Ed Kornoelje DO, FAOASM Metro Health Sports Medicine

Medical Director !! Metro Health Grand Rapids Marathon (and !) !! Groundhog Marathon (winter trail) !! Fifth Third River Bank Run/25K National

Championship (5/10/25K) !! Reed’s Lake Run (5/10K) !! Bridge Run (10 Mile) !! North Country Run (13.1/26.2/50 mile trail) !! Michigan Titanium Triathlon (Ironman distance) !! Grand Rapids Triathlon !! Reed’s Lake Triathlon !! Tri Del Sol !! Meijer State Games of Michigan (8,000+ athletes, 4

day Olympic style event)

Types of Races We Cover

!!Event participants: "! 100 to 20,000.

!!Race length: "! 5K to 50 mile (including half marathon, 25K,

full marathon, and triathlons including ironman distance).

!!Event type: "!Road, trail, triathlon, bicycle, multi-day.

Objectives

!!Understand the logistics that go into planning for and covering mass sporting events.

!! Identify the key components of a medical team.

!!Discuss medical supplies. !!Review medical conditions that may be

encountered.

Why Get Involved? !! Support your

community. !! Support a cause. !! Promote your

practice. "! Info in packet/on

website. (Important for medical info as well).

"! Logo on t-shirt. !! Utilize your

expertise.

What Type of Coverage?

!!Minimal triage type: "! Band aids/ice/minimal wound care. "!Non-dedicated EMS.

!! Intermediate: "!Dedicated EMS. "! Strains/sprains/stretching/wound and lac

care. !! Full Service:

"! Above plus IV’s/electrolyte monitoring/nebs.

Medical Director or Coordinator?

!!Medical Director should be MD/DO with some knowledge of event planning and coverage.

!!Medical Coordinator should have medical background (RN/PT) and has more of an administrative role.

Legal Considerations !!Check with race director to see what

insurance coverage is provided for medical providers. Usually comes from RRCA or USATF.

!!Most will be covered by medical malpractice insurance—check with your insurance provider or hospital system (particularly for nurses, PT’s).

!!Good Samaritan laws vary widely state to state (and usually do not apply).

Why plan? !! “Marathons are not exercises in sports

medicine; they are exercises in disaster planning.”

"! Marvin Adner, Retired Medical Director, Boston Marathon

"! Estimates for deaths: as high as 1 in 50,000 at marathons to 1 in 300,000 at shorter distances.

"! Estimates for runners needing medical tx range from 1-3% under optimal weather conditions to 10% or more during extreme conditions.

Short Checklist(from “Organizing Running Events” pp.93-94)

!! Recruit medical staff to help at the event. !! Order the necessary medical supplies. !! Pay attention to the weather forecast, and

prepare for heat or cold related illnesses or problems as needed.

!! Develop contingency plans for emergency weather conditions.

!! Make sure you have a communications plan that covers receiving information about downed runners on the course and contacting local emergency providers.

!! Ensure adequate on-course medical coverage.

Medical Staff !! Who: Physicians (Primary Care Sports Med,

FP, Ortho, ER) Nurse, PT’s, ATC’s, EMT’s. Others to consider: Pod, Cardiologist, First-Aid trained personnel, spouses, other non-medical (spotters/catchers).

!! Our goal: "! 3-4 at each aid station including one physician, one

PT/ATC, one other first-aid trained volunteer. "! Finish line: ER doc(s), PCSM, nurse with IV

experience, PT(s), ATC(s). "! EMT’s along course and at S/F line.

Paramedic/Ambulance Coverage

!! Questions: "! Dedicated rig at S/F area? "! Golf cart/gator/bike coverage on course? "! Other rig(s) on course?

!! For any race we like to have a dedicated rig at the S/F line, with access to others if needed. Races ! marathon or longer station at least one on course. Use golf carts/bikes as needed on course as well. Can use to pick up runners from aid stations as well.

Medical Supplies !!Many lists available. Following is our list

for the marathon. !!Review list with ambulance company.

We find a dedicated ambulance at the S/F area works well. They have defib, nebs, ACLS meds. They will take an extra drug bag, IV’s, blankets, and wheelchairs. Also rectal thermometer.

!!AED’s at as many stations as possible and on course with paramedics.

Medical Aid Station Bins

Medical Aid Station Bins

Medical Aid Station Bins

Medical Aid Station Bins

Medical Aid Station Bins

Main Medical Bins

Storage

Storage

Emergency Action/Medical Plan

!!Written medical/safety plan that outlines how the medical staff will handle various types of medical emergencies. Our plans include: "! I. Emergency Plan Personnel "! II. Emergency Communication "! III. Emergency Equipment "! IV. Map of Venue "! V. Storm Safety Plan "! VI. Follow up

Communication

!!Cell phones: "!Master cell phone list—designated person at

each aid station. "!Coverage. "! Standard-use v. “direct connect.”

!!Ham radios/walkie-talkie radios: "! Separate channels. "!Don’t use too many channels.

Communication

!!We have one designated person to receive calls from aid stations. EMS coordinator is right next to this person. There are two “loops” that intersect here: aid station medical and the EMS loop. Any transports are noted by either of these personnel and placed on a master list. We have all of the participants on a zip drive.

