# COMAR Title 09 — Maryland Department of Labor

## Subtitle 14 — State Athletic Commission

### Chapter 04 — Safety and Health Standards for Contestants

**Authority:** Business Regulation Article, §§4-205, 4-304, 4-304-1, 4-310, 4-314, and 4-315, Annotated Code of Maryland

**Administrative History:** Effective date: October 1, 1965

**Administrative History:** Subtitle revised effective August 26, 1985 (12:17 Md. R. 1705)

**Administrative History:** Regulation .01 amended effective September 3, 1990 (17:17 Md. R. 2079)

**Administrative History:** Regulation .02 amended effective September 3, 1990 (17:17 Md. R. 2079); March 29, 1993 (20:6 Md. R. 581)

**Administrative History:** Regulation .03 repealed and new Regulation .03 adopted effective December 28, 1987 (14:26 Md. R. 2745)

**Administrative History:** Regulation .03 amended effective September 3, 1990 (17:17 Md. R. 2079)

**Administrative History:** Regulation .04I, J adopted effective December 28, 1987 (14:26 Md. R. 2744)

**Administrative History:** Regulation .04 amended effective September 3, 1990 (17:17 Md. R. 2079); March 29, 1993 (20:6 Md. R. 581)

**Administrative History:** Regulation .05 amended effective September 3, 1990 (17:17 Md. R. 2079)

**Administrative History:** Regulation .06B amended effective July 13, 1986 (13:14 Md. R. 1633); September 3, 1990 (17:17 Md. R. 2079)

**Administrative History:** Regulation .08 amended effective September 3, 1990 (17:17 Md. R. 2079)

**Administrative History:** Regulation .09C amended effective September 3, 1990 (17:17 Md. R. 2079)

**Administrative History:** Regulation .10 amended effective September 3, 1990 (17:17 Md. R. 2079)

**Administrative History:** Regulation .10B amended effective March 9, 1998 (25:5 Md. R. 367)

**Administrative History:** Regulation .10E adopted effective December 28, 1987 (14:26 Md. R. 2744)

**Administrative History:** Regulation .11B amended effective March 29, 1993 (20:6 Md. R. 581)

**Administrative History:** Regulation .12B amended effective September 3, 1990 (17:17 Md. R. 2079)

**Administrative History:** Regulation .12B amended as an emergency provision effective May 14, 1999 (26:12 Md. R. 923); emergency status expired November 15, 1999; amended permanently effective January 24, 2000 (27:1 Md. R. 75)

**Administrative History:** Regulation .12B amended as an emergency provision effective March 30, 2002 (29:7 Md. R. 616); emergency status expired August 28, 2002; amended permanently effective November 25, 2002 (29:23 Md. R. 1811)

**Administrative History:** Regulation .13 adopted effective March 9, 1998 (25:5 Md. R. 367)

**Administrative History:** Chapter revised effective July 6, 2009 (36:13 Md. R. 898)

**Administrative History:** Regulation .04B amended effective May 22, 2017 (44:10 Md. R. 471)

**Administrative History:** Regulation .10C amended effective May 22, 2017 (44:10 Md. R. 471)

**Administrative History:** Regulation .12 amended as an emergency provision effective January 10, 2013 (40:3 Md. R. 215); amended permanently effective July 8, 2013 (40:13 Md. R. 1073)

#### Regulation .01 Medical Examinations.

*COMAR 09.14.04.01*

A. A contestant applying for a license or license renewal shall have a comprehensive physical examination by the applicant's personal physician performed within 30 days before the application is submitted to the Commission.

B. The findings from a physical examination under §A of this regulation shall be reported by the applicant to the Commission at least 5 business days before the date of the contest.

#### Regulation .02 Ophthalmological Evaluation.

*COMAR 09.14.04.02*

A. In this regulation, “ophthalmological evaluation” means an examination by an ophthalmologist to detect abnormalities of a person's vision and includes, but is not limited to:

  (1) Assessment of the cornea, lens, macula, and retina of the eye;

  (2) Visual acuity; and

  (3) Peripheral vision.

B. A contestant applying for a license or license renewal shall submit to the Commission an ophthalmological evaluation completed by an ophthalmologist licensed by or eligible for certification by the American Board of Ophthalmology, performed within 30 days before the date of filing the application.

