Providing medical services for combat sports

To participate in a combat sport contest in NSW, a person must be registered with the Combat Sports Authority of NSW (the Authority) as a combatant in the applicable class. An application for registration as a combatant must be accompanied by:

• Certificate of Fitness (PDF, 482.12 KB)
• Serological Certificate (PDF, 144.85 KB)
   

The purpose of a medical examination of persons wishing to register or maintain their registration as a combatant under the Combat Sports Act 2013 (Act) is to minimise the risks of participation in combat sports. It is a condition of each combatant’s registration that they complete a Health Screening Questionnaire and provide a Certificate of Fitness (signed by a medical practitioner) in the approved form to the Authority each year (no later than 12 months after the date of the previous certificate).

The Medical Practitioner, in examining the patient, should consider the responses in the Health Screening Questionnaire and look for abnormalities which may increase the risk of injury, or decrease the ability of the person to effectively defend themselves.

It is acknowledged that such examination will not prevent injuries arising during a contest from strikes to the head and  body. The purpose of the questionnaire and examination is to detect those persons who are particularly at risk due to pre-existing disease or anatomical abnormalities.

The medical practitioner should undertake any medical examinations and tests they believe are necessary to give them confidence to issue the Certificate of Fitness. Combatants must be, in the medical practitioner’s opinion, in good health and fit to engage in combat sport. Excessive weight and wasting should be considered with caution, although this would not necessarily exclude participation. If you do not consider the combatant fit to compete in combat sports then you should not issue the Certificate of Fitness.

The Authority does not require details of the examination undertaken, the medical test results obtained, or a copy of the Health Screening Questionnaire, and the confidentiality of this information should be maintained between the medical practitioner and combatant.
In addition to these annual examinations, the Act requires that combatants be examined by an attending medical practitioner (“ringside doctor”) before every contest, after every contest and at any time as directed by the Authority. These examinations are for the health and safety of combatants and any resulting medical suspensions are shown in the combatant’s Medical Record Book.

Combatants must supply a current Serological Clearance Certificate in the approved form to the Authority to be registered or maintain their registration.

• Combatants 18 years and over must supply a current Serological Clearance Certificate every six months to be eligible to compete.
• Combatants under 18 years must supply a current Serological Clearance Certificate every twelve months to be eligible to compete.

A current serological clearance is a certificate by a registered medical practitioner or a person who provides a pathology service that states:

1. the medical practitioner or person is of the opinion that a specified person is not capable of transmitting a medical condition or disease specified by the Combat Sport Regulation 2014 (Regulation), and
2. the opinion is based on the results of blood tests or other tests carried out on a date specified in the certificate.

The medical conditions or diseases specified by the Regulation are:

• HIV
• Hepatitis B
• Hepatitis C

In order to complete the Serological Clearance Certificate the medical practitioner or pathology service provider must order the following screening tests to be conducted:

• HIV combined antigen - antibody (HIV Ag/Ab),
• Hepatitis B surface antigen (HBsAg), and
• Hepatitis C antibody (HCV Ab) with PCR HCV if positive

The certificate must state the date of the test and may only be completed if based on the results of the above tests and the issuer is of the opinion that the person is not capable of transmitting a medical condition or disease specified by the Regulation. 

In the event that any of the screening tests are positive and the medical practitioner or pathology service provider is of the opinion that the specified person is capable of transmitting the specified disease / medical condition then the serology certificate must not be issued.

The Combat Sports Authority does not require the results of the pathology tests, only the completed Serological Clearance Certificate. It is recommended that a combatant keeps a record of their results as this may be required by other regulatory authorities if they compete interstate or overseas.

An AMP must be accredited by the Authority under Part 2A of the Act. A registered medical practitioner can apply to the Authority for accreditation as an AMP, subject to the requirements prescribed in sections 37B and 37C of the Act.

