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Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines

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Abstract

An increasing participation in ultra-endurance foot races is cause for greater need to ensure the presence of appropriate medical care at these events. Unique medical challenges result from the extreme physical demands these events place on participants, the often remote settings spanning broad geographical areas, and the potential for extremes in weather conditions and various environmental hazards. Medical issues in these events can adversely affect race performance, and there is the potential for the presentation of life-threatening issues such as exercise-associated hyponatremia, severe altitude illnesses, and major trauma from falls or animal attacks. Organization of a medical support system for ultra-endurance foot races starts with a determination of the level of medical support that is appropriate and feasible for the event. Once that is defined, various legal considerations and organizational issues must be addressed, and medical guidelines and protocols should be developed. While there is no specific or universal standard of medical care for ultra-endurance foot races since a variety of factors determine the level and type of medical services that are appropriate and feasible, the minimum level of services that each event should have in place is a plan for emergency transport of injured or ill participants, pacers, spectators and event personnel to local medical facilities.

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Acknowledgments

The authors have no potential conflicts of interest that are directly relevant to the content of this article, but acknowledge being Director of Research for the Western States Endurance Run (MDH), and Medical Directors of the Tahoe Rim Endurance Races (AP), Leadville 100 Race Series (MK, JCH), Remote Medical International (DAT), Al Andalus Ultimate Trail (BVS), Racing The Planet (BJK, GSL) and Dokever (PB). Each has also provided medical coverage at a variety of other endurance events, and most are experienced endurance athletes. We thank our ultramarathon running buddies who offered constructive comments on the work, including race directors Dr. David Horton and Craig Thornley, and Western States Endurance Run Board member Attorney Charles Savage. This material is the result of work supported with resources and the use of facilities at the VA Northern California Health Care System. The contents reported here do not represent the views of the Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. Department of Physical Medicine & Rehabilitation (117), Department of Veterans Affairs, Northern California Health Care System, 10535 Hospital Way, Sacramento, CA, 95655-1200, USA

    Martin D. Hoffman

  2. Silver Sage Sport Performance and Silver Sage Center for Family Medicine, Reno, NV, USA

    Andy Pasternak

  3. St. John of God Murdoch Hospital, Murdoch, WA, Australia

    Ian R. Rogers

  4. University of Notre Dame, Murdoch, WA, Australia

    Ian R. Rogers

  5. Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA

    Morteza Khodaee & John C. Hill

  6. Department of Medicine, Division of Emergency Medicine and Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA

    David A. Townes

  7. Borders General Hospital, Melrose, UK

    Bernd Volker Scheer

  8. Team Axarsport, Alicante, Spain

    Bernd Volker Scheer

  9. Department of Rehabilitation, Orthopaedics and Sports Medicine, University of Washington and Seattle Children’s Sports Medicine, Seattle, WA, USA

    Brian J. Krabak

  10. Dokever, Pierre-Bénite, France

    Patrick Basset

  11. Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Grant S. Lipman

  12. Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA

    Martin D. Hoffman

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Correspondence to Martin D. Hoffman.

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Hoffman, M.D., Pasternak, A., Rogers, I.R. et al. Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines. Sports Med 44, 1055–1069 (2014). https://doi.org/10.1007/s40279-014-0189-3

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