Skip to Main Content




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


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.


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.


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).

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


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.


Race organization


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


  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, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

Clinical Sports Medicine Collection Full Site: One-Year Subscription

Connect to one of the most renowned references in sports medicine and explore all aspects of diagnosis and management of sports-related injuries and physical activity. Subscription includes access to a library of sports medicine videos.

$65 USD
Buy Now

Pay Per View: Timed Access to all of Clinical Sports Medicine Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.