tag:blogger.com,1999:blog-2521340694231331042024-03-06T15:02:07.648-05:00International Institute for Race MedicineThe International Institute for Race Medicine (IIRM) is a worldwide collaboration of medical and health professionals who are working together to promote research, education, and best practices in marathons and other endurance races throughout the world.International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-252134069423133104.post-63427687236457385212021-10-08T12:56:00.002-04:002021-10-08T13:44:31.032-04:00Thoughts on Being Cancelled<p><i><span style="font-family: times;">[The
following narrative depicts
the views of the writer and does not represent any official statements nor policies
of the Department of Defense or Marine Corps Marathon Organization.]</span></i></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: times;"><span style="font-size: 12pt; text-indent: 0.5in;">We</span><span style="font-size: 12pt; text-indent: 0.5in;">
dodged a bullet, or so we thought. The Army Ten-Miler announced its
cancellation. We had heard rumors earlier in the day and were anticipating the
announcement. But we were not concerned about the Marine Corps Marathon
suffering the same fate. Although we shared many of the same partners for our
events, we had a solid plan in place to keep moving forward with our race. We
were in constant contact with our partners and had affirmative responses to the questions posed to us.</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: times;"><span style="font-size: 12pt; text-indent: 0.5in;">Was the threat outlook low for the
National Mall and federal lands? YES. Did we meet the intent of the National
Park Service rules for COVID-19? YES. Did we meet with our medical partners to
discuss staffing, support, and hospital bed space?</span><span style="color: red; font-size: 12pt; text-indent: 0.5in;"> </span><span style="font-size: 12pt; text-indent: 0.5in;">YES.
Did we collaborate with other scheduled races to be sure we had viable plans
for best practices, concerns, and solutions? YES. Did we meet with Public
Health Leads from our region and share our mitigation strategies and answer
their concerns? YES.</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: times; font-size: 12pt; text-indent: 0.5in;">On Friday, September 17, we had a late
afternoon call with a senior member of one of our partners. He voiced some
concerns about our mitigation and wanted to know why we thought we could make
this work when other military events cancelled. He had to take our final race
approval to a higher level but voiced support for our plan and the detailed
process we had gone through to get the “YES.”</span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: times;"> On Monday,
September 20, I left for the Inaugural Annual Meeting & Scientific Conference,
a sports medicine conference in Indianapolis. I was super excited because I was
presenting twice on topics that support my role at the Marine Corps Marathon
Organization; this is something for which I am passionate. The first talk, “Sideline
Management and Emergency Response of Adaptive Sports,” is based on lessons
learned from our 2019 race. The second talk, “Physical Therapists Running the
Show: Exploring Leadership Roles of the Sports Physical Therapist at Large Running
Events,” would be presented with Dr. David Nolan, the lead physical therapist
for the Boston Marathon. Dave and I have collaborated on and shared many of our
work experiences. Our presentation highlighted the roles PTs can and do play in
the administration and execution of large-scale events. <o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: times;"> Throughout the
conference I was checking in with work via text and email because I knew I had
a lot to do upon my return to Quantico. We had only five weeks remaining to complete
everything for our events. In addition, because of the move to virtual in 2020,
several of our team members and volunteers were new and had no real experience
with managing care at races. This, of course, added the pressure of getting
them prepared. But we were excited for the event. There is something “electric”
about race week preparation and, for me, I enjoy the chaos and problem-solving
that happens on race day. Also, I always see people rise to the occasion and
figure things out; that is very satisfying.<o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: times;">Wednesday night I
saw a message on my cell phone. It was my boss. He rarely calls outside of
working hours, but I thought it was related to a personnel issue he and I were
both managing (I did not review the message as I was trying to enjoy the conference
and knew I would speak with him in the morning). Then, on Thursday morning, I received
a message that I needed to join a conference call. I called my boss; the news
was not good, but there was still a chance. We huddled for over 90 minutes
talking about other options should one of our partners not support. We needed
to move forward and see if we <span class="normaltextrun"><span style="background: white;">could gain momentum and support for another plan</span></span>.
In the meantime, we also needed to stop contracts where we could, if possible.
There would be another meeting on Thursday afternoon with an advocate who we
hoped would keep us at YES. I reached out to my medical partners asking them to
keep this information at close hold and we reviewed our plan again with them.
