Sports Medicine

, Volume 44, Issue 8, pp 1055–1069 | Cite as

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

  • Martin D. HoffmanEmail author
  • Andy Pasternak
  • Ian R. Rogers
  • Morteza Khodaee
  • John C. Hill
  • David A. Townes
  • Bernd Volker Scheer
  • Brian J. Krabak
  • Patrick Basset
  • Grant S. Lipman
Review Article


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.


Acute Kidney Injury Acute Mountain Sickness Automate External Defibrillator Medical Guideline Emergency Transport 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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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Copyright information

© Springer International Publishing Switzerland (outside the USA) 2014

Authors and Affiliations

  • Martin D. Hoffman
    • 1
    • 12
    Email author
  • Andy Pasternak
    • 2
  • Ian R. Rogers
    • 3
    • 4
  • Morteza Khodaee
    • 5
  • John C. Hill
    • 5
  • David A. Townes
    • 6
  • Bernd Volker Scheer
    • 7
    • 8
  • Brian J. Krabak
    • 9
  • Patrick Basset
    • 10
  • Grant S. Lipman
    • 11
  1. 1.Department of Physical Medicine & Rehabilitation (117), Department of Veterans AffairsNorthern California Health Care SystemSacramentoUSA
  2. 2.Silver Sage Sport Performance and Silver Sage Center for Family MedicineRenoUSA
  3. 3.St. John of God Murdoch HospitalMurdochAustralia
  4. 4.University of Notre DameMurdochAustralia
  5. 5.Department of Family MedicineUniversity of Colorado School of MedicineDenverUSA
  6. 6.Department of Medicine, Division of Emergency Medicine and Department of Global HealthUniversity of Washington School of MedicineSeattleUSA
  7. 7.Borders General HospitalMelroseUK
  8. 8.Team AxarsportAlicanteSpain
  9. 9.Department of Rehabilitation, Orthopaedics and Sports MedicineUniversity of Washington and Seattle Children’s Sports MedicineSeattleUSA
  10. 10.DokeverPierre-BéniteFrance
  11. 11.Division of Emergency Medicine, Department of SurgeryStanford University School of MedicineStanfordUSA
  12. 12.Department of Physical Medicine & RehabilitationUniversity of California Davis Medical CenterSacramentoUSA

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