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Introduction

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Three months ago, this seemed like a good idea! On the back of a t-shirt during a marathon

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The organizers of endurance events are obliged to provide medical coverage both to enable competitors to have immediate access to optimal management of medical problems and to relieve the burden on local medical services. These endurance events include marathons, ultramarathons, triathlons and ironman triathlon events, as well as long-distance events such as walking, swimming, cycling, and cross-country skiing. Many of these events have large numbers of competitors with varying degrees of fitness.

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Blisters, bruises, lacerations, and muscle cramps are the cause of a large number of presentations to the medical tent at these events. Overuse injuries may develop or be aggravated in sportspeople during an endurance event, and traumatic injuries may occur (e.g. as a result of a fall in a crowded running field or from a bike). Thermal injuries (heatstroke or hypothermia) are common (Chapters 58 and 59). As there is the possibility of cardiovascular collapse during such events, appropriate facilities, including an automatic external defibrillator (AED), must be available.

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The precise medical services required depend on the particular sport, the duration and intensity of the activity, and the prevailing environmental conditions.1 Experienced medical teams for endurance events are able to predict the expected numbers of casualties. It is vital to keep medical records for all sportspeople treated at a particular event, and to analyze these data for historical trends (Table 65.1).

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Table Graphic Jump Location
Table 65.1

The expected percentage of race starters at a sporting event with 1000 competitors likely to be admitted to the central medical care facility1

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In this chapter, we consider a marathon foot race with 1000 competitors as the basis for our recommendations. The figures should be adjusted according to the type of events and the number of competitors.

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Race organization

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Specific pre-race strategies to enhance the safety of the competitors include the following:

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  1. Schedule the race at a time of year and day when environmental conditions will not adversely affect performance or health. The medical director of the race should have the authority to cancel the race should adverse weather conditions prevail. The American College of Sports Medicine position statement recommends that if the wet bulb globe temperature index is above 28°C (82°F) or if the ambient dry bulb temperature is below –20°C (–4°F), organizers should consider canceling or rescheduling the event.2

  2. Ensure adequate provision of carbohydrate-containing fluids en route, ...

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