for Road Race Medical Staff

Patient transport

Stretchers

Wheelchairs

Triage

Cots

Thermometers (rectal)

Blood pressure cuffs

Stethoscopes

Pulse oximeters

Disposable gloves

Heat emergencies

Ice

Immersion tubs

Water

Fans

Towels

Hydration

Oral fluids

Cups

Intravenous (IV) fluids with IV start kits (catheters, etc.)

Sharps container for needle disposal

Handheld blood gas and electrolyte analyzer (e.g., i-STAT system; Abbott, Princeton NJ, USA)

Salt/bouillon cubes

Sudden cardiac events

Automated external defibrillator (AED)

Electrocardiogram (ECG) monitors

Oxygen tanks/masks/cannulas

Musculoskeletal injuries

Elastic bandages

Splints

Plastic bags/ice packs

Wound care

Gauze bandages

Tape

Medications

Benzodiazepine (midazolam, diazepam) for seizures

Allergy kit (diphenhydramine) (EpiPen; Meridian Medical Technologies, Columbia, MD, USA)

Metered-dose inhalers (MDIs) for asthma

Advanced Cardiac Life Support (ACLS) medications

Clipboards

Pen

Medical teams can be volunteer or paid; however, there are very few paid medical teams in road racing. The medical team is best organized in a unified command structure [5]. A chain of command establishes the responsibilities of the personnel involved and connects the medical personnel with the public safety assets in the community. The medical team should work closely with local emergency medical services (EMS) and health-care facilities to integrate within the community and reduce the impact on the community health care. Some events will reach the level of prominence that requires heightened security for participants, spectators, and staff, which may involve personnel from federal and state agencies as part of the health and safety plan for the event.

A communications system is a critical part of the race command structure and the medical team. The medical team must have communication with personnel along the course and in the finish area, as well as race officials, local EMS, and health-care facilities. A redundant system with mobile phones, hand held radios, and ham radios will reduce the risk of communications failure. Security services are critical for medical care areas, equipment storage, and supplies to avoid theft and tampering. Security on race day is essential to reduce unnecessary traffic through the medical area and to preserve runner confidentiality. A diagram depicting a recommended medical team structure is shown in Fig. 11.1 [6].

../images/471692_1_En_11_Chapter/471692_1_En_11_Fig1_HTML.jpg — Fig. 11.1

Representative members and corresponding roles and responsibilities of the sports medicine team that are recommended to be included when organizing and executing a medical program at a mass participation event. (From Adams et al. [6], with permission)

The medical team should be easily identified on race day with T-shirts, jackets, vests, bibs, or caps. Credentials with the individual’s name, level of training, and role should be worn by all volunteers. Medical care sites should be clearly identified and easily accessible to the runners.

The location of medical care areas along the racecourse is often determined by the geography of the course, the anticipated environmental conditions, and the number of participants involved. The Falmouth Road Race (11.4 km) that takes place every year in Falmouth (Cape Cod), Massachusetts, USA, in August, (https://falmouthroadrace.com/), with 12,000 runners, has 2 runners with exertional heat stroke (EHS) per 1000 participants that occur at or near the finish line [7]. The medical care areas must prepare to triage runners to find and accommodate at least 2 runners per 1000 participants who will have EHS (Fig. 11.2). There is often a constant flow of runners that cross the finish line, requiring the medical team to manage many patients simultaneously. (Observations over a 3-year period at this race show a rather predictable pattern of activity at the finish line medical tent (Fig. 11.3) [8]).

../images/471692_1_En_11_Chapter/471692_1_En_11_Fig2_HTML.png — Fig. 11.2

Medical tent setup at a mass participation sports event

../images/471692_1_En_11_Chapter/471692_1_En_11_Fig3_HTML.png — Fig. 11.3

Admittance of exertional heat stroke (EHS) patients to the medical tent and the number of cooling stations needed to effectively treat each patient, assuming that each patient required at least 20 min of cooling treatment and medical attention. The race started at 9:00 am (zero point in the x axis). (From Hosokawa et al. [8], with permission)

Longer-distance races will usually have medical care areas dispersed along the route. In very large mass participation events, a medical care area may be necessary at the start area with the entire field of runners confined to a relatively small area. Along the course, teams of at least two providers can be stationed at intervals along the route equipped with an AED, basic first-aid supplies, and a radio for communication with the course unified command center for dispatch of more advanced care. On course, teams may be stationary and on-foot or use bicycles, golf carts, or Gators to be mobile.

