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Your body will argue that there is no justifiable reason to continue. Your only recourse is to call on your spirit, which fortunately functions independently of logic.

Professor Timothy Noakes

The organisers 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 may 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 will 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 may be aggravated in athletes by competing in an endurance event, whereas traumatic injuries may occur as a result of a fall in a crowded running field or from a bike, for example. Thermal injuries (heat stroke or hypothermia) are common in endurance events (Chapters 23 and 24). As there is the possibility of cardiovascular collapse during such events, appropriate facilities must be available.

The precise details of the medical services required will depend on the particular sport, the duration and intensity of the activity and the prevailing environmental conditions. Medical teams that have worked at endurance events for years are able to predict the expected numbers of casualties. It is vital to keep medical records for all athletes treated at a particular event and to analyse these data for historical trends (Table 39.1). We will 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.

Table 39.1Expected percentage of race starters to be admitted to central medical facility at a sporting event with 1000 competitors


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 ...

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