Spring is upon us in Durango, and we are shaping up for a great spring backcountry ski season. At lower elevations, trails are starting to melt and dry out, and you can see road bikes with regularity heading up through Hermosa. Race season will soon be here!
Smart racers know to focus on training and nutrition for a successful race, but what if something goes wrong on race day? Are there qualified and appropriately equipped professionals able to help?
There is little regulation into what medical support is required for a race. Generally, we expect established, large and well funded events to have great medical support for their athletes. Unfortunately, this is not always the case. I recently spoke with an Ironman finisher who collapsed with intractable muscle spasms and soon fainted after finishing a race. Their spouse brought them to the med tent to find the few remaining staff breaking down, packing up, and unable to assist with more than an hour left before the course closed! This athlete was taken to the ER by ambulance, and stuck with thousands of dollars in bills for what should have been addressed on site in the medical tent.
As this story illustrates, a poorly organized race medical plan can leave athletes in a bad situation or worse. Race organizers and athletes alike are encouraged to take a hard look at the potential risks of the event and what support is in place to address them. Ideally, athletes should be served by a qualified & equipped medical professionals who are available for at least as long as the course is open. A “friend who is an EMT” that brings whatever supplies they can scrounge up is a poor substitute for a proper race medical program.
What does a good race medical program look like? I think there are several key components.
Medical Direction. The medical program should be supervised and coordinated by a physician with documented interest and knowledge in the specific medical issues of athletes. Board certification in sports medicine is one metric to assure this knowledge base. The medical director advocates for the athletes by assuring that the staff and equipment are appropriate, advising the organizers on safety issues, and providing interface between the race and local EMS, hospitals and other medical resources.
Appropriate Staffing. This will vary largely with the size of the event. EMT’s, Nurses, PTs, Athletic Trainers, Physicians, Massage Therapists, Paramedics and radio operators might all be involved with a complex event.
Planning. Experience at similar or prior years’ events as well as published research and position papers is used to guide the extent and set up of the medical program. Did you know there is science that can inform the physical design of the finish line area or the location of aid stations?
Equipment. While not perhaps the most important of all the components, it is certainly the most photogenic. Some of the equipment that Durango Sports Medicine has that might be used at a race includes:
Defibrillator. An AED or cardiac defibrillator is essential for treating potential heart emergencies. Even elite athletes can be at risk, and if you need one of these, you don’t have time to wait. The Zoll unit owned by the practice in addition to being an AED can function as an artificial pacemaker, do complete hospital EKG to diagnose heart attacks (the sooner the diagnosis is confirmed, the better the outcome), and measure oxygen and CO2 in athletes with breathing difficulty.
Oxygen & related equipment. Medical oxygen is used to treat breathing problems and is especially important at high altitude. Other items can help medical professionals assist if an athlete has stopped breathing or has a collapsed lung.
Thermometer. A special thermometer capable of measuring core temperature is need for diagnosis of athletes heat stroke or hypothermia. Regular thermometers have been shown to provide wildly false readings in some of these situations.
Heat Stress Gauge. For warm weather events, American College of Sports Medicine recommends using special equipment to monitor humidity , solar radiation, air temperature and wind to compute overall heat stress and consider course changes and safety messaging.
Medications. Epinephrine is a time critical treatment for severe allergic reaction. Some athletes may be at greater risk during exercise. Other medications may be brought, depending on the specific needs of the event.
IV Fluids. While still playing a role, research (much done by my outstanding friend and colleague Dr Marty Hoffman) has demonstrated that liberal use of IV fluids post race is unneeded and potentially life threatening. In situations of exercise hyponatremia, unthoughtful used of IV fluids can be quite dangerous. It is my opinion that businesses offering IV’s for cash post race (this is becoming more common on the front range) are engaged in an unethical, exploitative and dangerous practice. Avoid these!
Splint, bandages & wound care. Road rash, cuts, sprains, blisters are common on course injuries. They need to be cleaned prevent infection and evaluated so the athlete can be appropriately advised if they can safety return to the race, to goto the hospital or some option between these extremes.
Diagnostic equipment. A variety of other tools to help race physicians diagnose eye & ear problems, concussion, and other medical issues.
Radio gear. Safety and organization at large event can be increased with good walkie-talkies. The practice owns a variety of equipment to interface with EMS, public safety, ham radio, etc.
Durango Sports Medicine has already been out to support several events this year, including Snowdown Strongman and Truck Pull Events, as well as the Silverton Whiteout. I am looking forward to supporting more events this year, including 12 Hours of Mesa Verde and again this year at the Hardrock100! If you are planning a race or event in our area and need some input or help with your medical program, please contact me.
Thanks for reading and have a safe and successful race season!