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

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.

Does Acute Kidney Injury From an Ultramarathon Increase the Risk for Greater Subsequent Injury?

“…The findings also provides further rationale for avoiding overzealous rehydration due to concern for the renal system, which can place athletes with mild hyponatremia at risk for becoming acutely symptomatic. 24–26 …”

Correct Wilderness Medicine Definitions and Their Impact on Care

“…Second, in accidental hypothermia, altered consciousness is reportedly seen at temperatures lower than 32°C (90°F), with impaired shivering at 30°C (86°F), [5] not at 33°C as stated in the review [1]. As dilutional hyponatremic encephalopathy has been reported in cold environments [6] and may be misdiagnosed as severe hypothermia, these temperature thresholds for clinical signs and symptoms are more than a purely academic discussion.…”

“…The recent review piece on the management of collapsed or seriously ill participants of ultra-endurance events in remote environments [1] contained several inaccurate definitions pertaining to potentially critical environmental medical situations. This letter is written to correct these, provide more accurate wilderness medicine definitions, and discuss their potential impact on patient care.…”

Quantifying the “Slosh Stomach”: A Novel Tool for Assessment of Exercise-Associated Gastroparesis Symptoms in Endurance Athletes

“…The bulk of physiologic research concentrates on marathons and shorter running events. However, there has been an increasing body of work aimed solely at understanding medical issues specific to the endurance athlete during race day [5, 6]. These ultramarathons frequently occur in remote geography and often subject athletes to harsh environmental conditions.…”