FEDERATION INTERNATIONALE DE SKI INTERNATIONAL SKI FEDERATION INTERNATIONALER SKI VERBAND MEDICAL GUIDE 2001/2002 Table of Contents FOREWORDS.4 THE TASKS, RIGHTS AND DUTIES OF THE MEDICAL COMMITTEE OF THE INTERNATIONAL SKI FEDERATION .6
The Structure of the International Ski Federation.6
THE FIS MEDICAL SUPERVISOR AND HIS ROLE.6 MEDICAL SERVICES AT SKI COMPETITIONS.7 GENDER VERIFICATION . 11 FIS DOPING AND MEDICAL CONTROL REGULATIONS . 13 FIS DOPING RULES. 14
RULE 1 - DOPING . 14RULE 2 - ANCILLARY OFFENCES . 15RULE 3 - RESPONSIBILITY FOR DOPING AND MEDICAL CONTROLS. 15RULE 4 - BLOOD SCREENING . 15RULE 5 - IN COMPETITION TESTING . 15RULE 6 - OUT OF COMPETITION TESTING . 16RULE 7 - NOTIFICATION OF NATIONAL TESTS . 17
PROCEDURAL GUIDELINES FOR DOPING AND MEDICAL CONTROLS . 18 A. BLOOD SCREENING . 18
1. Introduction. 182. Procedure . 183. Start prohibition. 204. Blood Screening of the whole starting field . 205. Administration of the results . 206. Miscellaneus . 207. Exceptions . 20
B. DOPING CONTROL DURING COMPETITIONS . 22
1. General . 222. Medical Supervisor. 223. Facilities and Equipment (provided by Organisers). 224. Selection and number of competitors to be controlled . 235. Procedure for notification and attendance at the doping control station. 256. Collection of Urine Sample . 266. Collection of Blood Sample . 277. Analysis of samples. 298. Communications of results . 30
C. OUT-OF-COMPETITION DOPING CONTROL . 31
1. General . 312. Procedure for registration of competitors selected for out-of-competition doping controls . 313. Procedure of Selection of National Ski Associations and Competitors. 324. Appointed Sample Collectors. 325. Identification. 336. Procedure for out-of-competition doping control . 337. Storage and dispatch of samples. 338. Analysis of samples and communication of results. 349. Waiver. 34
D. DISCIPLINARY PROCEDURES FOR DOPING OFFENCES . 34
RULE 1 - DISCIPLINARY PROCEDURES FOR DOPING OFFENCES. 35RULE 2 - SANCTION . 35
E. EXCEPTIONAL CIRCUMSTANCES . 35 F. LIST OF BANNED DOPING CLASSES AND METHODS . 37
1. Prohibited classes of substances . 372. Prohibited Methods. 373. Classes of drugs subject to certain restrictions . 37
G. EXAMPLES AND EXPLANATIONS . 38
1.1 Stimulants . 381.2 Narcotic analgesics . 391.3 Anabolic agents . 401.4 Diuretics. 411.5 Peptide hormones, mimetics and analogues . 421.6 Alcohol. 421.7 Cannabinoids (marijuana, Hashish) . 43
2.1 Blood doping. 432.2 Pharmacological, chemical and physical manipulation . 43
3. Classes of drugs subject to certain restrictions . 43
3.1 Local anaesthetics . 433.2 Glucocorticosteroids . 443.3 Beta-blockers. 44
G. MEDICAL ASPECTS OF SKIING. 46
1. Concussion . 462. Anterior Cruciate Ligament Injury . 463. Protective Equipment. 474. Medical Considerations in Assessing a Skier's 'Fitness to Race'. 475. Sport at Low Temperatures. 486. Danger of Anorexia Among Ski Jumpers. 487. Medical Aspects on Cross-Country Ski Races at High Altitude. 498. Alcohol. 49
A. Stimulants . 50B. Narcotics . 50C. Anabolic agents . 50D. Beta blockers . 50E. Diuretics . 51F. Masking agents. 51G. Peptide Hormones . 51
Instructions fo use of Doping Control Form. 53
National Association Training Programme . 55
FOREWORD 2001 "Errare humanum est, perseverare diabolicum"
If the FIS and its Medical Committee had not reacted vigorously following the sad eventsof the FIS Nordic World Ski Championships in Lahti it would hardly have been able toabscond from the accusation of complacency or even irresponsibility, which one wouldhave had the right to make.
This new version of the Medical Guide 2001/2002 demonstrates in an undisputable waythat the FIS authorities have taken the menace of doping very seriously and that theyhave taken measures to ensure such occurrences will not be repeated. But what mayappear to be a reaction, was not really one. Only insiders can know that the competentskiing authorities had already implemented doping control procedures using newly-developing methods on a trial basis before the scandal which affected the Nordic WorldSki Championships.
In addition, and before the lessons from numerous persons who appear to know betterafter such difficulties, the FIS and its Medical Committee have established a close col-laboration that has already proved to be valuable with the newly created World Anti-Doping Agency, whilst maintaining the existing excellent relations with the IOC MedicalCommission and the International Winter Sports Federations.
In brief, following intensive work, the chapter about anti-doping controls has been re-vised and we are convinced that FIS now has available an efficient working instrumentwhich is accurate, scientifically defendable and adapted to the particular specifics of ourdisciplines which remain outdoor sports that take place in the mountains.
The FIS is fully engaged in organising sport at the highest level, that is clean, healthy andsetting an example. The Medical Committee has never had the slightest problem to fol-low – sometimes even precede this policy. All together, with the athletes as our concern,we can and will win the fight against one of the worst calamities threatening our belovedsport. FOREWORD 2000 "I am fully aware and conscious of the dangers involved in the performance of all FIS disciplines and of the dangers caused by gravitational forces, be it during training runs or during the actual competition. I recognise that there is a risk in reaching excellent re- sults which requires me to stretch my physical abilities to the absolute limit. I know and accept, that by engaging in such competitive sports, life and physical safety could be endangered."
This is the introduction to the athletes declaration for an international FIS Licence. Skiand snowboard competition events comprises a number of different disciplines many ofwhich involve high speed and increased risk of acute traumatic injury (Ski Jumping,Downhill, Speed Skiing). Other disciplines involve particular medical concerns relativeto overuse and fatigue (Cross-Country). It is the responsibility of every doctor concerned with skiing to familiarise himself with allmedical aspects of this fascinating sport.
Some of the more common problems encountered in skiing are summarised in thisMedical Booklet which also includes the medical rules and regulations of FIS. FOREWORD 1999
Compared to the edition of 1998, this Medical Guide contains a fair number of changes.
First of all, it includes a new chapter concerning the haemoglobin controls, now intro-duced and carried out during two full seasons in all the Cross-Country disciplines.
Then we implemented all the changes found on the IOC List of Classes of ProhibitedSubstances and Methods of Doping published by the IOC on the 31st January 1999.
As a last point, we would like to call your attention to the Olympic Movement Anti-DopingCode, that will come into force on the 1st January 2000. FIS recognises this new docu-ment which in this way will become a part of our own regulations. THE TASKS, RIGHTS AND DUTIES OF THE MEDICAL COMMITTEE OF THE INTERNATIONAL SKI FEDERATION The Structure of the International Ski Federation (FIS) Known in brief as FIS, the legislative organ of the International Ski Federation is the Congress that convenes every other year. At present the delegates at the Congress rep- resent 100 National Ski Associations who elect the FIS Council (Executive) for a period of two years. This consists of the President, four Vice-Presidents, twelve members and the Secretary General. The FIS Council is advised by a series of committees and sub-committees (e.g. Cross- Country, Ski Jumping, Nordic Combined, Alpine Skiing, Freestyle Skiing, Snowboard- ing etc.). The Medical Committee is one of these special committees. Apart from having an advisory capacity, the various committees also have to undertake relevant tasks at the request of the FIS Council. The rights and duties of the Medical Committee are thus predetermined. Like the other committees in the Federation, the Medical Committee has no power of decree and is thus only able to act upon instruc- tions. Recent discussions have centred on the monitoring of physical health, the compi- lation and observation of clothing regulations (prohibiting plasticised suits) and the im- provement of safety precautions (e.g. compulsory helmets). One of the Medical Committee primary concerns is to maintain high standards of medi- cal services at skiing events and relevant details are to be found in the special sections of these guidelines. Since 1972 the Medical Committee has carried out regular doping tests at various events on behalf of the FIS Council. The first doping rules were compiled in 1972 and were amended in 1987 to incorporate the IOC Medical Committee rules. Although aligned with the latter, the current guidelines do also feature certain peculiarities specific to the sport of skiing. The time and place of doping checks is established by the Medical Committee and any FIS event organiser may be required to carry out doping controls. Blood controls, where FIS has played a pioneer role have a special place in the various duties of the Medical Committee of FIS. That is the reason why a special chapter is re- served for this specific subject. The Medical Committee is involved in a regular exchange of information with the other committees in the Federation, various international bodies such as the "International Working Group for Safety in Skiing" (ISSS), The Fédération Internationale de Médecins Sportive (FIMS), the Medical Commission of the IOC and medical representatives of the national associations. The Medical Committee of the FIS is committed to maintaining skiers' health and to minimising the risk of injury. THE FIS MEDICAL SUPERVISOR AND HIS ROLE Whenever a major event is scheduled (Olympic Winter Games, World Championships etc.), the Medical Committee of FIS will propose one or more Medical Supervisor(s), who are appointed by the FIS Council. Where possible this nomination will take place at least one year before the event is scheduled. As a rule, the Medical Supervisor will be a member of the Medical Committee of FIS but, by mutual agreement, the individual may be recruited from outside the committee. The only restriction placed on the Medical Supervisor is that the individual may not act
