Behind the Scenes of the 2002 Winter Olympics: The Unsung Heroes of Salt Lake City

By Barbara A. Gabriel

South Korean alpine skier Hye-Min Yoo receives care from University of Utah physical therapist Monica A. Mason.

The Olympic torch has been extinguished and the joyous triumphs and bitter defeats of the 2002 Salt Lake City Games are taking their place in Olympic history. Salt Lake will long be remembered as the place where 16-year-old Sarah Hughes beat both the odds and world champion Michelle Kwan to win gold in the women's figure skating competition. 2002 will be celebrated as the year bobsledder Vonetta Flowers became the first African American to win a gold medal in the Winter Olympics. And, of course, Salt Lake will be remembered for its scandals, one resulting in the awarding of two pairs of gold medals to four figure skaters from Russia and Canada.

But there was another Olympic "first" in Salt Lake that remains unknown to most of the world's spectators. Winter 2002 marked the first Olympic Games in which an academic medical center was responsible for providing medical services to the thousands of Olympic Village residents. Staffed by 123 physicians, dentists, and optometrists; 80 nurses and nurse practitioners; 145 physical and occupational therapists, pharmacists, dental assistants, and radiology technicians; and numerous clinical aides, clerks, data entry specialists, and administrators, the Salt Lake City Olympic Polyclinic was operated entirely by the University of Utah School of Medicine and University Hospital.

Keeping top international athletes in peak physical condition while the world is watching is a high-pressure job, even if the cameras aren't focused on you. A strained joint or sprained ankle can endanger the hopes of athletes who have trained their entire lives for a moment in the world's spotlight. Mark Elstad, M.D., associate professor of medicine at the University of Utah School of Medicine and medical intensive care unit director at the Salt Lake VA Medical Center, served as medical director of the Polyclinic. He says muscular-skeletal injuries such as sprains and strains made up a large portion of the cases seen by Polyclinic staff. "We had to determine the extent of injuries and the risk of competing," he says. "But these athletes will compete with knee sprains that would leave the rest of us sitting at home with our legs propped up. We treated them to the best of our ability, but the choice to compete was ultimately theirs."

A member of the Greek Olympic team receives physical therapy from University of Utah therapist Shayne Boyce.

Dr. Elstad says the University of Utah began preparing for its role in the 2002 Winter Olympics more than four years ago when he, Polyclinic Program Manager William Holt, and Stuart Willick, M.D., deputy medical director of the clinic, attended the 1998 Olympic Winter Games in Nagano, Japan. There, they observed first-hand how medical care was delivered to the athletes on site. Two years later, they were in Sydney for the 2000 Summer Games. "Each Olympic Games generates a report that describes the operation of the Polyclinic, how well the medical services ran, the number of patients seen, what they were treated for, etc.," says Dr. Elstad. "We gathered information in Nagano and Sydney by talking to clinic staffers and examining published data."

A Clinic of Olympic Proportions

Based on that information, Salt Lake Polyclinic managers determined how best to set up an extension of the University of Utah Hospital in the lower level of the university's Guest House, situated on the edge of the Olympic Village. There, they assembled a multi-specialty outpatient facility open 24 hours a day, seven days a week from Jan. 29 through Feb. 26 and then again for the Paralympic Games March 1 through March 19. Working with a $2.2 million budget, the University of Utah School of Medicine and University Hospital subcontracted with Intermountain Health Care, which had contracted with the Salt Lake Organizing Committee to provide medical care for the 3,500 athletes and coaches living in the Olympic Village. In addition to the Polyclinic, the university operated a first-aid station for the Games' many spectators and volunteers in the International Dome of the Olympic Village and provided on-site health care at the Olympic Stadium during the opening and closing ceremonies and at all rehearsals.

A University of Utah pharmacist assists a member of the Chinese short track speed skating team with a prescription.

Besides physicians, nurses, and aides, the Polyclinic made available to the members of the Olympic family a fully operational laboratory, a pharmacy, diagnostic X-rays, digital radiography, diagnostic ultrasound, and a mobile MRI unit. Holt says physical therapists were most in demand during the Games to care for both chronic and acute conditions presented by athletes. Muscular-skeletal injuries such as sprains and strains requiring orthopedic care ranked second in the types of injuries and illnesses treated by Polyclinic staff, followed by eye care, dental care, and upper respiratory conditions. In all, Polyclinic staffers handled 1,842 patient visits, nearly 40 percent of which were from competing athletes.