They were still giving us a YES. <o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: times;">I presented my first
talk on Thursday. I focused, and we had a great response from the audience. But
the day did not go so well; before it was over, we were told “NO.” The tears
started. I honestly believed we could safely run our events and provide a
morale boost to those within and outside of our organization. I was so beyond
disappointed, it is hard to describe. I reached out to each of the partners I
was coordinating with and some were surprised, others were not. Each commented
on our superb planning efforts to provide a safe event. <o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: times;">We sent out a
press release which, in part, read:<br /><br /><o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in; margin: 0in 0in 0in 0.25in;"><span style="font-family: times;">The
2021 Marine Corps Marathon (MCM) Weekend events scheduled for Friday, October
29 through Sunday, October 31 in Arlington, Virginia and the nation’s capital,
have been canceled due to security and safety precautions currently in place.
“After exhausting all possibilities, the opportunity to safely operate and
execute a live event is just not feasible at this time,” said Rick Nealis,
director of Marine Corps Marathon Organization (MCMO). “Though we had high
hopes to welcome home our running community this October…”<span style="font-size: 12pt;"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: times;">The most
difficult part was reading comments on social media. Some were brutal and the
attacks felt personal, many implying that we failed in our planning and
execution. Others were sympathetic with many of my friends and volunteers reaching
out to me. I had to stop looking. <o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: times;">I told my fellow
presenter Dave about the cancellation. Of course, we still had to deliver the
second talk at the conference but I did not know if I could keep my emotions in
check. After outlining everything we do to prepare for the race, my last slide read
“CANCELLED.” There was nothing more. <o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: 12pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: times;">Friends continued
to reach out. Several staff members from other races sent messages and I am happy to
see that many races are still being held. I continue to process the loss of our
event. In the scheme of life, it is a blip, but when you are passionate and
ready to return to some normalcy it hurts.</span><o:p></o:p></span></p>International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com0tag:blogger.com,1999:blog-252134069423133104.post-32318040825524880482021-01-27T12:21:00.007-05:002021-01-27T15:31:18.784-05:00Looking Ahead: Post-COVID<p><span style="font-family: georgia;">I have not felt capable of writing my IIRM blog for months. Today I sat down and began to reflect on the past year and where we are today.</span></p><p><span style="font-family: georgia;">If our collective prayers and wishes make a difference, then 2021 will be better; we will get back to normal. By spring we will be back to doing all the things we did before. Once we have the vaccine, we will be fine. Races will start again; people will come back. Beer tents and race stories will return. But, then again, maybe it won't be until the summer. <br /><br />Will the Olympics happen? The NBA bubble was great but look at the NBA now. College sports are shutting down and starting up again. High school sports are going on as normal or being played in empty gymnasiums with or without video feeds. Or they are not happening at all. Athletes at all levels have tested positive for COVID-19, some with devastating effects to their hearts and ending their careers or worse. This summer my 25-year-old son got COVID-19. He also had pneumonia in two lobes and cardiomyopathy. Today he is doing better.</span></p><p><span style="font-family: georgia;">Many of us have watched while others have had their events cancelled, and we’ve experienced our own cancellation after cancellation. We hear conflicting information about runners and events. Among the many comments floating around are: Virtual events are great. Virtual events will not last. We will include virtual events as an option with all our future events. Runners are not ready to come back. Runners are wanting to compete in-person. Waves and spacing work. Can we really manage spacing in larger events? Running with a mask may impede respiratory function. Running with a mask does not affect oxygenation levels.</span></p><p><span style="font-family: georgia;">We can socially distance (from the beginning I felt it should be physically distance and we should keep the social part). We can have drive-thru packet pick-ups and virtual expos. Permits are not being issued for many events yet. Boston April 2021 is not happening; maybe it will be Boston in October. Or, perhaps, November. What about the World Marathon Majors? Will we have runners and Marines in the streets of DC in October? Maybe it will all need to wait until 2022.</span></p><p><span style="font-family: georgia;">We held two small live events this year out of the 19 scheduled. Each had less than 325 entrants, spaced in waves and on wide courses. Everything after the finish was self-serve. There were no sponsors. I measured circles six feet apart at start lines and spray-painted dots on the ground at finish lines to keep runners apart. I reviewed medical protocols with my providers. I answered questions from runners and staff and volunteers. Medical staff wore full PPE in open air tents. In two events we saw only two runners with injuries. Most of our staff time was spent packing up shirts, medals, and premiums to mail out to our virtual runners. I decided to walk our 10K and marathon since I did not have anywhere to be on what would have been race day. I am fortunate, I still have a job.