Medical Screening of Participants

July 14, 2011

Are you ready (or able) to do this?

Ian McGregor, Ph.D.
Ian McGregor & Associates Inc.

If someone suffers a heart attack while participating in one of your programs, the courts may ask whether the participant was medically screened before participation. In other words, what attempts were made to determine whether the person was medically fit to participate?

Although it may not be practical or even reasonable to medically screen all participants, there may be some programs where it might be wise to determine if there are any medical reasons to exclude a participant. For example, taking a scuba class requires a medical examination by a physician, yet many fitness programs rely only on a simple screening tool such as the PAR-Q (Physical Activity Readiness Questionnaire). Is this a reasonable approach, or should certain high-risk participants in fitness programs (e.g. seniors) also be required to be screened by their physician prior to participation?

Considerations in Determining Type of Screening Protocol

1. Instruction classes that cater to special populations may warrant medical screening and/or a doctor’s clearance e.g. seniors’ classes, prenatal/postnatal sessions, cardiac rehabilitative classes. In such cases, it is in everyone’s best interest to obtain medical clearance before participation begins. While the logistics may be cumbersome and put pressure on staff resources, the standard of care is higher for these special populations and screening documentation can create an important paper trail should problems surface later.
2. Specialized programs (e.g. Personal Training programs) generally require the completion of a health history form as a requirement for enrolment, and require a physician’s clearance if there are flagged areas of concern. The benefit is that the instructor will get to know their client’s abilities and limitations, and will therefore be in better position to modify or customize a program based on the screening.

‘High-Risk’ approach to implementing Medical Screening Protocols
As a strong supporter of a ‘keep it simple’ approach to risk management, consider using the ‘Risk Matrix’ to classify your programs (and people) into ‘high’ and ‘low’ risk.

The next step is to consider requiring implementation of a suitable screening protocol for identified ‘high risk’ programs and people ONLY.

The ‘high risk’ approach is a reasonable, common sense approach that addresses the logistical reality of effectively implementing medical screening protocols. Again, check with your legal counsel before adopting any medical screening policy.

Some final thoughts on Medical Screening

1. Some institutions have made the conscious decision NOT to require any medical screening for ANY programs or people due to:
   – The complex logistics involved in collecting data
   – The duty to review the data after collection and follow up when appropriate (e.g. contacting the participant and requiring a physician’s clearance before allowing continued participation)
   – Concern over data security and confidentiality
2.  Instead of requiring forms to be completed and submitted, some institutions have adopted a ‘verbal Par-Q’ approach. Instructors either (a) verbally cover the contents of the PAR-Q form, or (b) refer participants to a wall chart describing the PAR-Q, or (c) hand out the PAR-Q form (but do not take it back), while at the same time indicating that participants should take responsibility for reviewing the form.

It is highly recommended that you check with legal counsel on your institution’s policy on medical screening of participants.

Reprinted from ‘SportRisk: Risk Management Planning Resource’   www.sportrisk.com/resources/