as a team doctor or doctor for the organising committee whilst performing the duties ofa FIS Medical Supervisor. The FIS Medical Supervisor will be nominated for one event only and his duties willcease at the end of the event. Nominations for the Medical Supervisor(s) will be passed immediately to the SecretaryGeneral of FIS for approval by the FIS Council and thereafter this information will be for-warded to the event organisers with a copy of the Medical Guide. Once notification has been received by the event organisers, it is their responsibility toliase directly with the nominated Medical Supervisor. The organising committee shouldcontact the Medical Supervisor immediately and provide information regarding the de-livery of health care at the event. The organising committee will also provide further in-formation regarding safety, doping, gender verification etc., and be responsible for anycosts that may be incurred if a pre-event visit is necessary. Visits to the event venueprior to competition will only be made by mutual agreement between the organisers andthe FIS Medical Supervisor. The role of the Medical Supervisor is to assist the organising committee in relation to"medical problems", in the broadest sense of the term. The Medical Supervisor willkeep the organising committee informed regarding current FIS medical guidelines andthe application of these guidelines before and during the event. The Medical Supervisorwill collaborate closely at all times with the FIS Race Directors and other FIS appointedofficials (TD, Technical Advisor, equipment control etc.). The Medical Supervisor may recruit an independent assistant of the opposite sex fromthe personnel already in attendance at the event, to monitor areas where "same sex"supervision is required. The FIS Medical Supervisor will not be directly involved with the blood screening ordoping controls. If a member of WADA is not present and he is therefore involved withthe random draw for the doping controls of athletes, it is as one person within a smallgroup, as described in section B, point 4 of the FIS Doping and Medical Rules. His jobin regard to the doping controls is to provide information to the team doctors and offi-cials in regard to the logistical arrangements, such as the whereabouts of the dopingcontrol station, timetable and to clarify any questions in connection with the rules. During the course of the event the Medical Supervisor will be treated in exactly the sameway as other FIS appointed officials, (particularly in relation to travel expenses, hotelaccommodation, eating arrangements, uniform, honorarium, etc.) and is expectedwhere possible to attend all technical meetings during the event. At the end of the event the Medical Supervisor will prepare a comprehensive report, acopy of which will be forwarded to each of the following:1. Secretary General of FIS2. Chairman of the Medical Committee of FIS3. Organising committee of the event
MEDICAL SERVICES AT SKI COMPETITIONS The health of competitors should be an important concern of every organiser of ski competitions whatever the level. In order to realise this aim, a sophisticated health care delivery service is very important. This document presents the essential characteristics of such a service. It is important that any health care delivery service be under the direction of a competent person who will co-ordinate the medical team and represent this service on the local organising committee. He/she will liase with the other officials of the organisation (secu-
rity, technical, information, etc.) to ensure that the medical support arrangements oper-ate in a smooth and expedient manner. If the director of the medical health care team isnot a physician, then a physician must be appointed to be responsible for the competi-tion. The exact composition of the medical team (medical and paramedical personnel) de-pends on the event. In alpine skiing, ski jumping, and freestyle skiing, the injuries may bedangerous. In Cross-Country skiing, injuries are more likely to be related to overuse ormedical in nature. Each event demands different staffing levels. The exact location of medical facilities at any competition depends on the event. Indownhill, the location of the first aid stations will depend on the specific configurations ofthe course. In slalom a station at the top and at the finish area is normally sufficient. In downhill and Super G, the safety and evacuation procedures are organised in con-junction with the FIS Race Directors at World Cup races, and the Technical Delegates atother level competitions and an efficient communication system is capital. The number and nature of the medical stations at a competition will depend on theevent. Along a course, the stations may be either open or in tents. They must be easilyrecognised (e.g. marked with a red cross). The medical equipment within the stationswill vary, but should include resuscitation equipment, immobilisation splints, suture setsand appropriate medication. If appropriate, equipment used for evacuation should alsobe included. A helicopter landing pad may be required if specialist medical facilities area long way away. The health care delivery system must be functional from the beginning of training to theend of the competition. Separate arrangements for the spectators must be integratedwith those for the competitors. The health care delivery service must involve the local medical system and indeed therewill usually be an overlap between the two with respect to personnel. Prior to the begin-ning of the competition, a meeting will occur between the team doctors and members ofthe health care delivery service. This allows support staff to be familiar with the medicalarrangements and provides an opportunity to supply a written summary of what is avail-able on site location of equipment, the medical and paramedical personnel involvedwithin the health care delivery system, information concerning local medical and para-medical personnel (address, telephone number), local and regional hospital, availabilityof evacuation (service, distance to definitive care), dentists (address and telephone),and other information. Collaboration between team physicians and the local health care delivery service shouldbe encouraged and any treatment of an athlete should be brought to the attention of theteam physician. The chief of the health care delivery system may also be responsible for femininity anddoping control (see specific chapters). In this regard he/she will need to be familiar withthe appropriate rules as outlined in this book. Further Reference: The pre-hospital treatment of severely injured athletes, by InggardLereim (available at he FIS Secretariat). Downhill Cross-Country Ski Jumping Freestyle: Freestyle: Giant Slalom Aerials/Moguls
Remark: WC means World Cup and World Ski Championships
Speed Skiing Snowboard Telemark Rollerski Grass Skiing
Remark: WC means World Cup and World Ski Championships
On the basis of different well reflected arguments and with the support of the MedicalCommittee of FIS, the FIS Congress 2000 in Melbourne decided to modify the rules forGender Verification, despite the good experiences made with the FIS specific two pacethree step procedure (first at national level, than international randomised test, three ex-amination levels).
Instead it is required that both female and male athletes undergo a thorough evaluationof their medical health, which is to be conducted in the athlete’s own nation. (ICR 221.1)
If any question or protest arises as to the gender of the athlete FIS and its MedicalCommittee will assume responsibility for taking the necessary steps to determine thegender of the athlete (ICR. 221.4).
This means in effect that it is no longer necessary for the competitor to undergo the gen-der verification procedure as described in the Medical Guide in order to register for theFIS points list. Nevertheless, it is still possible for a gender verification certificate to beissued to any competitor who undergoes the examination as per the described proce-dure:
Gender testing was introduced by FIS to prevent male athletes from competing inwomen's races and for women to compete on equal terms. The determination of gender is complex and depends on an individual's ChromosomalSex, Gonadal Sex, Genital Sex, Hormonal Sex as well as their Psychological Sex. In thevast majority of individuals, all these parameters are 'harmonised' but in rare instancesthis may not be the case, either -a) as a result of nature (e.g. intersex states) orb) as a result of human intervention (e.g. sex change surgery). There is no simple test that can identify all the different possibilities and it is misguidedto believe that a single chromosomal test (buccal smear) can be accepted as the onlyrequirement to establish an individual's gender. When undertaken correctly, Gender Testing is a dignified procedure that identifies thosewith potential advantage in ski racing (including males) and enables a rational decisionto be made about eligibility for female competition. It is essential that this testing is carried out in a friendly environment where time is avail-able for the appropriate counselling of the female athletes. The FIS therefore advises National Ski Associations (NSAs) to carry out the testing offemale athletes when they first join the national squad and well in advance of interna-tional competition. This will allow sufficient time for further specialist review should anyabnormality be discovered (e.g. androgen insensitivity - XY females). Tests for gender verification are primarily the responsibility of the NSA who must ap-point a suitably qualified medical officer to supervise the procedures involved. The ap-pointed NSA Doctor will be directly responsible to the Chairman of the FIS MedicalCommittee for the satisfactory accreditation of female athletes. At the FIS Congress in Montreux, May 1990, a protocol for gender verification wasagreed, which was modified in 1996 to include the following items:
1. Chromatin test buccal smear or total karyotype (blood)2. Gynaecological inspection (not examination) by a female doctor3. Blood hormone test for Testosterone. This protocol may be varied at the discretion
All three tests have to be carried out. A FIS Gender Form (Annexe 4B) should be completed for each athlete and held by theNSA Doctor in a confidential manner. When the results of all the tests are available, the NSA Doctor is entitled to issue the FISMedical Certificate (Annexe 4A "National Certificate") to the athlete concerned, provid-ing that the results confirm femininity. The NSA Doctor should forward a list of all National athletes that have satisfactorilycompleted gender testing to the FIS Headquarters who will provide this list to theChairman of the FIS Medical Committee. In any case of doubt (where any of the three tests are not of normal female configuration)the Chairman of the Medical Committee must be consulted before the FIS Certificate isissued.
FIS reserves the right to carry out random gender verification tests in case of any ques-tion as to the gender of an athlete as provided for in the International Competition Rules,Article 221.4. The athletes selected will complete the same FIS gender protocol (seeitems 1, 2 and 3 above) under the direction of a female gynaecologist appointed by theFIS Medical Committee or FIS Medical Supervisor for this purpose. Satisfactory completion of these tests under FIS supervision will preclude the need forany further testing of that athlete at any time in the future. In these circumstances an offi-cial FIS endorsement will be added to the gender certificate already issued by the NSA(see Annexe 4B "International Certificate"). FIS DOPING AND MEDICAL CONTROL REGULATIONS Introduction FIS is committed to maintaining the integrity of all skiing competitions and condemns the use of doping in sport. The FIS Doping Control Regulations have been compiled in accordance with:
• The mission statement of the World Anti-Doping Agency (WADA)
• The Olympic Movement Anti-Doping Code
• The "agreement for the prevention of doping in sport between the IOC and the Olym-
It is certainly not an exaggeration to claim that since years, FIS has been one of the mostactive and innovative leading International Sport Federations in the tough and very com-plex fight against doping.
More than ever, FIS is strongly committed to intensify this fight, in order to offer to allparticipants in every discipline fair and safe competitions.