</span></p><p><span style="font-family: georgia;">I attended online training with other event staff persons to learn best practices and share "survival" ideas. I met with my medical counterparts to talk about COVID-19 testing, mitigation strategies, and how to talk to our race directors about our concerns. I wore and continue to wear a mask every day. On January 22nd I received my first dose of the Pfizer vaccine. I feel lucky. Hopefully in three weeks there will be enough for me to get my second shot.</span></p><p><span style="font-family: georgia;">Many of you could write a similar story. Some of our colleagues have lost their jobs. Others, like me, are not planning race operations; instead, we are doing other things in hopes that we will soon be back to planning race operations. One year ago I was in Washington state visiting friends and having tea and talking about the year ahead. I had no idea what 2020 had in store for us. None of us did. <br /><br />Nowadays many of us are hoping that we will see an abundance of vaccine, that everyone will take it, and that the variants will not take hold. We are also hoping we can get permits and attend expos. Personally, I am hoping that on this November 1st, I can reflect on the prior day and grumble about my fatigue of being awake for 19 hours</span><span face="Calibri, sans-serif" style="font-size: 11pt;">—</span><span style="font-family: georgia;">and smile knowing we have come out on the other side. </span></p>International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com0tag:blogger.com,1999:blog-252134069423133104.post-7703604200809466782020-06-18T16:34:00.002-04:002021-10-08T13:48:22.362-04:00A Medical Coordinator's Thoughts Amidst a Pandemic<span style="font-family: Georgia, Times New Roman, serif;">Today I still have a job, my family is well, and my boss has accepted telework...at least for now. I am spending my days discussing, arguing, and fact-finding, explaining and teaching about COVID-19. I attend virtual webinars from industry leaders about COVID-19 and the impacts on events. I read about Joe Desena’s Spartan events this past weekend and the efforts to make it safe. I reach out to those smarter than me to inquire about epidemiology, false positives, and rates of infection and ask, “What would you do?” I hear many calling for no large-scale events until we have a vaccine.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I am tired and torn. I am confused about the different state “phases.” I am now reading about the skyrocketing increases in infection rates some states are experiencing as a result restaurants, bars, and other activities re-opening. Then I hear that running a race is no different from going to the grocery store right now.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I worry about our athletes in adaptive sports being pushed to the wayside because they are deemed higher risk. I hear some say it might be more convenient to cancel or postpone the race for adaptive athletes but let others participate. I see some of my elders who are fit and healthy still playing golf and tennis. They are carrying on.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I listened to my good friend who is a respiratory therapist in New York City and the stress she was under in April and May. I was proud to see the USNS COMFORT and MERCY deploy to assist and then disappointed when I saw the low numbers of cases, and maybe how those staffs could have been used to assist in nursing homes across the country.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I look at the vast number of events that have been cancelled and the small race operators who cannot pay their staff or issue refunds; they will not survive this year. I feel for the BQ’ers who will not have the experience of a lifetime in Boston this year. Event after event is cancelled. Some are successfully turning to virtual events and rejoicing in the runners who post their medals and family finish lines.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I miss my volunteers. We are in June and I have not seen any of my loyal medical volunteers since last November. I miss the exhaustion of planning, packing, and rehearsing for the big events. I spend my day working on countless courses of action for hosting an event. We have a small one planned in August, maybe 200 runners. I am worried about heat stroke and breathing issues and of course, the cardiac issues we are seeing associated with post COVID-19 infections.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I plan, check equipment, order some new items, and set up training and meetings. Fire/EMS is too busy to talk and plan right now. COVID-19 and social unrest are their immediate concerns.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">Do we change our waivers? Do we require anyone who had COVID-19 to get clearance from a cardiologist? Do we take participants’ temperatures? Should athletes be tested before they come to an event?</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I informally reached out to our past marathon medical volunteers to get a sense of what they are thinking. No formal surveys, just asking if they would come and "If yes, did they have any question and if no, why not?" Fifteen percent responded in just a couple of days. The physicians were split 50/50, many saying no because of travel restrictions from their organizations. Most nurses said yes and wanted to know about our Personal Protective Equipment (PPE) standards. Some stated that if our event were to happen, we must deem it safe.