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Intro

Combat sports legislation in WA

Combat sports in Western Australia is regulated by legislation administered by the Combat Sports Commission (CSC). The CSC register combat sport contestants, enforce health and safety guidelines, issue contest permits and are responsible for enforcing the combat sports regulatory system (Combat Sports Act 1987, Combat Sports Regulations 2004).

Certain requirements for medical practitioners exist within the combat sports legislation and the CSC recognise the vital and important role that medical practitioners play in this regulatory system.

Stages of medical practitioner involvement

The combat sports regulatory system requires medical practitioner involvement. The initial contact that a medical practitioner may be with a combat sport contestant, is for the completion of registration paperwork (figure 1). Contestants are responsible for selecting their own medical practitioner during the registration process. Secondly, medical practitioner involvement occurs when a promoter seeks a permit from the CSC to conduct a combat sports contest. Promoters must nominate and engage an approved medical practitioner to work at the contest as a designated ringside medical practitioner (RMP).

Figure 1: Medical requirements for registration

Requirements of registration as defined in the above text.

Contestant registration (3 years)

  • Certificate of Fitness
  • serology report
  • medical history of any contest injuries.

Ongoing

  • Certificate of Fitness (every 12 months)
  • serology report (6 month validity prior to any contest entered)
  • medical history of any contest injuries.

Renewal of registration (every 3 years)

  • Certificate of Fitness
  • serology report
  • medical history of any contest injuries.

Role of medical practitioner for contestant registration

Contestants are required to register every 3 years with the CSC. When applying for registration contestants are required to submit a Certificate of Fitness, serology test results and medical history.

The Certificate of Fitness must be issued by a medical practitioner using the CSC approved Certificate of Fitness form (PDF 856 KB) form (Appendix A). When conducting this assessment, the medical practitioner should review answers given by the applicant to determine if there are any unacceptable risks, such as:

  • prior head injuries
  • impaired vision
  • mobility impairments
  • extreme/rapid weight loss
  • unmanaged blood borne virus
  • skin infections such as staphylococcus.

In addition, the medical practitioner will also need to order the following serology tests to be conducted:

  • HIV
  • Hepatitis B antigen (HBsAG)
  • Hepatitis C.  

Contestants must continue to provide to the CSC a Certificate of Fitness on an annual basis and current serology reports (no more than 6 months old) prior to any contest they enter.

Engagement of ringside medical practitioner

A promoter of a combat sport contest must not permit the contest to occur unless an approved RMP is present at the contest. Promoters are required, through CSC permit conditions, to engage and pay for the services of a RMP. Nominated medical practitioners must be approved by the CSC to act in the capacity as a RMP. However, the engagement and payment for RMP services is a contractual arrangement between the promoter and medical practitioner, not the CSC. RMP duties are required during 3 phases of the contest (figure 2).

Figure 2: Ringside medical practitioner requirements

RMP duties are required during three phases of the contest as outlined int he text below

Pre-content

(Within 24 hours before contest)

  • medical examinations
  • ID and serology check
  • pregnancy test
  • determine contestant fit/unit
  • pre-contest medical form
  • certify Contestant Record Book.

Content

(During each bout)

  • preside ringside
  • inspect contestant injuries
  • notify referee of opinion for medical stoppage
  • medical attention to downed or unconscious contestant
  • record content result in Contest Record Book.

Post-contest

(Following completion of each bout)

  • medical examinations
  • determine contestant fit for future sparring/contests
  • post-contest medical form
  • record injuries, concussion or loss of consciousness arising from contest
  • certify Contestant Record Book.

Pre-contest role of ringside medical practitioner

The weigh-in is an official event to establish that each contestant has met a requisite weight class and must occur at a designated time, up to 24-hours prior to the contest. Weigh-ins are often conducted at a separate venue the night before a contest or can also occur at the same venue on the same day as the contest. Promoter permit conditions require the RMP to be present for the duration of the weigh-in and it is strongly recommended that the RMP conduct pre-contest medicals at the weigh-ins.