To reach this ambitious goal, FIS's Medical Committee, in close co-operation withneighbouring International Winter Sport Federations (ISU, IBU), the Medical Commis-sion of the International Olympic Committee (IOC) and very intensively with the WorldAnti-Doping Agency (WADA), has at its disposal a battery of different controls de-scribed below:
1. Blood screening
Pre competition blood controls with measurements of haemoglobin and other hae-matological parameters will be carried out at Cross-Country and Nordic Combinedevents to determine whether the athlete may start or not. Primarily this is not a dopingcontrol, but pathological values identify the need to carry out further a doping control. Additionally, blood screening on the entire starting field will be carried out at a num-ber of unannounced competitions. 2. Out-of-competition controls
As the wording says it clearly, such controls take place independently of a competi-tion. Nevertheless, the time point can be out of or during the season. All these controls will be conducted by WADA, and can include urine as well as bloodcontrols or blood screening. 3. Competition controls
"Classical" post-competition anti-doping controls, on ranked, drawn or "screened"athletes, with both urine and blood testing being possible. Members of the FIS Medical Committee are responsible for organising competitioncontrols in their own nation, respectively advising the national doping advising the na-tional doping agency of the competition calendars.
As we can see, there is no clear delimitation between health and doping controls anymore, the reason for which the blood screening and the haemoglobin start prohibitioncontrol is newly integrated in the chapter dealing with doping. FIS DOPING RULES Where appropriate in these rules, the masculine shall include the feminine and the sin- gular shall include the plural. As per article of 1.3 the FIS Statutes, the term "ski" shall include "ski and snowboard". RULE 1 - DOPING
The International Ski Federation (FIS), in accordance with the World Anti-Doping Agency (WADA) and International Olympic Committee (IOC) rules,condemns the use of products and methods, which affect different physio-logical systems in the body and serve the purpose of artificially improvingperformance in sport.
Doping is defined as:1. the use of an expedient (substance or method) which is potentially harmful
to athletes health and/or capable of enhancing their performance.
2. the presence in the athletes body of a prohibited substance or evidence of
the use thereof or evidence of the use of a prohibited method.
As it is possible by means of doping to gain an unfair advantage over otherathletes and because doping is a threat to physical and mental health, dop-ing is incompatible with the general standards of sporting ethics and is acontradiction of the rules and regulations of sport.
The FIS declares that doping is strictly forbidden for all FIS licence holdersand doping is an offence under the FIS rules in and out of competition.
The offence of doping takes place when a prohibited drug is found to be pre-sent within an athletes body tissue or fluids, or an athlete uses a bannedmethod, or an athlete admits having used a prohibited drug or a bannedmethod on the FIS list of doping classes and methods.
An admission may be made either orally in a verifiable manner or in writing.
In order to prevent the use of forbidden substances and methods, doping andmedical controls are carried out in accordance with the established FISRules.
FIS underlines the moral obligation not only to penalise offences but also toimplement preventive and educational programs. FIS draws the National As-sociations attention to the importance of these tools in the fight against dop-ing.
The FIS list of doping classes and methods is based upon the most recentpublished WADA/IOC list of doping classes and methods, without being re-stricted or bound by them. RULE 2 - ANCILLARY OFFENCES
A competitor who fails to attend the doping control or who refuses dopingcontrol after having being requested to do so by an appointed official, underRule 4, In-competition testing and under Rule 5 Out-of-Competition Testingwill have committed a doping offence and be subject to sanctions in accor-dance with Rule 7. This fact shall be reported to the FIS by his National SkiAssociation.
Any person assisting or inciting others, or admitting having incited or as-sisted others, to use a prohibited substance, or prohibited techniques, shallhave committed a doping offence and shall be subject to sanctions in accor-dance with Rule 7. If that person is not an athlete, the FIS Council may, at itsdiscretion, impose an appropriate sanction. RULE 3 - RESPONSIBILITY FOR DOPING AND MEDICAL CONTROLS
FIS will be responsible for doping and medical control at FIS World Champi-onships (WSC), major international competitions (World Cups, etc.). Out-of-competition testing shall be carried out by the World-Anti Doping Agency(WADA). RULE 4 – BLOOD SCREENING
At Major Championships and in World Cup Competitions in Cross-Countryand Nordic Combined, pre-competition blood screening tests are conductedby scientific experts in close co-operation with WADA if present, and the IOCat the Olympic Winter Games.
The expenses of this screening are born by FIS and the Organising Com-mittee.
The Organisers are required to make the necessary facilities for the screen-ing available according to the FIS rules, doping and medical regulations.
The analysis of the blood will be carried out on the spot and immediately byscientific experts equipped with instruments that can measure the necessaryparameters. RULE 5 – IN-COMPETITION TESTING
Doping control tests must be carried out at each FIS World Championshipand major events in accordance with the current FIS rules, under the supervi-sion of an officer of the FIS Medical Committee (Medical Supervisor) in re-gard to the logistical arrangements, and/or WADA. The expense of all thetests are the responsibility of the organisers.
The organisers of FIS World Championships and major FIS events are re-quired to carry out the control of doping classes and methods according tothe FIS rules and doping regulations.
Analysis of all urine samples must be carried out at a laboratory accreditedby WADA or IOC. Analysis of blood samples can only take place at a labo-ratory recognised for this purpose by WADA and/or the IOC.
Doping control tests at each Olympic Winter Games will be carried out ac-cording to the current IOC rules for the Olympic Winter Games, which mayvary from the FIS rules. It is the responsibility of competitors, coaches, physi-cians, and officials to be aware of any differences.
International CompetitionsDoping control tests are recommended at major FIS international competi-tions (World Cups, etc.). These tests must be carried out in accordance withthe FIS rules and doping regulations, and may be supervised by an officialFIS representative approved by the FIS Medical Committee and/or a repre-sentative of WADA. The expense of all testing is the responsibility of the localorganiser.
All National Ski Associations, respectively National Doping Agencies areobliged to inform FIS in confidence the date and location where a DopingControl will take place. Thereafter on the day of the control or the day before,the FIS Race Director or Technical Delegate (only) will be informed, in orderthat the programme of the event can accommodate the organisation of thedoping control without adversely affecting the programme for any athletes in-volved.
Further Doping ControlsNational Ski Associations are encouraged to carry out further doping controlsin accordance with the FIS rules and doping regulations. Where testing is theresponsibility of, or is carried out by, a National Ski Association, that NationalSki Association should adhere to the recommended procedures contained inthe "Procedural Guidelines for Doping Control". RULE 6 – OUT-OF-COMPETITION TESTING
It is a condition of membership of the FIS that a National Ski Associationincludes within its constitution:
a provision obliging that the National Ski Association conducts out-of-competition, no-notice doping control, a report of which must be submitted tothe FIS annually; and
a provision allowing the FIS to conduct out-of-competition, no-notice testingon that member's athletes.
Procedural guidelines for the conduct of out-of-competition, no-notice testingare to be found in the "Procedural Guidelines for Doping Control".
Out-of-competition testing shall be conducted in respect of doping classesand methods as requested by the FIS Medical Committee and/or WADA.
It is the duty of any National Ski Association to assist the FIS and, if appro-priate other National Ski Associations in the carrying out of such testing, andany National Ski Association preventing, hindering or otherwise obstructingthe carrying out of such testing shall be liable to sanctions according to theFIS sanction catalogue.
Where an athlete has been declared ineligible for a period, other than life,and wishes to resume competing after his period of ineligibility has expired,he must make himself available for out-of-competition testing at any timeduring his period of ineligibility. RULE 7 – NOTIFICATION OF NATIONAL TESTS
Every National Ski Association (NSA) shall inform the FIS Secretary Generalof any positive result(s) and sanction(s) that are imposed in the course ofdoping controls carried out by the National Ski Association. These sanctionsshall be reviewed at the next meeting of the FIS Council. At this meeting, theFIS Council will decide to accept or amend the sanction imposed by the Na-tional Ski Association in relation to the FIS sanction catalogue. Where sanc-tions have been amended, the decision of the FIS Council is final and bind-ing upon all National Ski Associations. An appeal against the decision of theFIS statutory bodies may be made to CAS.
Where a doping control has been carried out by the FIS, every National SkiAssociation shall recognise the results of such doping control and shall takeall necessary action to render such decisions effective.
The FIS Council may recognise the results of doping control carried out by asporting body other than the FIS, with Rules and Procedures different fromthose of the FIS, provided that the testing was properly carried out and therules of the governing body conducting these test afford sufficient protectionto the athlete.
If the FIS Council decide that the result of doping control carried out by asporting body other than the FIS is to be recognised, then the athlete shall bedeemed to have breached the relevant FIS Rule and will be subject to thesame sanctions. National Ski Associations shall take all necessary action toensure that this decision is effective. PROCEDURAL GUIDELINES FOR DOPING AND MEDICAL CON- TROLS These procedural guidelines take into account the FIS doping rules 1 - 6 and the guide- lines should be followed as far as reasonable practicable. Where appropriate in these rules, the masculine shall include the feminine and the singular shall include the plural. BLOOD SCREENING Introduction Since 1989, examination of blood pictures was carried out within the frame- work of FIS doping controls at Nordic World Ski Championships. These analyses revealed a distinct increase in the haemoglobin values in female as well as in male Cross-Country skiers that cannot be explained with only physiological arguments.
Some of the values found can without discussion, be considered as patho-logical and dangerous, and would often need treatment in situations of nor-mal life. Undoubtedly, they represent an increased risk for the health of theathlete (cerebral apoplexy, acute death, other damages).
In 1997, FIS on recommendation of its Medical Committee, introduced acontrol of the haemoglobin value prior to an event for Cross-Country skiers,and Nordic Combined competitors before the Cross-Country event for per-mission to take part. These controls are not to be considered as classicaldoping controls, but do not exclude blood controls after the competition, asdescribed in the FIS Medical Guide. Nevertheless, if these controls revealabnormal parameters, further blood screening and doping controls can becarried out.