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">What does <i>safe</i> mean to you? That one is hard to grapple with. Many decisions are before us. Some are in the grey zone while others are based more on ethics and morals. I know others are worried, too. And they are uncertain. I ask that we keep talking and supporting each other and working together to reach decisions and answers that are best for each of our circumstances.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">I also ask, "How are <i>you</i> feeling?"</span><br />International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com0tag:blogger.com,1999:blog-252134069423133104.post-18021315927655081322020-02-05T18:20:00.002-05:002020-02-06T09:54:04.158-05:00The Medical Impact of Unofficial Runners<span style="font-family: georgia, times new roman, serif;">There are many reasons participants cheat at races. Most of the time it is unintentional, occasionally it’s about ego or proving prowess or trying to obtain an entry into a prestigious event like the Boston Marathon. In 2015, Runner’s World discussed this phenomenon in an article called “How Common Is Cheating at Marathons?” and analysts like Derek Murphy of Marathon Investigation report on those who cheat.</span><br />
<span style="font-family: georgia, times new roman, serif;"><br /></span>
<span style="font-family: georgia, times new roman, serif;">As the medical lead for the Marine Corps Marathon, I review the data after our events to look for injury trends, heat stroke body temperatures, and other relevant information to improve our support. We often receive runners in the medical tents who are not registered as participants. These are not large numbers; in the last three years we have averaged fifteen medical “bandits.” However, if we were to extrapolate those numbers to the full field, we would be looking at almost 400 bandit participants. Nevertheless, let us focus on the effects these runners can have on medical services.</span><br />
<span style="font-family: georgia, times new roman, serif;"><br /></span>
<span style="font-family: georgia, times new roman, serif;">These bandit athletes may have purchased a bib or swapped with someone. If a runner receives a bib through swapping, once he/she enters the aid station, there is a delay in identifying the athlete because there is no match in the database. If the athlete is conscious, we work to get their demographics with emphasis on age and date of birth and any past medical history. If the athlete is unresponsive, however, trying to obtain personal information or next of kin data is impossible. When this unidentified athlete is transported to a hospital for further care, they must then be listed as a Jane or John Doe. We have no way of contacting family members nor obtaining pertinent past medical history. Additionally, for events like the Marine Corps Marathon which uses a live tracker database, we cannot find the registered runner because we are looking for a person not in the event.</span><br />
<span style="font-family: georgia, times new roman, serif;"><br /></span>
<span style="font-family: georgia, times new roman, serif;">We had a case where a runner was picked up off the course and transported directly to one of our hospitals. There were several runners at this emergency room and we were providing updates to our liaison and the medical team about the participants. The information we sent for one athlete was based on the information in the database but, unfortunately, it was incorrect. She was listed as a 42-year-old female. The medical staff thought they were taking care the female shown in our database, and we reached out to her next of kin. But it was not her; instead, it was her 36-year-old friend. It then took additional time to get in contact with the bandit’s family.</span><br />
<span style="font-family: georgia, times new roman, serif;"><br /></span>
<span style="font-family: georgia, times new roman, serif;">What if bib swapping involves a minor? Most registrations require parental consent for a minor. What if we need to obtain consent from that parent for care? Other considerations might include winning an age group or award—protecting the participant’s own race history and records and insurance claims could be complicated if the runner is using someone else’s bib.</span><br />
<span style="font-family: georgia, times new roman, serif;"><br /></span>
<span style="font-family: georgia, times new roman, serif;">We do not want to discourage athletes from receiving care; the medical team, as always, will care for those in need regardless of who they are. But these types of cases certainly make it more difficult for us to do our job. We all need to work to educate our participants about the risks of bib swapping and running as bandits.</span>International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com0tag:blogger.com,1999:blog-252134069423133104.post-57560129990025422632019-12-12T15:49:00.004-05:002020-02-05T18:20:37.528-05:00 A Tale of Two Races in One Day<span style="font-family: "georgia" , "times new roman" , serif;">Like many of the Marine Corps Marathon runners this year, October 27, 2019, will stick in my mind for a long time. In my 16 years as the medical coordinator, it was the first time it rained- buckets- 2.5 inches, rivers of water on the road and then the sun came out and it was hot. We hit 80 degrees near the end of the race. Runners were in water above their ankles at miles 12-14. The water was running like rivers on the side of the road, so all the runners were crowding into the center of the road to lessen the impact of the water. At least we did not have the predicted thunderstorms. However, we did have the Vice President of the United States show up unannounced to watch his son and then stay for an hour to congratulate thousands of runners. </span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif;">The impact of the weather on the runners was significant. Cold, wet, and windy conditions produced lots of hypothermia. We had core body temperatures as low as 91 degrees and many in the mid 90s. The bright side to running in the cold and wet was the number of Personal Records (PRs) being set that day. The seasoned runners wore garbage bags on their bodies and shoes until the start of the race. Some had sandwich bags with extra socks to change during the event. Many discarded layers and layers of clothing as the miles went by. Then at 11:13 AM that big yellow ball of heat rose from the clouds and the puddles started to dry up, more clothes were shed and body temperatures began to rise……….. 