Health Care Services at the Athens Olympics 2004

George Petropoulos, MD, PhD

Greece was the birthplace and site of the ancient Olympic Games. The first modern Olympic Games were held in Athens in 1896. In 2004, from August 12 to August 29, the Olympic Games will return to Athens as the XXVIII Olympiad.

The Games have grown tremendously. This year there will be about 38 competition venues, 100 training venues, a media center, and sponsor hospitality areas. There will be 301 events in 28 sports involving 10,500 athletes from 201 countries, 5,500 team officials, 60,000 volunteers, 21,500 media personnel, up to several hundred thousand spectators on site at any one time, and a worldwide audience of more than 4 billion viewers and listeners.

Some 40,000 security personnel will work at the Games, including police, military personnel, fire-fighters, private security forces, and 5,000 trained volunteers. The Olympic Village will house 16,000 athletes and team officials and another 6,000 during the Paralympic Games. (These Games will be held in Athens following the Olympic Games, from September 17 to September 28, with more than 4,000 athletes from about 130 countries competing. The Paralympic Games, also known as the Special Olympics, are the games for disabled athletes.)

ATHENS 2004, with the guidance of the International Olympic Committee, is the official Greek organization in charge of the Games. Athens 2004, together with the Greek Olympic Committee and the Greek Health Care Ministry has developed a comprehensive and sophisticated infrastructure to help insure the health of the more than one million athletes, support staff, and spectators expected.

Officials urge travel health professionals to inform travelers about recommendations for staying healthy while in Greece and to make travelers aware of the health care facilities available for visitors, especially for visitors with ongoing health problems. The Games will take place in five Greek cities: Athens and surroundings, Thessaloniki, Heraklion, Patra and Volos (see map). Most of the important Olympic-related events will take place in Athens.

Greece is a Mediterranean country with about 11 million people. It is surrounded by sea, and includes thousands of islands. The usual August temperatures in Greece are between 35^o and 40^o C (95 ^o and 104^o F).

Greece has extensive experience dealing with tourism, hosting about 13 million arrivals annually. This experience, along with improved preparedness of the health care services, will greatly help the country cope with the increased number of visitors expected for the Games.

Health Services Department

Specially selected teams of doctors of various specialties, nurses, first aid officers, physiotherapists and other health care professionals will serve athletes. A separate support staff will tend to spectators, members of the media, staff and volunteers. In all, approximately 3,000 such volunteers, all registered in their specialties, will be present to implement the program.

Health Guidelines for Attendees' Personal Care

• Bring comfortable shoes. Some venues are very large and visitors may have to walk considerable distances, queue and climb steps to seating areas.
• Greece is hot in August. Wear light-coloured clothing (made of natural fabrics) and hats that are cool, light and comfortable and offer some protection from the sun.
• Keep well hydrated (and avoid alcohol) throughout the day, and wear sunglasses and sunscreen.
• Bring along necessary medications and food supplements.
• Use insect repellents to avoid being bitten by insects.
• Make prudent food and water selections to help avoid gastrointestinal disorders.
• Watch your step when walking. Automobile-related accidents are common.
• Individuals with chronic diseases should consult a travel health professional for advice before leaving home.
• If in need of medical assistance, visitors should ask an ATHENS 2004 volunteer to direct them to the nearest spectators' medical office. These volunteers will be wearing easily recognizable insignia.

Immunization and Vaccinations

Required Immunizations

The only immunization required for entry into Greece is a yellow fever (YF) vaccination for individuals older than six months of age IF coming from or in transit through a YF-infected country. (The vector for the disease, Aëdes aegypti, is present in Greece.) According to Greek recommendations, children under one year of age should not be vaccinated; cases of encephalitis have been reported in this age group following the administration of this vaccine. All visitors from a country where yellow fever is present and or who have transited through such a country must carry a valid yellow fever vaccination certificate or a letter of exemption from a physician.

No other vaccination is required for entry. However, travellers are urged to review their immunization status with their physician or travel medicine clinic to insure that they are protected. Recommendations below serve a general guide only. Immunization needs depend on each visitor's health status, previous immunizations received, and their travel itinerary.