Following collaboration with six other International Federations coordinatedby WADA, for the 2001/2002 season FIS under the guidance of WADA hasintroduced the same procedures used by several other International Federa-tions for carrying out the blood screening examinations. Procedure Selection of the athletes Approximately 20% of the athletes on the start list will be selected by random, at the team captains meeting the evening before the event. This draw will be conducted by the Race Directors and the Technical Delegate and if present supervised by a representative of WADA, who keep the established list ab- solutely confidential. Information to the team captains At the team captains meeting, precise and complete information about the time and place of the controls as well as the method of receiving the names of chosen athletes will be given to the team captains. Nomination of the athletes About 2½ hours before race start time for Cross-Country races and usually after the Ski Jumping event for Nordic Combined competitions, the team captain or trainer asks the Race Director or the TD at the published place (office, telephone) if one of his athletes has been selected. It is his task to pass on this information to the athlete. Normally the information time is di- vided into two different groups based on the starting fields. Time of control After informing the team official, the selected athlete has 15 minutes to ap- pear at the control. All athletes who have been drawn for blood screening are required to attend, even those who may have withdrawn from the race. Place of control The location for the haemoglobin control and blood screening will be clearly indicated. The control station will be equipped as described in the FIS Dop- ing Control Regulations, Section C. Blood sampling See page 29 Collection of Blood Samples in the FIS Doping Control Regu- lations. Measurements At the World Cup, World Championships and the Olympic Winter Games, an independent scientific expert will be responsible for evaluating the results of the blood screening. The work may be supervised by a representative of WADA if present. The measurements will be done with the independent scientific expert’s measuring machines that are capable of measuring the haemoglobin, he- matocrit and reticulocytes. The result can be read immediately within about 90 seconds. The maximum tolerated haemoglobin values are: 16.0 g/dl for ladies 17.5 g/dl for men If an athlete has a higher haemoglobin value at the first measurement, a sec- ond measurement will be performed immediately and by the same proce- dure. The athlete is not allowed to leave the testing area.
Other hematological parameters will be measured at the same time as hae-moglobin (hematocrit, reticulocytes, etc). If abnormal, these results can leadto anti-doping controls, in either a post-competition or an out-of-competitionform as a urine doping control. Start Prohibition If an athlete shows higher values than the haemoglobin values of 16.0 g/dl for ladies and 17.5 g/dl for men after the 2 consecutive measurements, he/she will be notified by the Jury that he/she is not allowed to start. The time be- tween the two consecutive measurements may not exceed 5 minutes. Only the athlete or his/her National Ski Association has the right to comment on this notification. This interdiction to take part in the competition is not a sanction, but is to be considered as a protection of the health of the athlete. Consequently, no dis- ciplinary measures will be taken. Given the extremely short time available to carry out the analysis and make a decision, an appeal is not possible. Information to the athlete In the case of a result which exceeds the haemoglobin values of 16.0 g/dl for ladies and 17.5 g/dl for men, this information will be provided to the athlete in writing straight away. He will sign this form, confirming in this way he has ap- proved the whole procedure. Blood screening of the Whole Starting Field In addition blood screening on the entire starting field will be carried out at a number of unannounced competitions. Teams will be informed when and where the controls take place either at an Information Meeting or Team Captains Meeting. Teams will be summoned on a nation by nation basis. All other procedures under the above points 2.5 to 2.8 apply, with the exception that only one blood screening measurement will be carried out. Administration of the results Only the scientific expert(s) and the representative of WADA shall be present during the evaluation of the blood sample. The results of the screening will be stored in a database accessible only to WADA and FIS. The National Ski Association of the athlete concerned may obtain the results of its own ath- lete(s) from FIS on request in writing. This information will not be released to coaches or National Association representatives at the competition site by the scientific expert. Miscellaneous The costs for the above blood controls are born by the FIS (travel, expenses for the scientific expert) and the Organising Committee (accommodation, meals for the scientific expert).
The Organising Committee is required to organise a local nurse(s), who isqualified to carry out phlebotomy for drawing the blood. The nurse should beable to communicate in English. Exceptions Athletes whose normal (natural) haemoglobin values exceed the limits of 17.5 for men or 16.0 for ladies are required to provide a certification to the FIS Office before the start of the season, respectively their first competition.
This certification must come from a Hematological Department and containthe athlete’s full history and hematological profile from an early age in life. The athlete will also be subject to a further examination by a hematologicalinstitution approved by WADA and FIS, and the IOC during the period of theOlympic Winter Games. DOPING CONTROL DURING COMPETITIONS
Athletes, coaches and team officials should acquaint themselves with the FISDoping Rules 1 - 6 and these procedural guidelines.
These guidelines must be followed as far as is reasonably practicable, how-ever, a departure or departures from these guidelines shall not invalidate thefinding of a prohibited substance or method, unless it was such as to castsubstantial doubt on the reliability of the finding.
All costs incurred for in-competition doping control are the responsibility ofthe local organisers.
The doping control procedure at any event or out-of-competition doping con-trols may include blood sampling in addition to urine sampling.
The Doping Control Notification shall state whether the competitor is requiredto undergo blood sampling in addition to urine sampling.
Blood sampling may be performed prior to, or after the urine sampling pro-cedure at the convenience of the Doping Control Officer. All blood samplesshall be taken by qualified personnel. FIS Medical Supervisor
When a FIS Medical Supervisor has been appointed by the FIS Council, hewill be responsible at the designated competition for liasing with the Organ-ising Committee and the doping agency carrying out the doping controls inregard to the organisational aspects of the doping control, in order to informthe teams and Jury.
When no FIS Medical Supervisor is in attendance, this roll may be carried outby an official FIS representative approved by Council on recommendation ofthe FIS Medical Committee.
If necessary, a Medical Doping Control Committee can be formed under theChairmanship of the FIS Medical Supervisor or a designated FIS Repre-sentative. This committee should include a physician specifically appointedby the organisers of the competition for doping control.
Additional members such as assistants, interpreters, couriers, etc. may berecruited to aid in carrying out the duties and functions of the Medical DopingControl Committee.
The World Anti-Doping Agency (WADA) may attend any FIS doping controlas an independent observer and supervise all stages of the proceedings. Facilities and Equipment (provided by Organisers)
The organiser shall provide a doping control station, which must be situatednear to the finish area and clearly marked, where urine and blood samplingcan be undertaken. The station must consist of a waiting area, a working room and WC's (menand women). It is recommended that the doping control station is also equipped with run-ning water, shower and TV set. Canned refreshments (mineral water, soft drinks, fruit juice, etc.) must beavailable in the waiting area. These drinks must contain no caffeine or alco-hol.
EquipmentSample collection equipment should consist of a standard set of the followingmaterials:- sterile collecting vessels,- sterile glass or plastic bottles,- unique sealing device,- doping control forms,- dipstick for pH and specific gravity measurements and/or refractometer. There must be sufficient equipment available to offer the athlete a choice.
The Doping Control Station shall contain a supply of sterile blood collectionkits. The room(s) for collecting blood samples shall be adequately equipped andfacilities to allow the phlebotomist to wash his/her hands and fulfil the stan-dards of "university hospitals". Selection and number of competitors to be controlled
The method of selecting competitors and the total number to undergo dopingcontrol must be decided before the beginning of each competition by the FISMedical Supervisor or FIS appointed official in conjunction with the competi-tion jury and the representative of WADA if present.
The selection of the athletes must be carried out on the basis of a previouslyfixed system (usually top four and one or more at random).
Athletes selected at random will be drawn by the WADA representative, FISMedical Supervisor or FIS appointed official with a representative of the juryaccording to the selection procedure described under point 4.6.
The selection of the athletes has to be implemented so that the competitorsor officials of the participating countries have no warning before the end ofthe race in which the athlete is scheduled for doping control.
Any competitor in FIS competitions may be subject to doping control at anytime during the competitions. This may not however infringe on the actualcompetition itself and must respect the competitor's pre-competition prepa-ration. Selection of Random Competitors for Doping Control per Discipline The following guidelines for the different disciplines and events are given to assist the doping control officers/WADA representative, FIS Medical Super- visor and jury in determining the selection of random competitors.
In all disciplines, reserve competitors will be drawn in case a random drawfinishes in the top 4 positions. Cross-Country Competitors are drawn according to their starting numbers (bibs).
Cross-Country Sprint EventsCompetitors are drawn from the finals starting field according to their startingnumbers (bibs). If a competitor qualifies for the quarter-finals, semi-finals orfinals then he/she will be summoned to the doping control only after elimina-tion from the competition. Ski Jumping Competitors are drawn according to their starting numbers (bibs). Nordic Combined Competitors are drawn according to their starting numbers (bibs). The sum- mons to the doping control will only be issued after the final part of the com- petition. In the case of the Mass Start events, the Ski Jumping event is last; in Individual Events, the Cross-Country race is last. Alpine Skiing Downhill, Super G Competitors are drawn according to their starting numbers (bibs). Reserve starting numbers are drawn in case one or more of the previously drawn competitors does not finish the race.
Slalom, Giant SlalomCompetitors are drawn after the first run according to their starting numbers(bibs). Reserve starting numbers are drawn in case one or more of the previ-ously drawn competitors does not finish the race.
CombinedCompetitors are drawn before the final run according to their starting num-bers (bibs). Reserve starting numbers are drawn in case one or more of thepreviously drawn competitors does not finish the race. Freestyle Skiing
MogulsCompetitors are drawn according to their starting numbers (bibs).
Dual MogulsCompetitors are drawn from the finals starting field according to their startingnumbers (bibs). If a competitor qualifies for the quarter-finals, semi-finals orfinals then he/she will be summoned to the doping control only after elimina-tion from the competition.