106, 107, 108.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif;">We had several runners with hyponatremia, hypothermia, hyperthermia, heat stroke, and blisters. In fact, the blisters and abrasions were everywhere due to the rain. We also had more falls and fractures than our average race due to wet leaves, water, and hidden surfaces. We transported 36 runners; there were reports of several more going to the emergency departments on their own later that night.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif;">What is the take home message from this day? When planning, you need to be prepared for anything and everything. We needed last-minute orders for more ponchos for the roaming medical staff. Generators can short out in pouring rain, making lights dim. Floors in aid stations get slippery and muddy and the gear gets muddy. Runners are muddy and very wet. Tape does not stick; walking on crutches can be hazardous. Paperwork and bibs get wet, tear, and can get lost.</span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif;">You need to be prepared and you need to be flexible. The best-laid plans may have to be scrapped once you cross the start line. The key is having leaders who can make good decisions in short order and having prepared plans that can flex and adjust. We were given less than a 10-minute notice that the VP wanted to come by. The security plan and egress plan for medical had to flex. He then wanted to stay, chat, and congratulate runners (all during the height of the finish). We did take the opportunity to highlight our medical teams—opportunity knocked!</span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif;">As any of us who plan, coordinate, provide logistics, and support all the other pieces of events can tell you, lots of preparing, planning, formulating, and rehearsing can go a long way to be ready for anything on the big day.</span><br />
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International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com0tag:blogger.com,1999:blog-252134069423133104.post-49551735616171512132019-07-02T15:52:00.000-04:002019-07-02T16:13:26.740-04:00"That's a full-time job?"<!--[if gte mso 9]><xml>
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<![endif]--><span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-size: small;">I routinely get that response when someone asks me what I do
for a living. It is usually preceded by my statement, “I’m the medical
operations coordinator for the Marine Corps Marathon Organization.” I then
further explain we have seven event weekends throughout the year, with 18
events ranging from one-mile fun runs to a triathlon and now an ultra. Our
participants range in age from five to eight-six. The raised eyebrow stays, as
they wonder what it takes to host and execute an event. These comments emanate
from runners and non-runners alike.</span></span><br />
<br />
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<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-size: small;">For runners, the experience is typically this: they visit
the exposition, pick up their bib and t-shirt, shop from a few vendors, maybe
sightsee, eat a good dinner, and then hope to sleep well before they toe the
line. On race day, hopefully, they cross the finish and receive their bling,
get some food fuel, hang out for a beer, and talk about their times. A few will
earn an award. Many will have used porta-potties and taken water or food from a
station along the course. Some will visit the aid stations; some will lose
contact with their running buddy and go to lost and found. But most have no
appreciation of the behind-the-scenes Herculean efforts undertaken to be “race
day ready” or as we call it here at Quantico MISSION READY!</span></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-size: small;"><br /></span></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-size: small;">Each event has its own signature and theme and identity and uniqueness.
What we all have in common are the checklists and policies and protocols that
need to get done in preparation for race day. The end of the event is just the
beginning for race organizations. Media posts go out. All the equipment and
supplies need to be packed up. The clean-up—<i style="mso-bidi-font-style: normal;">oh
the clean-up</i>. Cups and trash and discarded clothing all need to be picked
up and disposed of properly. Usually, the day after the event, permits and
venues have to be secured for the next year. Phone calls start coming in about
lost items, missed timing mat check points, and ill-fitting t-shirts. In the
following week, bills need to be paid to law enforcement, Fire/EMS, and vendors.
Participant feedback is solicited. Reports are completed to note what
improvements are needed for next year.</span></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-size: small;"><br /></span></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-size: small;">For several of our organizations, there is already another
event to be planned and executed. Marathon planning is year-round. There are so
many aspects that need review, completion, and verification. Organizations have
different structures, yet we all deal with finances, business, marketing,
sponsorship, logistics, vendors, security, legal, medical, timing, and results.