Dr. Elstad and Holt knew from observing the Nagano and Sydney Games that dental and eye care services would be highly utilized. Holt explains that many Olympians hail from countries that lack high-quality care in these disciplines. "Our dentists were running pretty constantly, and our optometrists gave out over 250 pairs of glasses," he says. Holt adds that in providing these services to athletes, coaches, and officials, Polyclinic health care workers went above and beyond their obligation to provide "urgent" or "emergent" care. "Their own conscientiousness as medical service providers led to them providing more extensive services than we originally anticipated, but in the end, I feel that's something we can be proud of," says Holt.

The Paralympics and Threat of Terrorism: Special Considerations

University of Utah medical staff and volunteers prepare for the closing ceremonies. Seven mobile teams and four medical stations provided care to more than 300 patients at the Olympic Stadium during the Games for ailments ranging from a heart attack to minor cuts and scrapes.

Three days after the Olympic flame went out, the Paralympic torch lit up the same stadium and the Games began again. "It's important to remember that the Paralympians are first and foremost athletes," says Holt. "People get into the mindset that because some of them are in wheelchairs or have prostheses, they are all patients. Like the Olympians, only when they had a problem that required our assistance did they become patients."

Holt says that all of the services made available to the Olympic athletes and their coaches were also available to their Paralympic counterparts, just on a smaller scale. Providers were briefed on special medical considerations to look out for, such as additional risks of infections for paraplegic athletes and skin care concerns for amputees. "But their needs were far more similar to than different from the Olympic athletes," says Dr. Elstad.

Like their predecessors, the approximately 500 Paralympians in Salt Lake kept primary care physicians, dentists, and optometrists busy. But Holt says the services most in demand were repairing and replacing orthodics, prostheses, and wheelchairs. "These services were more akin to keeping their 'sporting equipment' honed and ready for competition," says Holt.

Of much greater concern to Dr. Elstad and Holt were the unprecedented security measures that marked these Olympic and Paralympic Games. "I was very worried about how increased security measures were going to impact our operations," says Holt. "Because the Polyclinic was so close to the hospital, we wanted to rely on being able to quickly transport patients needing urgent care to the emergency room. Normally, this would be a two-minute trip by van, but gates and security checkpoints easily could turn such a trip into 30 minutes," adds Dr. Elstad. "We were therefore provided with an emergency 'breakthrough' gate that was at our disposal should we really need to get someone to the hospital fast. Fortunately, we never had to use it."

"Ultimately, my concerns didn't come to fruition," affirms Holt. "There were noticeable security measures in place," he adds, citing a fence enclosing the village with electrified wire across the top, the presence of Secret Service members, and other less visible safeguards. "The first couple days were a challenge, but once we understood how the security measures worked, we were able to transport patients and supplies as we needed to without interference. Overall, I felt it was a very secure venue."

Polyclinic Medical Director and University of Utah faculty member Mark R. Elstad. M.D., confers with a team doctor from New Zealand.

To guard against potential bioterrorist attacks, Dr. Elstad says the services of infectious disease specialists were enlisted. "In addition, we had two officers from the Centers for Disease Control and Prevention (CDC) who were epidemiologists specifically trained to contain epidemics," says Dr. Elstad. "Their primary role was to help us with data management in terms of our records and their accuracy; the second was to act as consultants had a bioterrorism event occurred. They were our direct line to the CDC, and we were their resources should they have needed us."

The Legacy of the Salt Lake Polyclinic

Now converted back to meeting and conference rooms, the Polyclinic, like the Games, has faded into Olympic history and its experience will be used to help others provide medical care on an Olympic scale at future Games. There were no gold medals awarded to the health care providers who kept Salt Lake's athletes in shape to compete while the world watched, but Holt says being part of the Winter 2002 Olympiad was its own reward. "We feel our work was very much a success," he says, "and very much worth the effort."

Photos courtesy of Bradley R. Nelson, University of Utah School of Medicine.

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