AerialsCompetitors are drawn according to their starting numbers (bibs). Snowboarding
Giant Slalom, SlalomCompetitors are drawn after the first run according to their starting numbers(bibs). Reserve starting numbers are drawn in case one or more of the previ-ously drawn competitors does not finish the race. It is also possible to carryout the draw before the first run and include all participants, however if acompetitor qualifies for the second run then he/she will be summoned to thedoping control only after the end of the competition.
Parallel Giant Slalom, Parallel Slalom, Snowboardcross, HalfpipeCompetitors are drawn from the finals starting field according to their startingnumbers (bibs). If a competitor qualifies for the future rounds, quarter-finals,semi-finals or finals then he/she will be summoned to the doping control onlyafter elimination from the competition. Procedure for notification and attendance at the doping control station
Immediately after the athlete concerned has finished the competition, all ath-letes selected for doping control shall be notified in writing by an authorisedperson. They will be informed if blood sampling will be undertaken. The testing notification shall include the competitor's name, starting numberand the statement that a companion (team official, coach, interpreter, ordoctor) may be present when the competitor reports to the doping controlstation. It shall also point out the possible consequences if an athlete should fail toreport for doping control within the given time limit.
The time of notification shall be entered on the form, and the athlete is re-quired to sign the form in acknowledgement of receipt of notice.
A copy of the notification form will be handed to the athlete.
Once an athlete has been given notice, he must be accompanied at all timesby an authorised person and must report to the Doping Control Station withinthe time limit stated on the notification form.
The competitor and any companion shall be attended in the waiting room bya member of the doping control team.
The identity of the athlete will be checked by suitable means (identity card,accreditation, starting number, etc.).
The time of arrival and personal data of the competitor shall be noted in therecords.
Only one competitor at a time shall be called into the doping control room.
In addition to the competitor and the companion, only the following personsmay be present in the doping control room:a) a FIS Medical Supervisor or official medical representativeb) a representative of WADAc) the Doping Control Officerd) a male and a female assistant to witness the delivery of the specimene) an interpreter. Photographs may not be taken in the doping control station at any time dur-ing doping control. It is recommended that a security officer be positionedoutside the doping control station to monitor the flow of people in and out andto keep unauthorised persons from entering the station.
The specimens to be analysed for doping substance or methods is a) urinealone or b) urine and blood. The procedure for urine sampling is described inchapter B6. The procedure for blood sampling is described in chapter B7. Collection of Urine Sample
When the athlete feels he is ready to provide a sample, he shall select asample collecting vessel from a number of sterile, unused vessels.
The athlete shall urinate into the collecting vessel under the observation of anauthorised witness of the same sex. A minimum volume of 75 ml is required. If insufficient urine has been provided by the athlete, the partial sample shallbe sealed and coded. The athlete will remain under observation until suffi-cient urine has been provided and sample taking procedures are complete.
Each athlete selects the bottles to hold the specimen from a selection of ster-ile, unused bottles provided by the collecting agency or WADA/IOC labora-tory. The athlete also selects a unique code number and both bottles are markedwith this code number.
The athlete will pour approximately 2/3 of the urine sample into the containerbottle marked A, and 1/3 into the container bottle marked B. Both containerbottles will be tightly closed and sealed. The code numbers will be recordedand cross-checked.
Using a residual volume of urine in the collection vessel, specific gravity andpH of the urine must be measured. These values will be recorded. If the spe-cific gravity is lower than 1.010 then double the volume of urine (minimum150 ml) must be submitted by the athlete. If measured by refractometer thislevel may be 1.005.
The athlete shall be asked to declare any medication used in the last tendays prior to the test.
The bottles will be placed in transportation bags.
The doping control forms will be competed by the doping control official. Theathlete's identification data, code numbers of the bottles and seal numberswill be cross checked. Any irregularities identified by the athlete or compan-ion should be noted on the doping control forms before signing it.
The athlete shall certify the accuracy of the information by signing that he/sheis satisfied with the sample collection procedures. The doping control formsshall also be signed by the sampling officer, the athlete's companion (if pres-ent), and the WADA or FIS official representative (if present).
The Doping Control Form should be so devised that duplicate copies areproduced at the same time. These should be distributed as follows:- the original sent to the FIS Office,- the first duplicate copy transmitted to the local Organising Committee, to
- the second duplicate copy given to the athlete,- the third duplicate copy sent to the laboratory which is to conduct the
analysis. This copy shall contain no information on the name or any identi-fying details of the athlete or companion.
Any modification from the above procedure must be authorised by the FIS tobe considered valid. Collection of Blood samples
The competitor shall select one blood control kit, open it, inspect the contentsand place these on a table in front of him/her. The blood sampling procedureshall be explained to him by the Doping Control Officer.
PhlebotomyThe athlete should be sitting safety and on comfortable chair with adjustablearmrest during phlebotomy.
Samples of venous blood are taken from a superficial forearm vein only.
Phlebotomy will be carried out by the appointed phlebotomistnurse.
The total number of phlebotomy attempts is limited to 3 on each arm.
Standard procedure for skin cleansing and phlebotomy are to be employed.
Two samples for blood doping control of 3 cc - 5 cc are to be collected intostandard tubes containing anti coagulant (e.g. ACD or heparin) and labelledA and B (3 cc - 5 cc in each).
Labelling, Storage and DespatchThe tubes are to be labelled witha) Dateb) Unique code numberc) "A" or "B"
The Doping Control Officer shall check that the code numbers on the sampletubes and shipping containers are identical and record the code number onthe Doping Control Official Record. The competitor shall then check that thecode numbers on the sample tubes and shipping containers are identical tothat recorded on the Doping Control Official Record. The competitor shallplace the blood tubes in the respective shipping containers for A and B sam-ples. The competitor shall close the lids on the shipping containers carefullyand the Doping Control Officer shall check that these are completely and cor-rectly sealed.
The competitor shall declare to the Doping Control Officer any blood transfu-sion(s) he may have received in the preceding six months, the date, the rea-son for the transfusion(s), and the name of the doctor/hospital who adminis-tered the transfusion(s). The Doping Control Officer shall record these state-ments on the Doping Control Official Record.
The athlete shall sign the Doping Control Official Record and will be providedwith a copy to keep.
If the competitor refuses to permit blood sampling, the possible conse-quences shall be explained to him by the Doping Control Officer or FISMedical Committee representative. If the competitor still refuses, this factshall be noted in the Doping Control Official Record. This shall be signed bythe Doping Control Officer and the FIS Medical Committee representative, ifpresent. The competitor and the companion shall be requested to sign aswell. The FIS Medical Committee representative shall be responsible forcommunicating the refusal to the Chairman of the FIS Medical Committee.
At the end of each group collection, the shipping containers containing the Aand B samples shall be placed in the transport container(s). The corre-sponding laboratory copies of the Doping Control Official Record shall beplaced in an envelope. This envelope shall be sealed and placed in thetransport container containing the A and B samples. Each transport containershall then be sealed with a unique numbered seal. If the time from collecting the blood until the samples are received in the labo-ratory is likely to exceed 24 hours, the transport container(s) should be storedat 0 - 4°C during transport.
For the blood screening, some slight differences exist from the regulationsconcerning collection of blood samples (pt. 7.1 to 7.9):- the phlebotomy will be carried out by the nurse arranged by the Organising
- only one (1) sample of 2.5 cc is collected in a syringe containing EDTAThis syringe with a code is then handed over to the scientific expert whodoes the immediate measurements.
In addition to blood screening, the blood samples can be used for researchto develop further methods to control of performance manipulation afternegative ("not manipulated") results have been received, if the athlete hasgiven (signed) permission for it, providing that the details of the research hasbeen submitted in advance to WADA and/or FIS in writing and that the re-quest to undertake such research has been approved by WADA and/or FIS. Analysis of samples
All samples provided by athletes for the purpose of doping control (urineand/or blood) immediately become the property of FIS.
Only laboratories accredited by the IOC or by WADA may be used to carryout analysis on urine or blood samples taken in connection with doping con-trol. Blood screening shall be carried out on site at the competition venue,hotel, etc. or any other location where out-of-competition blood screening iscarried out.
The analysis of samples must be carried out as soon as possible after arrivalat the laboratory.
If at any stage, a question or issue arises on the testing or interpretation ofresults, the person responsible for testing at the laboratory may consult theFIS Medical Supervisor or the Chairman of the FIS Medical Committee forguidance.
If at any stage, a question or issue arises in relation to the sample, the labo-ratory may conduct any further tests necessary to clarify the fact or issue soraised and such tests may be relied upon by the FIS when deciding whethera sample has tested positive for a prohibited substance or method. Communications of results
The laboratory report on the analysis of the "A" sample is issued to the FISSecretary General.
If the analysis of the "A" sample provides evidence of a prohibited substanceor method, the FIS President or Secretary General shall immediately informthe athlete's National Ski Association, who shall request an explanation fromthe athlete within a period determined by FIS.
Once the athlete's National Ski Association has been informed, the labora-tory shall arrange a date (within 21 days) for the analysis of the reserve "B"sample. This analysis of the B sample is not compulsory and left to the deci-sion of the National Ski Association of the athlete. If this “B” analysis is re-quested, the National Ski Association shall be informed of the date and timeof the analysis of the "B" sample and the National Ski Association must in-form the athlete immediately. Should he choose to do so, the athlete and/orhis representative, may be present at the analysis of the "B" sample. A rep-resentative of the athlete's National Ski Association may also be present, asmay a representative of WADA and/or the FIS Medical Committee. Oncetesting of the "B" sample is complete, the laboratory report must be sent tothe FIS Secretary General.