Each of these areas has a multitude of smaller areas of focus to complete. So
yes, it is a full-time career.</span></span><br />
<br />
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="font-size: small;">I invite you to share your “ah ha moment” of what you
learned about marathon planning that you didn’t know before and I invite to
come spend some time with me or other coordinators to see and experience all
the moving parts.</span></span></div>
International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com0tag:blogger.com,1999:blog-252134069423133104.post-57182523174645084762018-11-30T14:18:00.000-05:002019-03-24T20:33:56.807-04:00Where are the Bandaids?<!--[if gte mso 9]><xml>
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<span style="font-family: Georgia, Times New Roman, serif;">“…needed more bandaids,<span style="mso-spacerun: yes;">
</span>…..the supplies seemed to be short on bandaids, …..we couldn’t find the
bandaids.” These were some of the feedback comments we received as we closed out
our 2018 Marine Corps Marathon this year. As the medical coordinator, the
comments initially made me a bit annoyed, but then I sat back and thought there
are some more fundamental issues here in the planning and executing of large
venue events.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">Our warehouse of medical supplies and equipment holds
several thousand dollars’ worth of various consumable supplies. We have
bandaids, we have roller bandage gauze, we have 4 x 4 sterile and non-sterile
gauze. We also have Tegaderm™, Opsite™, New Skin™, Coban™, sticky back felt,
moleskin, Durabond™ and many other wound care dressings. There are so many more
dressings and bandages available on the market.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">Care in the field is very different than care in the clinic.
That includes your supplies. Most of our events rely heavily on our volunteers.
They are the key to our success in our medical tents. They come with a lot of
enthusiasm and giving hands and many of them come with little understanding of
supplies that are most useful in the sporting environment.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">Adhesive bandages with gauze pad center (the generic
definition of bandaids or Band-Aids™) work in many environments but not once an
athlete is sweating. They just don’t stick, they don’t work over a joint or in
a shoe. Sometimes you can use benzoin of tincture, betadine or other glues to
make it stick better but there are better supplies that work in the athletic
environment. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">Our role in educating our volunteers and staff includes
protocols and algorithms but I think it also means giving them a bit more lay
of land in the logistics area. We stock eight types of tape—some for the musculoskeletal
practitioners, some for the IV’s and the duct tape—in case everything else
fails. Some might say that is way too many. For our events these are the ones
we use and our AT’s and PT’s like and have asked for over time. We train our
supply petty officers and they pack their gear but on race day they cannot be
everyone where in the tent.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">So maybe for next year I’ll create a go-by with a catalogue
of our supplies and how they can be used.</span></div>
International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com1tag:blogger.com,1999:blog-252134069423133104.post-12821867345264176352018-08-02T10:30:00.000-04:002019-03-24T20:36:36.310-04:00At What Cost? The Price of Safety<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">Yesterday [July 31] I attended the Blue Ribbon Study Panel on Biodefense: The Cost of Resilience: Impact of Large Scale Biological Events on Business, Finance and the Economy. Former Representative Jim Greenwood facilitated this meeting with the panel’s co-chair, former Senator Majority Leader Tom Daschle. Panel members included Former Senator Joe Lieberman, Former Governor Tom Ridge, and Former Homeland Security Advisor Ken Wainstein. Testimony to the panel included Congressional Representatives; representatives from the pharmaceutical industry; FedEx; ExxonMobil; World Bank; and Dr. Lou Marcianci, Director of the National Center for Spectator Sports Safety and Security, from the University of Southern Mississippi.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">It was truly an interesting day. In their discussions, the various presenters offered comments ranging from the need for federal oversight, financial support, integration of the public private partnerships in various areas and at various levels of the government involving biodefense, and more tactical discussions including the best way to remove a drone from a mass gathering. You are probably asking how this affects us as members of the International Institute of Race Medicine (IIRM). </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">Each of our events coordinates and communicates with law enforcement and emergency services. We participate in the development of the Incident Action Plan (IAP) and we develop our own Emergency Action Plans (EAPs) for severe weather, road closures, and a sentinel event. Most of this is behind the scenes; runners and spectators are not aware of all the planning and work that must occur to make our events safe. That safety, however, is costing more and more. Major events spend millions in law enforcement and emergency services. Before 911, local law enforcement supported the Marine Corps Marathon with a big smile and the promise of a shirt. In 2017, we were required to add blocking vehicles in several locations on our course. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">For those of us who answer to boards, sponsors, governments, etc., what is the financial tipping point for us? Is there a registration fee ceiling that our participants will not exceed? As the number of events grow but registration numbers remain flat or decrease, how do we keep our events safe, exciting, and memorable for our participants and spectators without breaking the bank? I always comment that no one focuses on medical at our events except us, and I still agree with that statement. The expectation is we are trained, ready, and prepared to handle what comes our way. Runners do not plan to visit aid stations, enter emergency rooms or stay overnight at a hospital (or worse, not come home). As we continue to develop more robust safety plans and add specialty law enforcement and emergency services, how do we educate our customers? How do we mitigate risk? And how to we afford to stay in business?</span><br />