C. The evaluation under §B shall include an official report of the indirect ophthalmoscopy and slit lamp.

D. The findings from the evaluation under §§B and C of this regulation shall be reported to the Commission at least 5 business days before the date of the contest.

E. In order to participate in a contest, a contestant shall pass an ophthalmological evaluation and:

  (1) Have visual acuity:

    (a) Of at least 20/80 in both eyes, or

    (b) Between 20/80 and 20/200, with special permission of the Commission; and

  (2) Have 100 percent peripheral vision in both eyes.

#### Regulation .03 Neurological Testing.

*COMAR 09.14.04.03*

A. In this regulation “neurological test” means an examination by a physician to detect abnormalities of the nervous system and includes, but is not limited to:

  (1) Assessment of mental status, cranial nerves, motor function including power, tone, and bulk, cerebellar function, deep tendon reflexes, and plantar responses;

  (2) Physical examination;

  (3) Laboratory procedure; and

  (4) Other specialized testing.

B. A contestant shall be examined by a neurologist or neurosurgeon appointed by the Commission before the contestant's first bout in Maryland each licensed period and annually after that.

C. The Commission shall require a contestant to be reexamined by a neurologist or neurosurgeon, appointed by the Commission, before participating in a contest:

  (1) If the contestant has participated in more than 12 contests in or outside the State;

  (2) If the contestant has been knocked out or receives a technical knockout as a result of neurological injury in two consecutive contests; or

  (3) Upon recommendation of a ringside physician.

D. The Commission may require a contestant to undergo additional neurological testing and evaluation as prescribed by the examining neurosurgeon or neurologist.

E. A neurologist or neurosurgeon, appointed by the Commission, shall be licensed in Maryland and be certified by the American Board of Neurological Surgery or the American Board of Psychiatry and Neurology.

F. A contestant may not be licensed or permitted to participate in a contest if the neurological examination demonstrates abnormalities suggestive of acute, subacute, or chronic nervous system abnormalities.

#### Regulation .04 Precontest Examinations.

*COMAR 09.14.04.04*

A. A contestant and any substitute contestant shall undergo a final physical examination by a physician at a location, and on a date and time, approved by the Commission.

B. A contestant may not engage in a contest if any of the following physical conditions are determined by the Commission’s physician:

  (1) A significant hernia or varicocele;

  (2) Organic heart murmurs or dysrhythmia;

  (3) Active pulmonary lesions;

  (4) Vision that fails to meet the requirements of Regulation .02E of this chapter;

  (5) Oral temperature over 100°F;

  (6) Systolic pressure or diastolic pressure outside of acceptable limits;

  (7) Infectious skin lesions, such as boils or infected wounds;

  (8) Wounds, especially on face and ears, that are incompletely or poorly healed;

  (9) Hand injuries and fractures less than 6 weeks old that would be detrimental to the contestant's showing or to subsequent healing;

  (10) Use of narcotics, stimulants, depressants, or strong analgesics; or

  (11) Detached retina, retinal tear, or macular hole in one or both eyes.

C. Upon certification by a contestant's ophthalmologist who performed the operation, and upon review and approval of the Commission's senior physician, a repaired retinal abnormality may not automatically disqualify a contestant from participation in a contest. Documentation shall be submitted to the Commission 1 month in advance.

D. The Commission may cancel a boxing contest if either contestant in a contest fails to appear for the final physical by 12 p.m. on the day of the contest.

E. Within 1 hour before the first contest, the Commission's physician may, at any time, conduct a brief examination to determine if a contestant's physical condition has changed since the final physical.

F. A referee shall be given a physical examination before officiating a contest.

G. A contestant under contract who is injured or becomes ill before a contest shall submit to the Commission, before the date of the contest, a notarized medical report by a physician detailing the nature of the injury or illness and the prognosis for recovery.

H. On the date of the contest, a contestant shall declare use of any medication on the final physical examination form including the name, the dosage, and the time of the last injection or ingestion of any prescription or non-prescription drug.

I. The Commission shall provide the contestant with a written statement which explains the contestant's rights and responsibilities under these regulations at the pre-fight examination on the date of the contest.