Selective Vaccination for Greece: Hepatitis B Vaccine

Because of the high rate of hepatitis B carriers in Greece, vaccination is recommended for persons on working assignments in the health care field (e.g., dentists, physicians, nurses, laboratory technicians) or working in close contact with the local population (e.g., teachers, missionaries, Peace Corps volunteers), or persons foreseeing sexual relations with local inhabitants.

Routine Immunizations

Travel is a good occasion to remind people that their routine immunizations may require updating. Surveys indicate that up to 80% of adults in the western world have not maintained their immunization status since their school years. If you belong to this group, the following vaccinations are recommended before leaving home. (Note that recommended vaccination schedules vary greatly from country to country. Editor.)

Sections of Action in Health Care Services

With the general coordination of the Ministry of Health Care and Welfare, the health care functions at the Olympics have been divided in to five sections:

(1) Administration
(2) Public Health
(3) Primary Health Care
(4) Emergency Medicine
(5) Hospitalization

Administration

Much time and effort has been spent to create an infrastructure to help insure the health, safety and comfort of visitors, including extensive contingency plans involving numerous public and private agencies in case of unexpected events - environmental (earthquake) or terrorist activity, for example.

Public Health

The Health Services Department, along with the Ministry of Health and Welfare, will coordinate public health surveillance programs to oversee sanitation and environmental health within the Olympic areas, both in the competition and non-competition venues. They will:

• Define specific protocols to be followed by all authorities, services, companies and other participants to keep public health at a high level.
• Establish a wide network of surveillance to avoid disease outbreaks, epidemics, and quickly control outbreaks should they occur.
• Enforce rules for public health and hygiene in airports, seaports, railway stations, hotels, cruise ships, and other critical sites where visitors will pass through, visit and reside.
• Use appropriate tests to monitor air and water quality and air conditioning systems.
• Ensure the hygiene of food and water.

Primary Health Care

The 3,000 registered health professionals will be present to implement primary health care in all five Olympic cities. At the Olympic Village in Athens, there will be a newly constructed and fully equipped 2,700 square meter Olympic Polyclinic. The Clinic will provide 24-hour Emergency Services and 18-hour Primary Health Care Services.

Emergency Medicine and Health Care

Several medical-related organizations will work closely with the National Centre of Emergency Help (EKAB) to provide emergency care. EKAB has mobile units and has the primary responsibility for pre-hospital care. The units will be placed in all important locations. EKAB will also provide onsite emergency care and transfer patients to the Olympic Polyclinic or the Emergency Rooms of the Olympic Hospitals for further care or hospitalisation. EKAB's health care units are fully capable of performing emergency transfers by land, air or sea. In addition, plans are in place to include other authorities (police and the army, for example) in case of unexpected events, such as epidemics, unexpected weather conditions, terrorist activities, and toxic, chemical or biological disasters.

As of July 30, the fully operational Polyclinic will provide services to all residents of the Olympic Village. This service will include a 24-hour emergency medical facility supported by EKAB ambulance service. Specialists will be available from 8:00 to 23:00 in the following fields: sports medicine, medical imaging, podiatry, dentistry, physiotherapy, ophthalmology, (opticians and ophthalmologists), orthopaedics, gynaecology and, likely, in other fields. There will also be extensive laboratory services. These services will be linked to the Greek National Health Service System, which will provide free access to emergency services offered by dedicated Olympic Hospitals. In addition, a first aid service will operate in the International Zone (the Olympic Village).

A medical response service will also operate at each training venue during their operating hours. The level of this service will vary depending upon the risk of the sport and the requirements of the International Federation.

The Health Service Program will track and report to the International Olympic Committee Medical Commission all medical incidents within venues, as well as all individuals requiring transportation for medical reasons and hospital admission.

Olympic Hospitals

ATHENS 2004 is working closely with the Ministry of Health and Welfare to ensure that onsite services are linked via EKAB ambulances to a network of dedicated Olympic Hospitals, allowing for seamless transfer and hospital admission of individual requiring additional care.

