p*** **, and don't go dying during one of my events!!! I just don't want that.

Anyway, that was an isolated incident, but it does show three reasons that from an organizer's point of view the French approach makes some sense. Maybe you think you are in okay shape mentally and physically, but then again, you might be wrong. If something happens it just might be very horrible for the organizers.

Good point, AZ.

It seems like in your example there was some responsibility on the shoulders of the people she was traveling with to forbid her from doing a course on her own, even though she obviously wanted to.

It might be worth remembering that just a few years ago, a competitor who was about my age had had some medical issues and had them checked out by a doctor, including stress testing, I believe. The diagnosis was inconclusive, and they were going to look at some more things, but instead he had a heart attack and dropped dead near the end of his course at an A-meet hosted by EMPO (he was on the way to winning his category (M45 IIRC) at that point, based on the splits recoved from his epunch). I'm not sure what lesson to take from this, though.

It is usually amusing to see somebody's irrational fears causing these types of cumbersome restrictions to be put on normally safe activities. But when it comes to my sport these types of unnecessary restrictions are no longer funny but quite irritating.

An estimate of OUSA statistics would put the number of orienteering starts in the US since the sports inception at about 2 million. To my knowledge there have been 2 deaths at US events (both heart attacks). This means there is roughly a 1 in a million chance of dying at an Orienteering event. These odds are far less than dying from auto accidents (1:85), drownings (1:1073) and dog bites (1:119998 .) (Stats from National Safety Council Website)

So those who are sincerely interested in public safety need to expend their regulatory efforts towards traffic safety or maybe dog leash laws. But leave Orienteering alone. It is a safe and healthful activity.

I think the French rule has a wider umbrella than just orienteering - I believe it covers all sports, so those stat might need more data ;-) But still, I'm not entirely sure what the benefit of this requirement is, since I can't imagine how bad your condition would have to be before you weren't allowed to compete.

I've suffered through this French thing for two seasons. The first year I was able to talk around it, but last season they became very strict about it. I can tell you that the organizers are not happy about this either - they have sympathy for the non-French participants but there isn't much they can do.

The main problem we had was that the form was in French and asking a doctor to sign it is quite tricky. The COF did contact the French Federation and suggest they at least provide an English translation. I'm not sure if one is available.

But my advice to people thinking about going to Europe is to put up with the inconvenience. Orienteering in France is fantastic - the maps and terrain I've been on were some of the most fun and challenging I've ever experienced, and the atmosphere is vibrant. I anticipate WOC will be spectator friendly, with great public races, and in a wonderfully beautiful part of the world. Don't miss it just for this small pain in the butt.

As they say in France, "ne mangez pas votre nez pour spite votre visage"

AZ, they do provide an English translation now.

From a search and rescue point of view, sudden death from a heart attack or stroke happening to someone alone in the woods is one of the most benign situations we deal with. I say benign because we feel consoled, knowing that nothing we did or did not do could have made any difference to the dead person. The downside is we don't know this until we find the body.

For an orienteering meet organizer, however, this is a very different situation and there is little or no emotional consolation. Maybe you could have saved the person's life, if the attack occurred in camp and you were prepared with an AED on hand or an EMS team standing by. For you, consolation can come only from knowing (if it is true) that the person who died would have considered it a good way to go.

I do not advocate stronger controls over who can go out on a course. Instead, I would advocate for access by meet directors to far more and better training.

New Mexico SAR has several youth teams. Most of our youth teams do not respond for known or likely dead subjects. I helped one youth team recover the body of a suicide. The team thought they could handle it, but certain details of that mission were devastating for them and the team no longer exists. That mission messed me up fairly well too. What messed me up was not the dead body but certain remarks by the family, likely of no great import to them, that unfortunately connected to something painful in my own life. I went to a critical incident stress debriefing after that mission, which helped, but in retrospect I should also have asked for grief counseling.

In SAR, a lot of training is done as "table top" exercises, in a meeting room with a map, forms, and other information tools we would use during an actual mission, and scripts. One person knows the scenario and works from the scripts, evolving the situation for the trainees. The exercises generally are based on actual SAR missions.

Collectively, our orienteering community has a set of real situations that could be used in training. Examples include the orienteer with early stage dementia, anyone dropping dead on course, the famous hypothermia at the Georgia meet, the scout who runs off course and keeps running. I can contribute one or two scenarios of my own: child overdue, advanced orienteer overdue, someone falls and breaks a bone, someone bails out and runs off course in the general direction of town. What would we need to make these useful for training? Copies of the course maps for those meets, details of the staging (parking, start, finish, aid stations), area maps for access points, and a basic writeup of what happened and why.

don't let my heirs sue the people who were good enough to put on the meet

The waivers may help with this. However, we all might do well to discuss this with our families. Consider the "living will" and organ donor programs. Those involve written documentation of your wishes but the literature that explains them stresses the importance of you actually discussing your wishes with your family.

This means there is roughly a 1 in a million chance of dying at an Orienteering event.

We're blessed in the U.S. with not having many teenagers, who are the category most likely to suddenly die from undiagnosed cardiovascular issues. The opposite contribution of having many elderly people doesn't quite balance that out, but soon will.

This means...

Geoman, your mastery of probability is flabbergasting :)

What's your problem, Neil? Since orienteering started in the US, 1 in every 85 car rides has resulted in a fatality, right? Do you dispute that? (I've died in auto accidents eight times this year already.)

Neil is a mathematician... for the good of all of attackpoint users, please don't get him started

Guilty as charged.