All contestants competing in a contest must complete a pre-contest medical within a 24-hour period prior to the contest. In accordance with the Combat Sports Act 1987, the RMP conducting a pre-contest medical examinations must do the following:

  1. Inspect Contestant Record Book.
  2. Conduct a medical examination.
  3. Certify information in the Contestant Record Book.
  4. Record the results of the examination on the CSC approved Pre-contest Examination Form (Appendix B).
  5. Record, if of the opinion, that a contestant should not participate in the contest (based on medical condition).
  6. Give the Pre-contest Examination Form to the CSC appointee.

The CSC will provide the RMP with a medical file containing pre and post medical forms and contestant serology results. The RMP is responsible for conducting a medical examination, completing the Pre-contest Examination Form then declaring whether each contestant is fit or unfit to participate in the contest.

All female contestants over the age of 16 years must undertake a pregnancy test. The CSC provides RMPs with pregnancy testing kits. The RMP must ensure that eligible female contestants submit a urine sample and sign the Pre-contest Examination Form declaring that the sample provided is theirs.

The RMP may declare any contestant to be unfit to compete in the contest because of a medical condition. RMPs should consider whether the medical condition would render the contestant more likely than usual to suffer injury in the normal course of any contest or be less able to adequately defend themselves. This can include (but is not limited to):

  • any sign of use of a prohibited substance or alcohol
  • a recent fracture or cut
  • severe dehydration
  • an acute illness
  • a skin disease
  • any other condition that could be detrimental to either the contestant or their opponent.

Role of ringside medical practitioner at a contest

It is strongly recommended that the RMP arrive at the contest venue at least an hour prior to the commencement of the contest.

Key tasks to be completed prior to the first bout commencing, include:

  • test walk ring entry (stairs, enclosure) and conduct venue familiarisation
  • identify and set up the medical area to handle any medical concerns
  • check that the medical equipment (including stretcher) is ringside and oxygen delivery system is in good working order
  • discuss with the referees (and if available paramedics) how communication will take place during a bout
  • attend the officials meeting
  • familiarisation with air-horn/sound device usage.

The RMP must be present and preferably seated (ringside) during each bout. No contest, bout or round can commence or continue without the presence of the RMP and any bout in progress must cease should the RMP be required to leave ringside. During bouts, the RMP must remain observant of both contestants, follow the action in the ring and render medical assistance if required.

The RMP may assess a contestant during the break, between rounds, (either from the corners apron or inside the ring) and is urged to do so if a knock-down has taken place.

The RMP is to advise the referee, during the break and before entering the ring, if they wish to assess the extent of a contestant’s injury at close quarters.  

In the event of a significantly injured or unconscious contestant, RMPs should familiarise themselves with mouth guard removal, Oxyviva/stretcher location, emergency chain of command and venue evacuation routes/procedures. 

Ringside medical practitioner authority to stop a contest

The RMP is provided with an air-horn or sound device and at any time during a contest can sound the device to signify to a referee to terminate a bout. The RMP should direct a referee to stop a bout if of the opinion the contestant should not continue to participate based on their medical condition. A referee must discontinue a bout once informed of the RMP’s medical opinion. Consequently, it is the medical practitioner who has the ultimate power and authority to stop a contest.

At all times, the wellbeing of a contestant requiring the urgent assistance of the RMP takes precedence over the commencement of the next round or bout. Having caused a contest to stop, the RMP should enter the ring to render immediate assistance.

RMPs should consider if the following has occurred to at least one of the contestants when determining a medical stoppage:

  • health is at risk (i.e. too many hard hits to the head, loss of balance or disorientation)
  • concussion, head injury or suspected head injury
  • receiving undue punishment or inability to defend or avoid further injury
  • exhaustion
  • ruptured ear drum
  • fracture or possible fracture
  • eye damage or surrounding laceration (cuts).

The referee may directly call the RMP into the ring to examine a cut, nosebleed or other injury for medical determination. Most cuts will not require bout stoppage and a bout can continue at the RMP’s discretion. Medical stoppage decisions regarding possible eye damage or cuts should be individually assessed. Cuts with clinical significance (length, depth, shape, location of cut and source of bleed) or performance consequence (such as bleeding into the eye and reducing vision) should necessitate a stoppage.

Post-contest role of ringside medical practitioner

The RMP must conduct a medical examination of both contestants, immediately following the completion of a bout, then the approved Post-contest Examination Form (Appendix B) must be completed.