<br /></div>
<span style="font-size: small;"><span style="font-family: "georgia" , "times new roman" , serif;">
</span></span><br />
<span style="color: black; font-family: "calibri" , sans-serif; font-size: 12.0pt;"></span>International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com0tag:blogger.com,1999:blog-252134069423133104.post-15049506672300841262018-05-08T12:48:00.002-04:002019-03-24T20:34:21.695-04:00Athletes with Disabilities: Safety Considerations<span style="font-family: Georgia, Times New Roman, serif;">More and more physically challenged athletes are participating in traditional running events. Requests for entries for wheelchairs, handcycles, and “pushers” continue to increase. Renowned wheelchair athlete Craig Blanchette a former Olympian and pioneer in wheelchair racing, sued race owner Competitor Group, Inc. for gross negligence due to an injury at the 2014 Rock ‘n’ Roll marathon because race organizers altered the course without notifying him. A San Diego jury awarded him $4 million this week. Blanchette said that race organizers changed a portion of the course the morning of the race, on 11th Avenue near B Street, and did not inform him.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">Some events do not allow wheelchair or handbikes in their events due to safety and security concerns. This note is from the Footlevers Blue Ridge Marathon website:</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;"><i>The Foot Levelers Blue Ridge Marathon course is designed as a road running course. Multiple athletes with disabilities have inquired over the years about completing “America’s Toughest Road Marathon” using handcycles and wheelchairs. In 2014, organizers permitted a trial run of the half marathon course with two athletes with disabilities using handcycles. One athlete was a pro handcyclist, and the other was a recreational handcyclist. After observations of the athletes on the course and feedback from the athletes, it was decided that having an open field of handcyclists would not be safe for the race, given the course layout, extreme terrain, and that steep portions of the course are not fully closed to vehicular traffic. Organizers have also consulted with professional wheelchair racers, and these athletes indicated that the grades on the course are too dangerous for safe competition of racing wheelchairs.</i></span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">USATF provides guidance and has provisions in place for Athletes with Disabilities to compete in wheelchairs; however, USATF does not accommodate handcycles in competition. USATF has a very specific policy designed to assist race directors so they can deal with the complex questions surrounding disabled athlete participation. Members of the Road Runners Club of America (RRCA) should refer to the USATF policy on Americans with Disablities Act (ADA).</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">In 1979, the RRCA published “Guidelines for Wheelchair Athletes.” The purpose of these guidelines is to provide information for event directors and athletes. Hopefully, these guidelines will facilitate the inclusion of athletes with disabilities in road racing events and foster discussions among event directors, members of the disabled community, law enforcement and public safety personnel and others involved with a particular event. The guidelines are not intended to cover all events or situations.</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">While the safety of all participants in a running event remains the paramount concern of any event director, these guidelines will help event directors focus on real safety concerns related to a specific disability and not concerns based on false perceptions, stereotypes or generalizations about athletes with disabilities.</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">Pushing disabled athletes in a sport chair has become more and more popular. From time to time, RRCA members have struggled with having a “no stroller” policy and complying with ADA accommodations for events. If the persons seeking to enter the event meet any age restrictions placed on participation, then the event needs to make reasonable accommodations to allow a disabled athlete to be pushed in a wheelchair in the event by an able-bodied participant. This is in accordance with providing access to the event. Race organizers need to make decisions regarding registration of one or both athletes.</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">Should age restrictions apply as they do with able-bodied athletes? How do race organizers inform participants of terrain concerns or undesirable or non-negotiable terrain for a wheelchair? Concerns also include hairpin turns, elevations greater than 10% and steep hills that may increase speeds greater than 20 mph.</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">Recently the Marine Corps Marathon was informed by law enforcement agencies that wheelchair and handcyclists MUST have a reflective flag that is 4-6 feet in height to allow for visibility of the athletes in crowds. The MCM will be sending these athletes the information and requirements. What happens if the athlete shows at the starting line without the flag? Should they be pulled? Is it the responsibility of race organizers to place a flag on their equipment prior to the start?</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">What about requests for service animals to participate in events? Should organizers add veterinary professionals to the support staff?</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">These topics seem to be the third rail in many circles but it behooves all events to have the discussions to share their policies and better inform and work with athletes with disabilities to encourage fitness and participation where possible.</span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, "Times New Roman", serif;"><br /></span>
