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Managing Collapsed or Seriously Ill Participants of Ultra-Endurance Events in Remote Environments

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Abstract

Increasing participation in ultramarathons and other ultra-endurance events amplifies the potential for serious medical issues during and immediately following these competitions. Since these events are often located in remote settings where access may be extremely limited; the diagnostic capabilities, treatment options, and expectations of medical care may differ from those of urban events. This work outlines a process for assessment and treatment of athletes presenting for medical attention in remote environments, with a focus on potentially serious conditions such as major trauma, acute coronary syndrome, exertional heat stroke, hypothermia, hypoglycemia, exercise-associated hyponatremic encephalopathy, severe dehydration, altitude illness, envenomation, anaphylaxis, and bronchospasm. A list of suggested medical supplies is provided and discussed. But, given that diagnostic and treatment options may be extremely limited in remote settings, it is important for medical providers to understand how to assess and manage the most common serious medical issues with limited resources, and to be prepared to make presumptive diagnoses when necessary.

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Acknowledgments

The authors (MDH, IRR, JJ, CAA, WOR, and BDL) 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 and Chief Medical Officer for Ultra Medical Team (MDH); Medical Director of Ironman Syracuse, Empire State Marathon, Desert R.A.T.S., Grand to Grand Ultra, and Global Limits, Inc., and Clinical Medical Director of Jungle Marathon (JJ); and Medical Director of the Twin Cities in Motion and the Medtronic Twin Cities Marathon (WOR). No funding was received for the conduct of the work or for preparation of the manuscript. 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 and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA

    Martin D. Hoffman

  2. St. John of God Murdoch Hospital and University of Notre Dame, Murdoch, WA, Australia

    Ian R. Rogers

  3. Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA

    Jeremy Joslin

  4. Department of Family Medicine, Georgia Regents University, Augusta, GA, USA

    Chad A. Asplund

  5. Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA

    William O. Roberts

  6. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, and Division of Cardiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

    Benjamin D. Levine

  7. Department of Physical Medicine and Rehabilitation (117), Sacramento VA Medical Center, 10535 Hospital Way, Sacramento, CA, 95655-1200, USA

    Martin D. Hoffman

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  1. Martin D. Hoffman
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  2. Ian R. Rogers
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  3. Jeremy Joslin
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  4. Chad A. Asplund
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  5. William O. Roberts
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Correspondence to Martin D. Hoffman.

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Hoffman, M.D., Rogers, I.R., Joslin, J. et al. Managing Collapsed or Seriously Ill Participants of Ultra-Endurance Events in Remote Environments. Sports Med 45, 201–212 (2015). https://doi.org/10.1007/s40279-014-0270-y

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