Communication !! Let local ER’s and ambulance companies

know when your event is. In GR most ER’s are aware of events and/or have the capacity to handle any transports. If the weather dictates the potential for many transports, the ER’s may not be prepared for an influx, or you are covering an event in a remote area, communicating with the ER and ambulance companies prior to the race is imperative.

Medical Tent !! Location:

"! 50-100 yards past the finish line is ideal. "! Large/long races a second smaller tent near food/

recovery area also needed (may double as an elite runner medical tent if one is needed).

!! Size: "! Depends on size and distance of race. "! 10x10 for small or short races. We use this size for

our 5/10K events up to the 50 miler with 600 runners.

"! 20x80 for our 20,000 person 5/10/25K race. "! Open/closed depending on weather/time of year. "! Consider heaters/port-a-john.

Start/Finish Area !! Make sure you have direct access to finish

line. !! Place medical and non-medical (catchers)

just past finish line. !! Use wheelchairs (EMS may be able to

supply) to transfer to med tent. !! KEEP AREA CLEAR!! Will need “security”

to keep people moving and families out. Work with race organizers to barricade/fence the S/F area in and create family meeting area.

Start/Finish Area

Med Tent Placement

NOT Ideal Location

Triathlon Considerations

!!Monitor transition zone. !!Work in conjunction with life guards/

water rescue personnel.

Meetings/Prep !! Prior to our events we meet to discuss

assignments, logistical issues. !! For most events reviewing and adjusting

what was done in previous year(s) can be done close to the event. New events or events that have been changed significantly need to be studied more closely.

!! Before our largest events with “extra” volunteers we meet at the hospital for breakfast and a briefing.

On-Course Medical Aid Stations

!! 5K—none/one !! 10K—none/EMS/one !! 10 mile—EMS/one-two !! 13.1—multiple !! 25K—multiple !! 26.2—multiple !! Trail runs—usually one main medical—may be

more. !! Triathlons—depends on course. One at S/F,

one in transition area (may be the same), key point on course (hill), roving vehicle(s) on bike course. We often utilize EMS on course.

On-Course Medical Personnel !! Place at/near aid stations. !! 3-5 medical personnel including physician. !! Can call for transport if needed. !! Track numbers of runners who are out of

race and relay to main medical tent. !! Call ahead to next aid station(s) to keep

and eye on runners. !! Race Guards—started in 2012—“on-

course” medical who participate in event.

On-Course Treatment

!!On-course treatment allowed to make hands-on examination of a runner in medical distress without resulting in DQ as long as distance to finish line is not shortened (USATF).

!!Don’t hesitate to remove runner at serious medical risk.

Incident/treatment Forms !! Fill out for all encounters both on the

course and at main medical tent. !!Helpful in planning for next year’s event. !!Keep accurate weather data. !! *“Heat is the best gauge of the number

of runners who might need medical attention.”*

!!Keep injury records as long as you keep waiver forms.

Map of Venue

!!All lead medical personnel including aid-station leaders should have.

!!Prior to race need to make sure medical personnel are able to get to and patrol all locations of the course.

!! Identify potential large open areas to move runners to in the event of cancelation (heat, lightening…).

Conditions You May Encounter

!!MI !!Heat exhaustion/stroke !!Hyponatremia (i-STAT) !!Exercise-associated collapse !!Blisters/strains/lacs/contusions

Heat/humidity !! www.zunis.org

"! Free charts for 101 cities in US (over 100 more can be had for a fee) giving heat index values for every 1st and 15th day of the month all year for different times of day.

!! Heat Stress Advisor download. "! Need temp/humidity/time of day/cloud cover.

!! WBGT thermometer ($100). !! Local weatherperson. !! Misting station/tent and/or spray with hose.

Zunis

ACSM Guidelines !! WBGT >82° F Black Flag—Cancel. If race

always held under these conditions, must advertise.

!! WBGT 73° F-82° F Red Flag—Slow down and withdraw if at risk.

!! WBGT 65° F-72° F Yellow Flag—At risk slow down, warn others of increased risk of collapse.

!! WBGT <65° F Green Flag—Collapse can occur.

!! WBGT <50° F White Flag– Increased risk of hypothermic collapse.

Odds and Ends

!!Pool/tub !!Na+ monitoring (i-STAT) !!Elevated platforms in finish area !!Secondary medical tent !!Elite athlete tent !! Food in tent

(Almost) Final Thoughts

!!Be prepared. !!Work very closely with race director. !!Expect the unexpected. !!Oral hydration whenever possible. !!Watch the weather. !!Communication!

Expo

Expo

References !! Organizing Running Events: The Complete

Guide to Staging a Successful Road Race. Phil Stewart and Pam Balcke: Road Race Management, 2008.

!! Clinics in Sports Medicine: The Runner. 2010;29(3).

!! Preparing for the Surge: Perspectives on Marathon Medical Preparedness. George Chiampas and Carrie Jaworski. Current Sports Medicine Reports 2009;8(3):131-135.

References

!! FIMS Sports Medicine Manual: Event Planning and Emergency Care. David McDonagh Ed. LWW, 2012.

!!Preventing Sudden Death in Sport and Physical Activity. Douglas Casa Ed. Jones and Bartlett Learning/ACSM, 2102.

Resource

!! International Institute for Race Medicine (IIRM) "! Videos "! Event Medical Guidelines "! Forms

Thank you ed.kornoelje@metrogr.org