#### Regulation .05 Physician at Contest.

*COMAR 09.14.04.05*

A. The Commission shall appoint at least two physicians to insure the safety and health of all contestants in a contest.

B. One of the physicians appointed under §A of this regulation, may be a neurosurgeon or a neurologist.

C. The Commission shall designate a senior physician.

D. A senior physician has the following authority to:

  (1) Interrupt a contest at any time to examine a contestant;

  (2) Terminate a contest at any time after determining that serious injury has occurred or is immediately likely to occur to either contestant, or when a contestant is bleeding sufficiently to provide a health hazard to spectators and personnel;

  (3) Admit a contestant to a medical facility; and

  (4) Require a contestant to submit to a blood test or urinalysis.

E. The Commission shall designate ringside physicians.

F. The senior physician and ringside physician may render emergency treatment to a contestant on-site or while traveling to a hospital.

#### Regulation .06 Ringside Medical Equipment and Materials.

*COMAR 09.14.04.06*

A. The following items shall be available in good working order before each contest begins:

  (1) A stretcher;

  (2) A portable resuscitator or Ambubag with oxygen equipment;

  (3) A hard cervical collar;

  (4) Endotracheal tubes with laryngoscope;

  (5) A portable defibrillator; and

  (6) Advanced life-support medications.

B. Only the following materials shall be allowed in a contestant's corner:

  (1) Ice;

  (2) Water;

  (3) Cotton swabs;

  (4) Gauze pads;

  (5) Clean towels;

  (6) Aventine;

  (7) Adrenaline (one part per thousand solution);

  (8) Medical diachylon tape;

  (9) Enswell;

  (10) Petroleum jelly;

  (11) Safety scissors; and

  (12) Disposable latex examination gloves.

#### Regulation .07 Protection Materials.

*COMAR 09.14.04.07*

A contestant shall use a custom fitted mouthpiece with palate and a professional protection cup during the contest.

#### Regulation .08 Proximity of Contest to Emergency Medical Facilities.

*COMAR 09.14.04.08*

A. The location of a contest may not be more than 15 minutes by ambulance from a hospital providing neurosurgical evaluation and treatment facilities, with a neurosurgeon on call.

B. The medical facility in §A of this regulation, shall be notified by the State Athletic Commission 24 hours before a contest of the time and location of the contest, with a request for a neurosurgeon to be on call.

#### Regulation .09 Post-Fight Examinations.

*COMAR 09.14.04.09*

A. A contestant shall be given a brief post-fight physical examination by the ringside physician.

B. The ringside physician shall complete a post-fight medical recommendation form and give copies of the form to the contestant and the contestant's manager.

C. The following individuals shall remain in the arena and be available for medical evaluation until released by the senior physician:

  (1) A contestant suffering a knockout or technical knockout; or

  (2) A contestant who requires observation in the opinion of the ringside physician.

#### Regulation .10 Medical Suspensions.

*COMAR 09.14.04.10*

A. Medical suspensions may be issued at the discretion of the physician appointed by the Commission.

B. The following shall constitute mandatory grounds for medical suspension and minimum duration:

  (1) Laceration ... 30 days;

  (2) Technical knockout ... 30 days;

  (3) Knockout or technical knockout with loss of consciousness (first occurrence) ... 60 days;

  (4) Knockout or technical knockout with loss of consciousness (second consecutive occurrence):

    (a) Not less than 70 days from the date of the second occurrence, and

    (b) Not less than 120 days from the date of the first occurrence;

  (5) Knockout or technical knockout with loss of consciousness (third consecutive occurrence) ... indefinite;

  (6) Poorly conditioned ... 42 days;

  (7) Physically demanding contest or excessive blows to the head ... 30 to 60 days.

C. A contestant suspended indefinitely shall remain suspended until a medical examination specified by the Commission has been completed and the Commission has determined that the contestant has satisfactorily recovered.

D. Unless the Commission otherwise approves, a contestant may not participate in another contest:

  (1) For at least 14 days after a contest of four to eight rounds duration; and

  (2) For at least 28 days after a contest of more than eight rounds duration.

E. A contestant whose urine test results are positive shall be suspended pending a hearing.

F. Knockout occurrences in other states, suspensions, and durations of contests shall be used in determining the length of medical suspensions and the fitness of a contestant to compete.