To apply to become an AMP, a registered medical practitioner should complete the Application for Accreditation as an Attending Medical Practitioner (PDF, 302.67 KB) form and email to amp@sport.nsw.gov.au accompanied by the required supporting documents

There is no application fee applicable for accreditation as an AMP and accreditation expires three (3) years from the date granted unless sooner cancelled, or the term of accreditation extended or reduced under the Act. AMPs wishing to remain accredited as an AMP with the Authority will be required to complete an application for accreditation once the accreditation expiry date is reached.
For any enquiries regarding the application process or eligibility requirements, please email amp@sport.nsw.gov.au or call 13 13 02.

A registered medical practitioner may apply to the Authority for accreditation as an AMP subject to the requirements prescribed in sections 37B and 37C of the Act. An AMP must comply with the conditions of accreditation as detailed in section 37D. For the purposes of determining an application for accreditation, an application must be accompanied by:

• a current CV detailing medical qualifications and current certifications. The CV must be supported by evidence of current registration with the Australian Health Practitioner Regulation Agency (AHPRA) as a medical practitioner and provide that the applicant is not subject to any condition that would limit the applicant’s ability to exercise the functions of an AMP;
• a valid certificate of currency for medical indemnity insurance showing an appropriate level  to cover a combat sport contest. See further details below;
• completion of the mandatory training including:
  (i)    The Authority’s concussion training modules 1 – 5 (access the course curriculum here); and
  (ii)   Advanced Life Support (ALS) training.
  NOTE: Exemptions may apply. Requests for exemptions or recognition of prior learning and experience must be included at the time of application. See further details below.

Mandatory Training Requirements

There are two mandatory training requirements which need to be met by registered medical practitioners applying for accreditation. These are:

1. Concussion and Other Serious Head Injury Identification Training
   Prior to submitting an application for accreditation as an AMP, a registered medical practitioner is required to complete modules 1-5 of the online concussion training. The training is free to complete and there is no need to request a certificate of completion as once the training is completed, the Authority will be notified. To maintain accreditation as an AMP, it is a requirement to complete the training every 3 years. Access the course curriculum here.

2. Advanced Life Support (ALS) Training

   Exemptions may apply if the applicant can meet one of the following exemptions:

   • the applicant has completed a suitable ALS course (details of approved ALS courses below) and can provide evidence of current validity; or
   • the applicant can provide evidence that they possess the prerequisite skills, knowledge and experience. Applicants seeking to be exempt on this basis should refer to the Criteria for Recognition of Prior Learning and Currency of Practice (PDF, 150.38 KB). 

Note: The Medical Advisory Committee (MAC) will assess applications where an exemption is requested. Supporting documentation/justification must be provided at the time of application.

IMPORTANT INFORMATION:

• For registered medical practitioners applying for accreditation that have been regularly appointed as a medical practitioner at combat sport contests in NSW (prior to the commencement of the accreditation), the first enrolment for the ALS course fees will be paid to the relevant provider by the Authority. Note: medical practitioners need to seek confirmation from the Authority before invoice arrangements are made, there will be no reimbursement of fees if this step is not completed.
• Registered medical practitioners who need to confirm with the Authority if they qualify for the first ALS course fees to be paid by the Authority need to email amp@sport.nsw.gov.au.
• The Authority will only pay the course fees for the first application for accreditation. Renewal of an ALS course will be at the expense to the registered medical practitioner.
• If you are a registered medical practitioner that has been regularly appointed as a medical practitioner at combat sport contests in NSW, the MAC has approved the suitability of five (5) ALS courses and training providers for AMPs. These include:

• The provider names above that have been noted as providers that can invoice the Authority directly will need to send a tax invoice to amp@sport.nsw.gov.au. This should be sent as soon as the enrolment process has been completed with the chosen provider.

Medical Indemnity Insurance
All AMPs are required to hold medical indemnity insurance that provides suitable cover for the functions they perform at combat sport contests in NSW. A copy of the valid certificate of currency for medical indemnity insurance showing an appropriate level to cover a combat sport contest must be provided at the time of application. 
 

An AMP must comply with the conditions of accreditation as detailed in section 37D of the Act.

