by Todd Shatynski
Over the past few decades, there have been several high profile endurance events that have experienced tragedy. This ranges from mass casualty disaster to an athlete fatality. Previously felt to be safe, we have now realized that there are risks to participating in an endurance sport much greater than the overuse knee pain or stress fracture during training. As their popularity and participation has increased, the incidence of athletes suffering from medical conditions has also grown. As a result, the medical community has paid more attention to the issue of athlete safety at mass participation events like triathlons and long distance running races. While smaller, shorter events can usually be covered by a single ambulance, larger and longer events have a greater variety of conditions that can benefit from diverse medical involvement. Since 2011, I have been involved with the HMRRC in serving as a medical director for the marathon and half marathon events, helping to coordinate the medical care and safe participation of the runners.
Planning the medical coverage each year takes several months and multiple meetings between involved medical personnel and the race director. Our team has included a public health physician, emergency medicine physicians and a sports medicine physician (me). Our team-based model has enabled us to offer diverse medical experience and unique medical skills. Our focuses vary from public health and race day communication, medical care of the athletes on the course and at the finish line, and on EMS coordination with EMS as well as disaster preparedness.
My focus is on the care of the athlete on the course and at the finish line. The Mohawk Hudson races are both point to point and thus have 26.2 miles of course that needs coverage. In addition to ambulances stationed around the course, we usually have 10-20 medically-experienced individuals on bicycles patrolling designated areas. They are equipped with an AED (for any unfortunate runner who collapses from cardiac arrhythmias) as well as a variety of useful items to care for problems such as dehydration, hypoglycemia, and blisters. However, most of the athlete issues occur towards the end of the race thus most of the encounters are in the finish line medical tent. This is where a lot of preparation comes in! We staff our tent with a variety of medical professionals, ranging from EMTs, nurses, medical students, and physicians, both in-training residents as well as experienced, board certified doctors.
Most commonly in the tent, we evaluate a runner who complains of various forms of exhaustion or gastrointestinal problems. The key is determining who feels terrible because they just ran a marathon and who actually has something seriously wrong with them! Many first time marathoners don’t realize how awful they can feel after the race and come in to be evaluated. We have seen cases of hyponatremia (low salt/sodium levels), heat illness, kidney failure, stroke, and cardiac conditions. Many of these can be treated in the tent but some need to be sent to the hospital via ambulance for more advanced level care. We have the ability to cool athletes quickly with a cooling tub in cases of heat illness, IV capability, and a variety of medications to treat everything from pain, inflammation, muscle cramps, allergy and nausea. We also have extensive equipment for treating blisters and skin conditions. Still, our most common handout is a bag of ice!
Our planning for the race day begins after the conclusion of the coverage the previous year! We inventory what supplies are remaining and what can be used again. We keep a list of things that worked and things that didn’t so we can improve in the future. We then compile a list how many athletes were treated and what medical services were provided. At the end of the day we are worn out almost as much as the finishers! We welcome the down time of the next several months but then 4-5 months out from race day we start having meetings again so we can review any changes for the coming year.
Planning for the marathon medical coverage requires a comprehensive understanding of the event. Considerations include course format, expected weather conditions, and known conditions of competing runners among them. Anticipating needs and planning for the unexpected is a challenge each year but fortunately it becomes easier each year! The marathon medical coverage has become a rewarding experience for me and the other medical volunteers. I have been a runner for almost forty years and I see the experience to be way to give back to the sport that I love!
Todd helping out at HMRRC Just Run Event with his son