At FIS World Championships, the analysis of the reserve "B" sample mustbegin within 24 hours of the communication of the positive "A" sample" to theNational Ski Association concerned. This analysis of the “B” sample is notcompulsory and left to the decision of the National Ski Association of theathlete.
Any costs associated (analysis, own representation) with the analysis of the“B” sample is the responsibility of the National Ski Association of the athletewho provided the positive “A” sample. If a member of the FIS Medical Committee or another representative is ap-pointed by FIS to attend the analysis of the “B” sample, then FIS covers histravel expenses.
A copy of the report of the positive test will be forwarded immediately by theFIS Secretary General to the athlete's National Ski Association after the re-sult of the "B" sample has been received, if the National Ski Association onbehalf of its athlete has requested that the “B” sample is also tested. Other-wise this communication will follow after the National Ski Association has ad-vised FIS that it has waived its right to test the "B" sample. The National SkiAssociation must also be informed that the athlete has breached the Rules ofthe FIS and is therefore subject to disciplinary proceedings in accordancewith the FIS Doping rules, Disciplinary Procedures for Doping Offences(chapter D).
At all times, details of the investigation should be treated as strictly confiden-tial by all persons connected with doping control. OUT-OF-COMPETITION DOPING CONTROL
Out-of-competition doping controls are carried out by the World Anti-DopingAgency (WADA). These procedural guidelines for out-of-competition dopingcontrols take into account the FIS doping rules 1 - 8 and the procedures forcollecting samples to be analysed for doping substances or methods. TheFIS procedural guidelines for doping controls shall be followed as far as rea-sonable practicable also by WADA. Where appropriate in these guidelines,the masculine shall include the feminine and the singular shall include the plu-ral.
Athletes, coaches and team officials should acquaint themselves with thedoping control procedures contained in FIS Doping Rules 1 - 8 as well asthese procedural guidelines for out-of-competition doping controls.
These guidelines must be followed as far as reasonably practicable, how-ever, a departure or departures from these guidelines shall not invalidate thefinding of a prohibited substance or method, unless it was such as to castsubstantial doubt on the reliability of the finding.
The costs for out-of-competition testing organised and carried out by WADAare covered by the World-Anti Doping Agency (WADA) or FIS.
Samples (urine or blood) obtained during out-of-competition testing are cur-rently analysed for anabolic agents (class 1.3), Diuretics (class 1.4), Peptidhormons, mimetics and analogues (class 1.5) and prohibited methods (class2). Other doping classes or methods may be tested at the request of the FISMedical Committee. Procedure for registration of competitors that may be selected for out-of-competition doping controls
Before the 1st of May each year, each National Ski Association will provideFIS with a complete list of competitors who are currently competing or whointend to compete internationally using the FIS Out-of-Competition DopingControl forms or the forms provided by the respective National Sports Gov-erning Body. Additionally, the name of any competitor who does not meet thecriteria above but has a reasonable probability of being selected for interna-tional competition in the coming year should be appended to the list. Each athlete listed shall be informed by their National Association that theyare eligible for FIS out-of-competition testing and must provide the NationalAssociation with a procedure for contacting them at all times. It should beemphasised that in all cases of holiday, training camps, or foreign travel theNational Association must be able to contact each listed athlete within 48hours. Failure of an athlete to make themselves available for out-of-competitiondoping control may be viewed as a positive test.
This information is then provided by FIS to WADA. Failure to provide thenecessary documentation will lead to WADA taking further action, which willinclude advising the Sports Governing Body of the nation(s) concerned.
When required to do so, the National Ski Association must be able to pro-vide the following information on all targeted athletes:- Date of birth- Passport (or equivalent document) number- Full address and telephone number (home or training site) where the
competitor can be contacted during the period of preparation.
- Number of years competing for National Ski Association and events at-
Each National Ski Association is required to complete and submit the FISDoping Control Forms for their respective teams in each discipline. Theseforms are available from the Rules and Publications section of the FIS web-site and are included as an appendix at the end of this guide:
Form A: National Team Information- a list of all competitors with their contact details
Form B: National Team Training Programme- details of the out-of-competition training programme
Form C: Training Camp Details- specific information about each training camp, including hotel, contact
Forms provided by the respective National Sports Governing Body may alsobe used if the above information is contained. Procedure of Selection of National Ski Associations and Competi- tors
The World-Anti Doping Agency will select individuals for testing on an annualbasis.
Not more than two (2) days before sampling, the National Ski Associationmay be contacted by an individual or organisation authorised by FIS to carryout out-of-competition testing and the National Ski Association is required toprovide all the information listed above (2.2) if necessary.
Contact with the selected athlete is the responsibility of the sample collectionor organisation authorised by FIS, and not the responsibility of the NationalSki Association. Appointed Sample Collectors
The FIS Council may, on the advice of the Medical Committee, appoint indi-viduals or organisations to conduct out-of-competition doping controls on be-half of the FIS.
All sample collectors used by the World Anti-Doping Agency or anotherdoping agency appointed by FIS for out-of-competition testing will be in pos-session of a letter of appointment. Identification
When an athlete is contacted by the authorised sample collector, this personmust provide proof of:a) identityb) authorisation from WADA or the FIS appointed Doping Agency (letter of
c) copy of the appointment of the Doping Agency to conduct Out-of-
Competition Doping Controls on behalf of FIS or copy of appointment ofthe World Anti-Doping Agency (WADA)
Procedure for out-of-competition doping control
The same procedures listed in the FIS Procedural Guidelines for DopingControl during competition shall be followed as far is as reasonable practi-cable.
The sample collector will make every effort to collect the specimen for analy-sis as discretely as possible and with maximum privacy.
Should a competitor fail to report to the agreed doping control station, thedoping official must inform the FIS and the National Ski Association. It is theathlete's responsibility to check prior to the arranged meeting that there is nopossible confusion over the arranged date, time and precise location wherethe meeting will take place. The sample collector will wait up to two (2) hoursbeyond the time agreed but thereafter the athlete will be declared absentfrom testing. An appeal on the grounds that the athlete did not fully under-stand where to go, or went at the wrong time, will not normally be considered. An athlete who is absent from testing will be deemed to have refused tosubmit to doping control (FIS Doping Rule 2) and may be subject to sanc-tions under FIS Doping Rule 6.
If the athlete refuses to provide a urine or a blood sample, the sample col-lector should explain to the athlete that by refusing to provide a sample, heshall be deemed to have refused to submit to doping control and may besubject to sanctions under FIS Rule 6. If the athlete still refuses to provide asample, the sample collector should note this on the Doping Control Form,sign his name to the form and ask the athlete to sign the form. The samplecollector should also note any other irregularities in the doping control proc-ess. Storage and dispatch of samples
The same procedures listed in the FIS Procedural Guidelines for DopingControl during competition shall be followed as far as reasonable practica-ble.
If at all possible, the outer container should not be opened during transit tothe laboratory but the opening of the outer container (e.g. by customs offi-cers) will not, of itself, invalidate the doping control protocol. Analysis of samples and communication of results The same procedures as listed in the Procedural Guidelines for Doping Control during competition shall be followed. Waiver The nature of out-of-competition doping control makes it inevitable that little or no prior warning is given to the athlete. Every effort will be made by the authorised sample collector to collect the samples speedily and efficiently with the minimum of interruption to the athlete's training plans and/or to his social or work arrangement. If there is an interruption, however, then no ath- lete may take action to gain compensation for any inconvenience caused, or loss of earnings. DISCIPLINARY PROCEDURES FOR DOPING OFFENCES RULE 1 - DISCIPLINARY PROCEDURE 1.
Where an “A” sample test is positive, a doping offence has taken place andthe following procedure will be undertaken:a) Notification of National Ski Association and athleteb) Analysis of B-sample (if requested)c) Disqualification and suspensiond) Hearinge) Confirmation of duration of ban by FIS Council
On receipt of a positive sample (“B” sample if requested), the competitor orteam will be automatically disqualified from the competition and the com-petitor suspended forthwith from participating in FIS calendar events until theFIS Council confirms the duration of suspension. If an athlete who tests positive is a member of a team (jumping, relay, etc.)then the whole team will be disqualified from the competition.
Prior to any decision by the FIS Council regarding sanctions, every athleteshall have the right to a hearing by the relevant tribunal of his National Asso-ciation or FIS, which may also take the form of a written statement. When it isdetermined that a doping offence has taken place after receipt of a positivesample, the National Association on behalf of it’s athlete shall be informed ofthe athlete’s right to a hearing. If the National Association on behalf of theathlete does not respond within 28 days of receipt, then it will be deemed tohave waived the athlete’s right to a hearing.
Detailed guidelines regarding the procedure for communication of results fora positive sample are to be found in the section "Procedural Guidelines forDoping Control, Communication of Results". RULE 2 – SANCTION
If an athlete is found to have committed a doping offence after the proceduredescribed in Rule 1. has been carried out, and this is confirmed after ahearing, respectively consideration of the written statement or the NationalAssociation on behalf of the athlete waives the right to a hearing, then heshall be sanctioned. The FIS Council decides on the appropriate sanctionaccording to the FIS sanction catalogue. The sanction is valid from the dateon which the sample was provided and the athlete’s results shall therefore beannulled from all competitions in which he has participated since then.
The athlete has the right to appeal the decision of the FIS Council to theCourt of Arbitration for Sport (CAS). FIS Sanction Catalogue
Suspension from participation in all international ski competitions for 2 yearsfor the first offence.
Suspension from participation in all international ski competitions for life-timefor the second offence.
Suspension from participation in all international ski competitions for 3months for the first offence (during a fixed period within the actual or nextcompetition season).
Suspension from participation in all international ski competitions for 2 yearsfor the second offence.
Suspension from participation in all international competitions for life-time forthe third offence.