If medical treatment is required, the RMP should determine if the treatment is required immediately or at the end of the event. Any medical assistance provided by the RMP is at the discretion of the RMP and may extend to providing treatment in the medical room, such as suturing a cut above the eye.

The RMP must document on the Post-contest Examination Form all treatment that is delivered i.e. cut (L) cheek — sutures or #RICE and X-Ray referral — possible (R) ulna fracture.

If, in the RMP’s opinion, a contestant is not fit to engage in future sparring or contests then the RMP must stipulate a date (period of time) medically suspending the contestant. If unable to define a period of time, the RMP is to write the type of assessment required (i.e. x-ray/CT) and stipulate that a medical clearance is required prior to commencement of sparring or the next contest.

Prior to recording any suspension periods, the RMP must check previous pages in a Contestant’s Record Book to determine if any prior or reoccurring suspension requires consideration. The RMP is to officially record medical suspension (dates) in both the Post-contest Examination Form and the contestant’s record book.

Medical suspensions

The legislation requires the following mandatory suspension periods if a contestant is knocked out. The RMP can recommend longer periods of suspension if in their opinion it is required.

First (1st) time knockout

Minimum of 30 days or longer if directed by the medical practitioner.

Second (2nd) consecutive knockout

60 days following the second contest or longer if directed by the medical practitioner.

Third (3rd) consecutive knockout

90 days following the third contest or longer if directed by the medical practitioner.

Where a contestant is unable to continue for reasons (injuries) other than a knockout, the RMP may apply a medical suspension for any period as they see fit.

 

Combat sport conditions that RMPs should familiarise themselves with include:

  • facial fractures (cheek, orbit, nasal)
  • arterial or excessive venous nosebleed
  • signs of altered consciousness or head injury
  • fracture of hand/wrist or upper/lower limb joint injuries
  • ruptured ear drum
  • fast expanding haematoma.

Contestant Record Book

Each contestant is issued with a Contestant Record Book (CRB) upon registration (figure 3). The CRB contains important medical information and must be inspected by the RMP during medical examinations (both pre and post contest). WA registered contestants cannot compete if they do not supply the RMP with their CRB.

Figure 3: Contestant Record Book (CRB)

An image of the front cover of the record book

It is a legislative requirement for the RMP to certify, in the CRB, that a contestant is fit to compete in the contest. Following the completion of a contestants bout the RMP will be further required to record the contest outcome (win/loss/draw) and certify the post-contest medical information before returning the CRB back to the contestant (figure 4).

Figure 4: CRB medical practitioner certifications

An example from the record book showing a form to be completed

Equipment checklist for ringside medical practitioner

Pre-contest medical examination:

  • spygmomanometer
  • stethoscope
  • auriscope/opthalmoscope
  • pregnancy tests provided by the CSC.

Contests:

  • basic doctor’s kit
  • disposable gloves
  • gauze
  • pen light
  • scissors
  • basic airway equipment.

*To be supplied by promoter:

  • oxygen delivery system (Oxyviva)
  • defibrillator
  • stretcher
  • air-horn/sound device provided by the CSC.

Post-contest medical examination:

  • suture kit/local anaesthetic vials/syringes/fine needles and swabs
  • basic immobilisation — splint/broad arm sling
  • simple analgesia
  • bandages and dressings
  • head injury and wound care advice sheets provided by the CSC.

Expected conduct of ringside medical practitioner

  • Provide accurate and complete information and not provide false or misleading information in response to any request for information that is made for official CSC purposes.
  • Consistently act in a professional manner.
  • Not knowingly be involved in a Sham contest.
  • Not wager on the result of the contest or publicly predict the result of the contest.
  • Not consume alcohol or illicit drugs on the day of or whilst at the contest.

How to become an approved ringside medical practitioner

You must be a medical practitioner registerable in Australia to become a RMP. As part of the approval process, you will also be required to attend a contest and complete shadow training with an approved RMP.

If you wish to become a ringside medical practitioner, please register your interest with the CSC via email: combatsport@dlgsc.wa.gov.au

Appendix A Certificate of Fitness forms

Certificate of Fitness form page 1

Certificate of Fitness form page 2

Certificate of Fitness form page 3

Certificate of Fitness form page 4

Appendix B Pre and Post Content Medical forms

Pre content examination form

Post content examination form
Page reviewed 16 March 2022