The following standard conditions are imposed on the accreditation of a person as an AMP. The person must:

1. complete any training as and when required by the Authority, from time to time, to maintain accreditation as an AMP;
2. not bet on, or cause any bets to be placed on, any contest in relation to which the person is engaged to exercise the functions of an AMP;
3. Notify the Authority in writing if their registration as a medical practitioner:
   • lapses, is suspended, or cancelled
   • is made subject to conditions
   • is disqualified
4. notify the Authority within 14 days of any change to their name, address, or contact details on the AMP register.

The Authority must keep a register of AMPs including personal and professional details. This information may be shared with promoters to ensure that they can contact AMPs to engage their services. The Authority may make some information publicly available on the register of AMPs, including, the person’s name and local government area in which they practice.

The functions of the AMP at combat sports contests is detailed in section 57 of the Act. 

At the Contest

An AMP is responsible for pre and post contest medical examinations of combatants, emergency response in the event of an injury, and during the contest must be present to observe the contest. 

Pre-Contest Medical Examination of a Combatant

A combatant must not engage in a combat sport contest unless the combatant has, on the day of the contest, been examined by the AMP. The examination must be undertaken:

1. on the day of the contest, and
2. prior to any other contests on that same day (e.g. if the combatant is engaging in an “eliminator” contest).

The pre-contest medical examination functions of an AMP in relation to a combatant in a combat sport contest are as follows: 

1. Conduct the medical examination as prescribed by regulations and outlined in the Pre-Contest Medical Examination form,
2. Record and provide required details in the combatant’s medical record book and any other prescribed documents,
3. Certify whether the combatant is medically fit to compete,
4. If the combatant is not medically fit to engage in the contest, the AMP must certify in writing that the combatant must not engage in a contest or sparring:
   • unless cleared by another medical practitioner, or
   • until a specified date, or
   • until a specified date and medically cleared,
5. Immediately notify the combatant and any combat sports inspector if the exam is just before the contest of any certification outcome.
6. Automatically certify the combatant as unfit if they lack a current serological clearance.

Post-Contest Medical Examination of a Combatant

A combatant must, immediately following a contest that they have engaged in, undergo a post-contest medical examination conducted by the AMP.  This requirement does not apply if the combatant is rendered unconscious or is otherwise unable to comply for medical reasons.

The post-contest medical examination functions of an AMP in relation to a combatant who has engaged in a combat sport contest are as follows:

1. Conduct the examination as prescribed by regulations and outlined in the Post-Contest Medical Examination form,
2. Record the required particulars in the combatant’s medical record book and any other prescribed documents,
3. Provide those particulars to any person, and in the manner, prescribed by the regulations,
4. If necessary for the combatant’s health or safety, certify in the medical record book, and other required documents, that the combatant must not engage in contests or sparring:  
   • unless cleared by a medical practitioner, or
   • before a specified date, or
   • before a specified date unless medically cleared,
5. without delay, notify the combatant and any present inspector if certification prevents them from engaging in contests or sparring before a specified date.

The AMP has the Power to Stop a Contest

The AMP has the power to direct the referee to stop the fight if they feel the combatant’s health is at risk. The AMP must direct the referee to stop and end the contest (unless the referee has already done so):

1. if in the AMP’s opinion:
   • there is a serious impairment to a combatant’s ability to defend themself or continue in the contest, or
   • there is a likelihood of serious injury to a combatant if the contest were to continue, or
2. if the AMP observes a Category 1 head injury sign in a combatant, or
3. in any other circumstances prescribed by the Regulations or specified by the Authority Rules 

Weigh-in of combatants

An AMP may attend the weigh-in for combatants to conduct preliminary examinations, however this is not compulsory.

Learn more about the role of the AMP at combat sport contests in the factsheet below:

The Role of the Medical Practitioner in Combat Sport in NSW (PDF, 405 KB)

The factsheet below contains guidance on managing concussion and other head injuries sustained at a contest:

Concussion or Mild Traumatic Brain Injury (PDF, 238.87 KB)

Mandatory Medical Equipment at Combat Sport Contests

The minimum resuscitation equipment that must be at each combat sport contest in NSW is prescribed in the Combat Sport Authority Rules.

The promoter must ensure that all medical equipment prescribed by the Authority Rules is present at the contest and there is someone suitably qualified and skilled to use it.