Infringements by doctors and other officials
Suspension from participation and accreditation in all international ski com-petitions for life-time. EXCEPTIONAL CIRCUMSTANCES
An athlete may appeal to the Court of Arbitration for Sport (CAS). Any deci-sion made by the statutory bodies of FIS may be submitted exclusively byway of appeal to the Court of Arbitration for Sport in Lausanne, Switzerland,which will resolve the dispute definitely in accordance with the Code ofSports-related Arbitration. The time limit for appeal is twenty-one days afterthe reception of the decision concerning the appeal.
According to ICR 203.2.1 the National Ski Association must guarantee thatall athletes registered for a FIS Licence accept the rules of the InternationalSki Federation, in particular the provision which foresees the exclusive com-petence of the Court of Arbitration for Sport as the court of appeal in dopingcases. LIST OF BANNED DOPING CLASSES AND METHODS
The following list is valid as of publication of this Guide. It corresponds to the IOC/WADAapproved list valid of 1st September 2001. This list will be valid at least until 31st Decem-ber 2002. Any subsequent changes to the IOC list shall automatically apply. Doping contravenes the ethics of both sport and medical science. The FIS Council'sdefinition of doping includes:Doping is (IOC Definition):1. the use of an expedient (substance or method) which is potentially harmful to athletes
health and/or capable of enhancing their performance.
2. the presence in the athletes body of a prohibited substance or evidence of the use
thereof or evidence of the use of a prohibited method. Prohibited classes of substances Prohibited Methods
Blood doping and administration of artificial oxygen carriers or plasma ex-
Pharmacological, chemical and physical manipulation
Classes of drugs subject to certain restrictions
NOTE: The following list represents examples of the different prohibited classes of sub-stances and prohibited methods to illustrate the doping definition. All substances be-longing to the prohibited classes cannot be used even if they are not listed as examples. For this reason, the term "and related substances" is introduced. This term describesdrugs that are related to the class by their pharmacological actions and/or chemicalstructure. If substances of the prohibited classes are identified by an IOC accreditedlaboratory the relevant authority will act. A larger list of examples belonging to different pharmacological classes of banned sub-stances can be found in the enclosed Annexe 1. EXAMPLES AND EXPLANATIONS Doping classes Stimulants Stimulants compromise various types of drugs which increase alertness, re- duce fatigue and may increase competitiveness and hostility. Their use can also produce loss of judgement, which may lead to accidents in some sports. One group of stimulants is the sympathomimetic amines of which ephedrine is an example. In high doses, this compound produces mental stimulation and increases blood flow. Adverse effects include elevated blood pressure and headache, increased and irregular heart beat, anxiety and tremor. Ephedrine is often present in cold and hay fever preparations which can be purchased in pharmacies and sometimes form other retail outlets without the need of a medical prescription. Ephedrine is banned under FIS Rules but other sympathomimetic amines are subject to monitoring only - see note 2 Thus no product for use in colds, flu or hay fever purchased by a competitor or given to him/her should be used without first checking with a doctor or pharmacist that the product does not contain a drug of the banned stimulant class. Another group of stimulants is the beta-2 agonists. These drugs are unusual because they are classified as both stimulants and anabolic agents. When taken by mouth or by injection they exert powerful stimulatory and anabolic effects. Oral and injectable administration of beta-2 agonists is banned. Of beta-2 agonists only FORMOTEROL SALBUTAMOL, SALMETEROL, and TERBUTALIN are permitted and only by inhalation. The FIS Medical Committee, WADA and the IOC are concerned with the high incidence of the use of asthma medication in athletes. There- fore skiers using anti-asthmatic medication (beta-2 agonists and/or corticosteroids) are requested to possess a medical certificate stating the diagnosis and the need for medication by a respiratory specialist. This procedure is compulsory for the validity of a medical certificate. Some examples of prohibited stimulants are: - amineptine - amiphenazole - amphetamines - bromantan - caffeine* - carphedon - cocaine - ephedrines** - fencamfamin - formorterol*** - mesocarbe - pentetrazol - pipradol - salbutamol***
- salmeterol***- terbutaline***.and related substances
For caffeine the definition of a positive is a concentration in urine greaterthan 12 micrograms/ml.
For cathine, the definition of a positive is a concentration in urine greaterthan 5 micrograms per millilitre. For ephedrine and methylephedrine, thedefinition of a positive is a concentration in urine greater that 10 micro-grams per millilitre. For phenylpropanolamine and pseudoephedrine, thedefinition of a positive is a concentration in urine greater than 25 micro-grams per millilitre.
*** Permitted by inhaler only to prevent and/or treat asthma and exercise-
induced asthma. Written notification of asthma and/or exercise-inducedasthma by a respiratory specialist or team physician is necessary on theFIS medical notification form, a copy of which is to be sent to the FISHeadquarters and a copy to be retained by the athlete to submit at anydoping control.
At the Olympic Winter Games, athletes who request permission to inhale apermitted beta agonist will be assessed by an independent medical panel.
NOTE 1: All imidazole preparations are acceptable for topical use. Vaso-constrictors (e.g. adrenaline) may be administered with local anestheticagents. Topical preparations (e.g. nasal, ophtalmological, rectal) of adrena-line and phenylephrine are permitted. Narcotic analgesics The drugs belonging to this class, which are represented by morphine and its chemical and pharmacological analogues, act fairly specifically as analge- sics for the management of moderate to severe pain. There exists evidence indicating that narcotic analgesics have been and are abused in sports, and therefore the FIS has issued a ban on their use. The ban is also justified by international restrictions affecting the movement of these compounds and is in line with the regulations and recommendations of the World Health Organisation regarding narcotics. Some examples of prohibited narcotic analgesics are: - buprenorphine - dextromoramide - diamorphine (heroin) - methadone - morphine - pentazocine - pethidine .and related substances NOTE: Codeine, dextromethorphan, dextropropoxyphen, dihydrocodeine, diphenoxylate, ethylmorphine, pholcodeine, propoxyphene and tramadol are permitted. Anabolic agents The Anabolic class includes anabolic androgenic steroids (AAS) and beta-2 agonists.
Anabolic androgenic steroids (AAS)The AAS includes testosterone and substances that are related in structureand activity to it. They have been misused in sport to increase musclestrength and bulk, and to promote aggressiveness. The use of AAS is asso-ciated with adverse effects on the liver, skin, cardiovascular and endocrinesystem. They can promote the growth of tumors and induce psychiatric syn-dromes. In males AAS decrease the size of the testes and diminish spermproduction. Females experience musculinization, loss of breast tissue anddiminished menstruation. The use of AAS by teenagers can stunt growth. Some examples of AAS are: a. clostebol, fluoxymesterone, metandienone, metenolone, nandrolone, 19- norandrostenediol, 19-norandrostenedione, oxandrolone, stanozolol . and related substances.
b. androstenediol, androstenedione, dehydroepiandrosterone (DHEA), dihy-drotestosterone, testosterone*. and related substances.
Evidence obtained from metabolic profites and/or isotopic ratio measure-ments may be used to draw definitive conclusions.
The presence of testosterone (T) to epitestosterone (E) ratio greater than six(6) to one (1) in the urine of a competitor constitutes an offence unless thereis evidence that this ratio is due to a physiological or pathological condition,e.g. low epitestosterone excretion, androgen production by a tumor, enzymedeficiencies. In the case of T/E higher than 6, it is mandatory that the responsible authority(NSA) conduct an investigation before the sample is declared positive. A fullreport must be written and will include a review of previous tests, subsequenttests and any results of endocrine investigations. In the event that previoustests are not available, the athlete should be tested unannounced at leastonce per month for three months. The results of these investigations shouldbe included in the report. Failure to co-operate in the investigations will resultin declaring the sample positive.
Beta-2 agonistsWhen administered orally or by injection, beta-2 agonists may have powerfulanabolic effects, and their use is therefore banned (See also section 1.1). Some examples of beta-2 agonists are: - bambuterol - clenbuterol
- fenoterol- formoterol*- reproterol- salbutamol*- salmeterol*- terbutaline*.and related substances
* Formoterol, salbutamol, salmeterol and terbutaline are permitted by inha-lation only (see 1.1)
For salbutamol the definition of a positive sample under the anabolic agentcategory is a concentration in urine greater than 1000 nanograms per millili-tre. Diuretics Diuretics have important therapeutic indications for the elimination of excess body fluids from the tissues in certain pathological conditions and for man- agement of high blood pressure. Diuretics are sometimes misused by competitors for two main reasons, namely: to reduce weight quickly in sports where weight categories are in- volved and to reduce the concentration of banned substances by diluting the urine. Health risks are involved in such misuse because of serious side- effects which might occur. Furthermore, deliberate attempts to dilute urine constitute clear manipulation which is unacceptable on ethical grounds. Therefore the FIS Medical Com- mittee has decided to include diuretics on its lists of banned classes of drugs. Some examples of prohibited diuretics are: - acetazolamide - bumetanide - chlortalidone - ethacrynic acid - furosemide - hydrochlorothiazide - mannitol1) - mersalyl - spironolactone - triameterene .and related substances 1) prohibited by intravenous injection Peptide hormones, mimetics and analogues - Chorionic Gonadotrophin (hCG-human chorionic godadotrophin)
It is well known that the administration to males of Human Chorionic Go-nadotrophin (hCH) and other compounds with related activity leads to anincreased rate of production of endogenous androgenic steroids and is
considered equivalent to the exogenous administration of testosterone. hCG is prohibited in males only. - Pituitary and synthetic gonadotrophins (LH). - Corticotrophins (ACTH, tetracosactide)
Corticotrophins have been misused to increase the blood levels of en-dogenous corticosteroids notably to obtain the euphoric effect of corti-costeroids. The application of Corticotrophins is considered to beequivalent to the oral, intra-muscular or intravenous application of corti-costeroids (See section 3.4). - Growth hormone (hGH, somatotrophin)
The misuse of Growth Hormone in sport is deemed to be unethical anddangerous because of various adverse effects, for example, allergic reac-tions, diabetogenic effects, and acromegaly when applied in high dosesfor a long period of time. - Insulin – like Growth Factor (IGF-1)
and all the respective releasing factors and their analogues;
- Erythropoietin (EPO)
EPO is the glucoprotein hormone produced in human kidney which regu-lates red blood cell production. Synthetic EPO is currently available andhas been demonstrated to induce changes similar to blood doping. Use ofEPO is banned by FIS. - Insulin;
permitted only to treat insulin-dependent diabetes. Written notification ofinsulin-dependent diabetes by an endocrinologist or team physician isnecessary.