Twenty-four General and Special Hospitals in the five Olympic Cities have been selected and prepared to serve the public during the Games (see TABLE III ). In the Olympic Hospitals, all emergency health care services will be free for the following groups:

Olympic Games Personnel
Olympic Volunteers
Media and Press Personnel

Other Health-related Services

Olympic Surveillance Network

A sophisticated system for the early detection of unusual infectious disease activity will be operational during the Games. The system was developed last year by the Hellenic Centre for Infectious Diseases Control (KEEL) and has been successfully tested. Should there be unusual disease activity _ gastrointestinal, respiratory, bleeding, exanthemas, for example _ the system will immediately alert Greek and international health authorities, and then coordinate communications among involved agencies. The system is an updated version of programs used at previous large global gatherings and is designed for earlier detection and more rapid communication, giving public health officials more time to react to epidemics, bio-terrorism, and other health challenges.

Health Services and Sports

All National Olympic Committees (NOCs) have already received copies of the Medical Care and Pharmacy Guides. These outline the level and extent of health services that will be provided. Eight months before the NOCs will arrive in Greece, they were asked to declare all medications and health substances they plan to bring into Greece to ensure that no inadvertent breach of Greek laws or customs regulations occurs. NOCs were also requested to provide the names and documentation of the health care professionals accompanying their national Olympic delegations. This information is necessary to provide temporary permission to these practitioners to legally practice medicine during the Games. Practitioners may only treat members of their team.

Athletes and Prescription Drugs/Illegal Drugs

A doctor's letter and/or a copy of the original prescription should accompany all medications brought into Greece. All items should be kept keep in their original containers and declared at customs when entering Greece. Athletes should be advised that it is illegal to carry illicit drugs into Greece. Athletes are likely to undergo random testing for performance enhancing and other drugs during the Games.

If athletes, for any reasons, seek medical advice while in Greece, they should inform the clinic staff, especially at non-Olympic health facilities, that they are Olympic athletes and that non-essential medications, including some pain killers, may be banned substances. Athletes who are placed on any prescribed medication may be required to notify drug testing authorities.

Accessibility

The Olympic Games are a unique opportunity to render the Olympic Cities more user-friendly for people with disabilities. For this purpose ATHENS 2004 formed the Accessibility Committee. The Committee consists of specialized officials from involved Government ministries and agencies and their task is to examine all proposed designs regarding new installations and renovations of existing ones. The goal: unobstructed circulation for wheelchair users (who represents the most demanding group in terms of dimensions and space requirements) and safe environments for individuals with vision or hearing impairments. Committee recommendations are then disseminated to the agencies responsible for construction. Accessibility is especially important in view of the Paralympic Games.

Accessible Olympic and Paralympic Games allowing independent, unobstructed and safe circulation of people with disabilities will be the Games legacy and will improve the quality of everyday life for Greeks and for visitors, and will do so for many years to come. (In Greece, for example, according to Greek and European statistics, 10% of the Greek population has a disability and perhaps 50% of the population has some mobility problem; this includes the aged.)

Pet Health and Control

Greek Public Health Authorities have placed under close control pets and other animals, especially those residing in the Olympic Cities, to minimize animal-transmitted health problems. Visitors wanting to bring their pets to Greece should contact Greek government offices overseas for instructions.

References

Athens Olympics Official Web Site
Health and Welfare Ministry of Greece Official Web Site
IAMAT's World Chart for Immunization
ISTM NewsShare. November 2003

George is a graduate of the Medical Faculty of the University of Athens, trained in internal medicine, a member of the American Diabetic Association, and is on the staff of the Naxos Hospital. He is a recognized authority in telemedicine, and serves in leadership positions in Greek and international telemedicine conferences and organizations. He is a founding member and first chairman of the Board of Institute of Digital Medicine and the international medical information portal, Asklipios. www.asklipios org.

Disclaimer: The author does not necessarily represent the views of the Athens Olympic Games Organizing Committee or any other agency connected with the Athens Olympic or Paralympic Games.)