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Recommendations on the Appropriate Level of Medical Support at Ultramarathons

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Abstract

Participation in ultramarathons continues to grow, especially among older individuals and among younger runners who may have less running and wilderness experience than many past participants. While ultramarathons tend to have relatively few serious medical issues, adverse medical incidents do occur. These factors make it increasingly important that appropriate safety precautions and medical support are defined and implemented at these events to enhance the safety of participants, spectators, and volunteers. This document establishes the minimum recommended level of medical support that should be available at ultramarathons based on current knowledge and the experience of the authors. It offers a balance that is intended to avoid excessive stress on the local medical system while also precluding undue burden on events to provide medical support beyond that which is practical. We propose a three-level classification system to define the extent of medical services, personnel, systems, supplies, and equipment in place and recommend the level of medical support based on event size, distance/duration, remoteness, and environmental conditions that may be encountered during the event. This document also outlines the recommended education and training of medical providers and discusses other medical and logistical considerations related to the provision of medical support at ultramarathons. We suggest that ultramarathon organizers review and adopt these recommendations to enhance safety and reduce the risk of adverse events to participants.

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Acknowledgements

The authors are grateful to the following ultramarathon race directors and medical directors for critical review of the manuscript prior to submission: Lucas J. Trihey, Tico Cervera, three anonymous race directors, and Drs. Robert H. Weiss, Jeffrey L. Jarvis, Marcelo Parada, Stephen E. Halvorson, and Timothy J. Durkin. As requested, we also acknowledge Dr. Volker Scheer, who chose to withdraw as an author of this work after initial drafting of sections on competitor and race volunteer education, pre-race screening, and sodium supplements and NSAID availability, and providing his comments on multiple versions of the manuscript.

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Authors and Affiliations

  1. Physical Medicine and Rehabilitation Service (117), Department of Veterans Affairs, Sacramento VA Medical Center, Northern California Health Care System, 10535 Hospital Way, Sacramento, CA, 95655-1200, USA

    Martin D. Hoffman

  2. Department Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA

    Martin D. Hoffman

  3. Division of Sports Medicine, Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, CO, USA

    Morteza Khodaee

  4. UCHealth EMS, Ft. Collins, CO, USA

    Nikiah G. Nudell

  5. The Paramedic Foundation, Duluth, MN, USA

    Nikiah G. Nudell

  6. American Paramedic Association, St. Cloud, MN, USA

    Nikiah G. Nudell

  7. Silver Sage Sports and Fitness Lab, Reno, NV, USA

    Andrew Pasternak

  8. Department of Family and Community Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA

    Andrew Pasternak

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  1. Martin D. Hoffman
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  2. Morteza Khodaee
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  4. Andrew Pasternak
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Correspondence to Martin D. Hoffman.

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Funding

No funding was received for the conduct of the work or preparation of the manuscript. This material is the result of work supported with resources and the use of facilities at the VA Northern California Health Care System. The content reported here does not represent the views of the Department of Veterans Affairs or the United States Government.

Conflict of interest

Martin Hoffman and Nikiah Nudell have non-compensated positions with non-profit foundations that share a financial benefit from the small registration fee for the online medical training referred to in this article. Martin Hoffman, Morteza Khodaee, Nikiah Nudell and Andrew Pasternak also acknowledge being medical directors or staff at various ultra-endurance events but have no other potential conflicts of interest with the content of this article.

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Hoffman, M.D., Khodaee, M., Nudell, N.G. et al. Recommendations on the Appropriate Level of Medical Support at Ultramarathons. Sports Med 50, 871–884 (2020). https://doi.org/10.1007/s40279-020-01272-1

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