#### Regulation .11 Duties of Promoter.

*COMAR 09.14.04.11*

A. A promoter shall furnish the following for a boxing, kickboxing, or mixed martial arts contest:

  (1) Sanitary dressing rooms for contestants that contain a restroom, rest table, and facilities for Commission physicians to examine contestants before and after a contest;

  (2) Emergency procedures at least 7 days before the date of the contest to the Commission for removing an injured contestant to a hospital pursuant to Regulation .08 of this chapter;

  (3) A ring conforming with the specifications of the Commission;

  (4) An ambulance to transport an injured contestant to a medical facility as required in Regulation .08A of this chapter; and

  (5) An ambulance crew consisting of:

    (a) One emergency medical technician—paramedic (EMT-P); and

    (b) One emergency medical technician—basic (EMT-B).

B. A promoter shall instruct contestants, managers, and individuals in charge of the arena in the safety standards of the Commission.

C. A promoter shall follow all safety standards required by the Commission and shall take all reasonable precautions to insure the safety and health of contestants, officials, and spectators.

#### Regulation .12 Female Contestant.

*COMAR 09.14.04.12*

A. A contest between female contestants shall be subject to all the requirements of this chapter.

B. The following requirements for a female contestant are in addition to the requirements under §A of this regulation:

  (1) A female contestant may not contract for, or engage in, a contest with a male contestant;

  (2) Contests shall be limited as follows:

    (a) Not more than eight rounds of 2-minute duration with a 1-minute rest period between rounds, depending on the skills of the contestants competing; and

    (b) Eight rounds of 2-minute duration with a 1-minute rest period between rounds for a championship contest;

  (3) An abdominal guard shall be worn and a breast protector shall be used as a binder;

  (4) Hair shall be secured in a manner that it does not interfere with the vision or safety of either contestant;

  (5) A boxer who is pregnant may not engage in a contest;

  (6) Promoters shall provide adequate, separate dressing rooms;

  (7) Cosmetic use shall be prohibited;

  (8) An examination under Regulation .01 of this chapter shall include a pelvic examination;

  (9) An examination under Regulation .04 of this chapter shall include an abdominal and breast examination with notations of any masses; and

  (10) Gloves used in the contest shall be:

    (a) 8 ounces for weight classifications less than 148 pounds; and

    (b) 10 ounces for weight classifications 148 pounds or greater.

C. A female contestant shall:

  (1) Take a HCG serum pregnancy test within 5 days before each contest; and

  (2) Submit the results of the test to the Commission at the final physical.

D. Failure of a female contestant to comply with §C of this regulation shall result in the immediate disqualification of the female contestant for a contest.

#### Regulation .13 Blood Tests.

*COMAR 09.14.04.13*

A. In compliance with the blood testing requirements of Business Regulation Article, §4-304.1, Annotated Code of Maryland, a blood sample from an individual desiring to participate in a boxing, kickboxing, or mixed martial arts contest shall be:

  (1) Taken by a physician, phlebotomist, or other qualified health care provider chosen by the individual; and

  (2) Analyzed by a medical laboratory, certified in accordance with the Clinical Laboratory Improvement Act, 42 U.S.C. §263(a), for the presence of:

    (a) Antibodies to the human immunodeficiency virus (HIV), and

    (b) The antigen of virus hepatitis B.

B. Only blood tests with negative results shall be submitted to the Commission.

C. The required negative blood tests:

  (1) Shall be submitted to the Commission by an applicant for licensure as a  contestant, a contestant, or an authorized representative of the applicant or contestant; and

  (2) May not be submitted by the person taking the blood sample, the medical laboratory testing the blood sample, or any other person.

D. The required negative blood tests shall:

  (1) Have been performed within 30 days of the individual's application for a license; and

  (2) Except as provided in §E of this regulation, be submitted to the Commission:

    (a) At the time the application is submitted to the Commission, or

    (b) Not later than the weigh-in for the first contest in which the contestant is to participate following the submittal of the application.

E. The Commission, in its discretion, may extend the time for the submittal of the required negative blood tests to a time immediately before the contestant's first contest following the issuance of a license.

F. To constitute documentary evidence satisfactory to the Commission, the negative test results from the medical laboratory shall be:

  (1) On the medical laboratory's letterhead; and

  (2) Signed by an authorized representative of the medical laboratory.

G. In addition to submitting the required negative blood tests before a contestant's first contest following the submittal of an application for licensure, a contestant is required to submit the required negative blood tests if:

  (1) The contestant previously tested positive for the antibodies to HIV or the antigens of virus hepatitis B; or

  (2) The Commission has reasonable cause to believe that the testing of the contestant's blood may not result in a negative test for the presence of the antibodies to HIV or the antigens of virus hepatitis B.