<span style="font-family: Georgia, "Times New Roman", serif;">What are your thoughts? How do you interact with these athletes?</span></span>International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com0tag:blogger.com,1999:blog-252134069423133104.post-88955807037151969582018-01-10T13:58:00.004-05:002019-07-15T16:37:43.015-04:00At What Age???<div align="center" class="MsoNormal" style="text-align: center;">
<div style="text-align: left;">
<b style="font-family: georgia, "times new roman", serif;">5k:</b><span style="font-family: "georgia" , "times new roman" , serif;"> Ava
Johnson, Megan Crum, Aaron Westrip, Daniel Skandera</span></div>
</div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;"><b>10k: </b> Ava
Johnson, Carrie Garritson, Aaron Westrip, Grattan O’Neill, Caleb Hymans<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;"><b>Half
Marathon:</b> Tabitha Francks, Nasiya Jobe, Matthew Feibusch, Charlie Westrip,
Grattan O’Neill<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;"><span style="font-family: "times" , "times new roman" , serif;"><b>Marathon:</b> Mary Etta Boitano, Tabitha Francks, Julie Mullin, Kevin Strain, Wesley Paul,
Charlie Westrip</span><span style="font-family: "times" , "times new roman" , serif;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: xx-small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;">According to
the Association of Road Racing Statistics, each of these runners holds a world
record time in the event listed. The surprising part of their record? Their age
at the time; ranging from 3 (Aaron 5k) to no more than 12 years and several of
these runners hold multiple age range records. When I reviewed published
reports and comments and quotes from these runners and their parents, they all
used the words “fun, family sport, exercising.” There was no mention of “punishment
or because my parents made me.” Many families see it as bonding time and a
chance to travel. In fact, youth half marathon times dropped quite a bit in
2016. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;">Nike has a
website called <i>Marathon Kids</i>; the
American Academy of Pediatrics (AAP) has issued statements in the past about
distance running for children. Some physicians and coaches recommend no
marathons until past the age of puberty. The AAP reports that sprint distance
triathlons are a good thing because they incorporate “lifetime sports, short
sensible distances, non-specialized training before puberty and have health and
weight benefits.” There is a lot of confusion, concern and conflicting
information. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;">However, for
those of us who set policies for our events, council our race directors to say
no to a parent of a 6-year-old who wants to run our marathon what is the best
answer? We know that our kids of today are not physically active – many are
couch potatoes. We know schools have cut back on many non-academic programs
including physical education and recess due to budget costs. We know 12% of our
youth are seriously overweight and have health issues because of it. We also
see more event weekends with kids activities added in to attract families and
not just mom or dad runners. <o:p></o:p></span><br />
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif; line-height: 107%;">So what is the answer? How does your event answer this question?</span></div>
<br />International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com6tag:blogger.com,1999:blog-252134069423133104.post-86832738911742899452017-12-06T09:24:00.002-05:002019-03-24T20:35:26.563-04:00Testing and Treatment<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">The 2017 Marine Corps Marathon was the second warmest
on record and the second busiest in the medical tents. Temperatures started at 53.2 degrees F and
reached a max of 77.3 degrees F. WBGT readings done every hour at three
locations on the course. With a low of 53.2 at 0800 and a high of 73.9 at 1400
on the course. Of our 42 transports 22
were heat related and one runner; a 61 yo female runner presented confused,
with several bouts of nausea and vomiting and a serum sodium of 131 mmol/L.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br />Various references define hyponatremia as a serum sodium
<135 mmol/L and critical hypernatremia as <120 mmol/L. Other risk factors
include fluid intake, gender, exercise duration > 4 hours, pre-exercise over
hydration, easy access to fluids on the course and temperature. Symptoms range
from confusion, nausea, vomiting, confusion, seizures and unresponsiveness.
Some runners have low serum sodium levels and no visible symptoms.</span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: georgia, "times new roman", serif;"><br /></span>
<span style="font-family: georgia, "times new roman", serif;">The discussion point I bring up is testing and treatment.
Should all runners presenting with symptoms of hyponatremia have sodium levels
tested prior to the introduction of an IV?
In cases where athletes are picked up on the race course and transported
immediately by EMS service, should an IV be withheld until testing is complete?
There are events that have few if any aid stations and protocols that do not
cover all these possibilities. Would you start an IV on a runner in your aid
station without a serum sodium level?</span></span></div>
<div class="MsoNormal">
<o:p></o:p></div>
International Institute for Race Medicinehttp://www.blogger.com/profile/18266126188347077257noreply@blogger.com5