The major medical areas are placed at sites with the most medical encounters. For most road races, the demand for medical care will likely be at or near the finish line. The finish line medical care area is usually located downstream from the finish line at a geographically convenient site that has ambulance access. It is reasonable to allow a space of 50–100 m to allow runners to “catch their breath,” but not so that it is difficult to transport collapsed runners to the medical tent [9].

Designated medical care areas along the course or at the finish area can be fixed or temporary structures depending on the location of the racecourse. Races that finish in a stadium or near a civic center or other large public building may utilize these fixed structures as medical care areas [10]. Otherwise, temporary structures such as tents or trailers may be used.

The geography of the course must be taken into consideration. It is important to have access to the runners and to have a clear egress for collapsed runner requiring transport to advanced medical care at the hospital. Long bridges, parkways, and limited access neighborhoods may present access challenges to the medical team. Train schedules may have to be altered to accommodate the course and can interfere with EMS response if roads are closed by trains passing through the race area. The Boston Marathon and Marine Corps Marathon in Washington, D.C., cross town and state borders, respectively, and require integrating several EMS jurisdictions into the medical plan. Determining mutual aid contingencies to assure continuous care between different jurisdictions is critical to runner safety. The central command model with integrated race protocols developed in advance of race day will allow the transition of care between regional EMS systems. Geographically isolated races may need to consider other evacuation methods such as watercraft or by air, but these methods can easily be limited by weather conditions and will need to be integrated into race cancelation protocols.

For all race venues, the majority of work for a safe and successful event is in the preparation phase leading up to the event. Planning for the medical coverage of a large-scale event should start months in advance. The medical director typically assembles a race medical operations committee to initiate pre-race planning. The medical personnel must be recruited and educated prior to the event. Volunteers not familiar with race medicine will need specific instruction to care for the common race maladies. The supplies and equipment needed to provide event-specific care must be obtained (see Table 11.1). The medical director(s) and medical operations team leads should work with the event coordinators to develop a budget that is sufficient to obtain the essential supplies and training for runner safety. The medical operations committee is responsible for developing a medical manual with protocols addressing common race medical problems for the medical team to review in advance of the race. A medical record is critical for accurate record keeping on race day; this forms the database that informs future races and is the legal record of care provided during the race. Local EMS , hospitals, and other health-care facilities should be aware of the event and the likely patient problems that may present from the event. It may be necessary for emergency departments to “staff up” so the potential influx of patients does not overload the emergency department (ED) and affect the care available to the community. Pre-planning in the unified command model involves the local EMS and public safety personnel, which ensures that routes to the local EDs affected by road closures or other detours are known in advance of the event.

Staffing

Staffing of on-site medical teams should include the personnel needed to care for the anticipated medical problems associated with the event. A combination of physicians, nurses, paramedics, emergency medical technicians (EMT), athletic trainers (AT), and physical therapists can address the usual medical problems. Nonmedically trained personnel are helpful as assistants for transporting runners, retrieving clothing, distributing food and drink, setting up and tearing down of the medical area, and recording patient information.

The number of participants and environmental conditions will determine the number of anticipated medical encounters, which in turn dictates the number of medical personnel needed for an event. The International Association of Athletics Federations (IAAF) has published competition medical guidelines with staffing recommendations that are useful for a new event, but the event historical data will drive the numbers for future races [11]:

Physicians	2–3 per 1000 runners
Nurses	4–6 per 1000 runners
Other professionals (EMT, AT, etc.)	4–6 per 1000 runners
Nonmedical (fetchers, scribes, etc.)	4–6 per 1000 runners