The presence of an abnormal concentration of an endogenous hormone orits diagnostic marker(s) in the urine of a competitor constitutes an offenceunless it has conclusively documented to be safety due to a physiologicalor pathological condition. Alcohol Alcohol is prohibited, in all skiing events. Breath and/or blood alcohol levels may be determined at the request of the FIS Medical Committee. The FIS require a "zero" level of alcohol during competition and positive results may lead to sanctions. Cannabinoids (marijuana, Hashis) Marijuana is prohibited in all FIS skiing and snowboarding disciplines. A concentration in urine of 11. nor-delta-9-tetrahydrocannabinol-9-carboxylic
acid (carboxy-THC) greater than 15 nanograms per millilitre is prohibited andconstitutes doping. Prohibited Methods Blood doping and administration of artificial oxygen carriers or plasma expanders In endurance sport, performance can be markedly improved by increasing the amount of circulating red blood cells and/or improving oxygen transport. The effect of blood transfusions have been known for several decades and the published data suggests that blood doping can produce a significant in- crease in VO2 max. and performance. There are several ways to increase the red cell mass and/or oxygen trans- port, which include a) heterologous transfusion (HT) b) autologous transfusion (AT) and c) erythroporetin (EPO) administration. d) artificial oxygen carriers e) related blood products f) plasma expanders Analysis of blood samples enables the measurement of haemoglobin, and other appropriate indicators to establish evidence of blood doping. The re- sults of these tests provides the FIS Medical Committee with the necessary information to identify the manipulation of blood constituents. Pharmacological, chemical and physical manipulation The FIS bans the use of substances and methods which alter the integrity and validity of urine samples used in doping control. Examples of banned methods are the administration of diuretics catheterisation, urine substitution and/or tampering, inhibition of renal excretion, e.g. by probenecid and related compounds and alterations of testosterone and epitestosterone measure- ments such as by epitestosterone or bromantan administration. If the epites- tosterone concentration is greater than 200 ng/ml, it will have to be investi- gated as in article 1.3.1. The FIS requires that under these circumstances further investigations be conducted. The success of failure of the use of a prohibited substance or method is not material. It is sufficient that the said substance or procedure was used or at- tempted for the infraction to be considered as consummated. Classes of drugs subject to certain restrictions Local anaesthetics Injectable local anaesthetics are permitted under the following conditions: a. that bupivacaine, lidocaine, mepivacaine, procaine, etc. can be used but
not cocaine. Vascoconstrictor agents (e.g. adrenaline) may be used inconjunction with local anaesthetics;
b. only local or intra-articular injections may be administered;c.
only when medically justified (e.g. the details including diagnosis; doseand route of administration must be submitted immediately in writing to
the representative of the FIS Medical Committee or the designated offi-cial in charge of the Doping Controls (See annex 2: "Notification Form"). Glucocorticosteroids The naturally occurring and synthetic corticosteroids are mainly used as anti- inflammatory drugs. They influence circulating concentrations of natural corti- costeroids in the body. They produce euphoria and side-effects such that their medical use, except when used topically, require medical control. The systemic use of corticosteroids is banned except: a) for topical use (anal, aural, opthalmological, nasal and dermatological);
by intra-articular or local injections.
Under no circumstances may injections of corticosteroids be given within 3hours of competition. Rectal use of corticosteroids is banned. Any team doctor wishing to administer corticosteroids by local or intra-articular injection, or by inhalation to a competitor must give written notifica-tion to the representative of the FIS Medical Committee or the designatedofficial in charge of the Doping Controls (See annex 2: "Notification form")prior to competition. Beta-blockers Due to the continued misuse of beta-blockers in some sports where physical activity is of no or little importance, the FIS Medical Committee reserves the right to test when it seems appropriate. The testing for beta-blockers is un- likely to take place in endurance events which necessitate prolonged periods of high cardiac output and large stores of metabolic substrates. In this activi- ties beta-blockers would severely decrease performance capacity. Some examples of beta-blockers are: - acebutolol - alprenolol - atenolol - labetalol - metoprolol - nadolol - oxprenolol - propranolol - sotalol .and related substances SUMMARY OF FIS REGULATIONS FOR DRUGS WHICH NEED PHYSICIAN WRITTEN NOTIFICATION SUBSTANCES Selected beta- agonists* Corticosteroids Local anaesthetics**
formoterol, salbutamol, salmeterol; terbutaline, all others beta-agonists are prohibited
SUMMARY OF URINARY CONCENTRATIONS ABOVE WHICH IOC ACCREDITED LABORATORIES MUST REPORT FINDINGS FOR SPECIFIC SUBSTANCES caffeine MEDICAL ASPECTS OF SKIING
In this short chapter we would like to handle a few particular subjects that arevery specific to skiing. The intention of this new part of the Medical Guide ofthe FIS is to make all those people, team doctors, physiotherapists, trainersand coaches aware of special situations encountered in the different disci-plines of ski sport. Obviously, the following paragraphs don't have the preten-tion of being complete, but even so should make the reader aware of theirexistence. The full information can be found in the scientific literature. Concussion When a skier falls, hitting her/his head against the snow, the possibility of a concessive injury must be explored by the examining physician. These inju- ries may occur in training and free skiing, as well as during competition, and the ski doctor, NSA doctor or event physician must be vigilant in diagnosing this potentially serious condition. In many contact sports, when a competitor is knocked out, she/he will be subject to an automatic 28 day suspension and even in sports that require the compulsory use of protective helmets (e.g. horse racing) the period of suspension for concussion is between 2 - 21 days. If a skier has suffered a transient episode of concussion, the examining doctor should suspend him/her from competition for no less than 48 hours. If the skier has suffered a short period of unconsciousness (less than 60 sec- onds) or has any degree of post traumatic amnesia, the examining doctor should suspend him/her from competition for no less than 7 days. In any case where unconsciousness lasts for more than 60 seconds, the ex- amining physician is to suspend the skier for no less than 21 days. In any World Championship or World Cup event attended by a FIS Medical Supervisor, he has absolute authority to suspend a competitor should she/he suffer a concessive injury during the competition. Anterior Cruciate Ligament Injury Knee injuries from alpine skiing have remained relatively constant in the re- lated statistics, but the distribution has significantly changed: the MCL inju- ries have decreased while the Anterior Cruciate Ligament injuries have in- creased dramatically. The reason of this vulnerability of the Anterior Cruciate Ligament is to be found in several factors such as the equipment, the new skiing techniques, the physical conditions and the slopes. High and stiff boots have a fulcrum which places direct forward pressure on the Anterior Cruciate Ligament. This fulcrum is particularly significant during backward position and falls where the skiers centre of gravity is falling back while the ski and the boot are moving forward. This creates forward dis- placement on the upper tibia in relationship to the femur, placing the cruciate at risk. The reversing of the camber of the ski, and the use of special device under the bindings are other factors which have been implicated.
There have also been technique changes which may affect knee biome-chanics (parallel turns with increased acceleration through the turn). Fatigue of the hamstrings as an agonist of Anterior Cruciate Ligament hasbeen suggested as an injury cause. Finally, higher speed can lead to more difficulty in maintaining control of theskis. The recognition of these injuries of the Anterior Cruciate Ligament is veryimportant, and even if it is usually obvious, it occasionally may be difficult. Acareful physical examination, the use of x-rays, MRI or arthroscopy should al-ways allow a proper and exact diagnosis. Treatment of Anterior Cruciate Ligament injuries in competitive athletes usu-ally includes repair and reconstruction of the ligament. A good rehabilitationwith early mobilisation is very important. It is important that physicians looking after competitive skiers are aware ofthe frequency of this injury, its assessment and appropriate treatment. Protective Equipment The wearing of protective equipment is common to many sports and skiing is no exception. Helmets have been worn in downhill competition since the six- ties and in ski jumping since 1980. In addition skiers wear goggles, gloves, forearm protectors (slalom), back protectors (downhill), gumshields etc. to reduce the risk of significant injury during training and competition. The FIS require that all children competing in FIS races must wear a helmet specifically designed for skiing. The European Community is currently con- sidering a standard for ski helmets and all EEC countries currently require helmets to carry the appropriate 'CE Mark'. The FIS require helmets to be worn by all competitors in
Individuals in these disciplines should also wear a gumshield during compe-tition and training. Goggles should be worn by all competitors with the exception of those takingpart in Acro and Cross-Country skiing. Gloves should be worn by all competitors. Medical Considerations in Assessing a Skier's 'Fitness to Race' Ski racing is a sport that requires each and every participant to exercise physical skills and judgement of an extremely high order. Any failure in a skier's performance may put him/her at risk of serious injury, permanent dis- ability or death. The FIS requires that all ski racers applying for a FIS Licence, or wishing to participate in any FIS event, undergo a medical examination to assess their physical fitness to compete. This medical examination may be conducted by the individual's personal physician (general practitioner) or the NSA doctor. Particular care is required when an individual is taking regular medication and in certain instances (e.g. epilepsy and insulin dependant diabetes) it may be necessary to refuse medical clearance to participate. In this regard it
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