Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T13:47:04.541Z Has data issue: false hasContentIssue false

Chapter 17 - Mass Gathering Events: Extended Duration Events

Published online by Cambridge University Press:  11 April 2024

William J. Brady
Affiliation:
University of Virginia
Mark R. Sochor
Affiliation:
University of Virginia
Paul E. Pepe
Affiliation:
Metropolitan EMS Medical Directors Global Alliance, Florida
John C. Maino II
Affiliation:
Michigan International Speedway, Brooklyn
K. Sophia Dyer
Affiliation:
Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Get access

Summary

Extended duration events, including both athletic and cultural events, present specific medical and logistical challenges for the medical provider. These events are heterogenous, ranging from remote ultramarathons to multisport adventures and stationary music festivals. Providers must therefore assess the specific risks and needs. However, in general they should expect to encounter a high volume of encounters, the majority for non-life threatening complaints such as wound care, musculoskeletal injuries or gastrointestinal distress. Endurance athletes in particular are at risk for numerous concurrent metabolic derangements that may lead to life-threatening pathology. The implementation of medical care may be significantly challenged by extended duration, remote or rugged locations, international borders and staffing limitations. Providers should engage closely with event staff and participants to minimize and mitigate catastrophic risks, while enjoying the unique events and their more common complaints.

Type
Chapter
Information
Mass Gathering Medicine
A Guide to the Medical Management of Large Events
, pp. 230 - 247
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Peterson, J. Twenty-One Runners Die in Sudden Cold Weather Exposure During 100 k Ultramarathon in China. Wilderness Medical Society News. wms.org/magazine/1108/Breaking-Wilderness-Medicine-News. Accessed June 25, 2021.Google Scholar
Hoffman, M. D., Pasternak, A., Rogers, I. R., et al. Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines. Sports Medicine. 2014;44(8):10551069.CrossRefGoogle ScholarPubMed
McCarthy, P. The Great New York 100 Mile Running Exposition [Internet]. tgny100. [cited November 22, 2021]. www.tgny100.com. Accessed November 22, 2021.Google Scholar
Cunningham, G. Running Beyond the Marathon: Insights into the Longest Footrace in the World. eText Press Publishing; 2014.Google Scholar
Heine, P. The Mentally Brutal Big Backyard Ultra Just Keeps Going Until One Person Is Left Standing. Runner’s World. 2018. www.runnersworld.com/trail-running/a24079861/big-backyard-ultra-winner/. Accessed November 22, 2021.Google Scholar
Scheer, V. Participation Trends of Ultra Endurance Events. Sports Medicine and Arthroscopy Review. 2019;27(1):37.CrossRefGoogle ScholarPubMed
Stöhr, A., Nikolaidis, P. T., Villiger, E., et al. An Analysis of Participation and Performance of 2067 100-Kilometer Ultra-Marathons Worldwide. International Journal of Environmental Research and Public Health. 2021;18(2):362–375.CrossRefGoogle Scholar
Hoffman, M. D., Krishnan, E. Health and Exercise-Related Medical Issues among 1,212 Ultramarathon Runners: Baseline Findings from the Ultrarunners Longitudinal TRAcking (ULTRA) Study. PLoS One. 2014;9(1):e83867.CrossRefGoogle ScholarPubMed
Scheer, V., Hoffman, M. D. Should Children Be Running Ultramarathons? Current Sports Medicine Reports. 2018;17(9):282283.CrossRefGoogle ScholarPubMed
Kluitenberg, B., van Middelkoop, M., Diercks, R., van der Worp, H. What Are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis. Sports Medicine. 2015;45(8):11431161.CrossRefGoogle ScholarPubMed
McGowan, V., Hoffman, M. D. Characterization of Medical Care at the 161-Kilometer Western States Endurance Run. Wilderness and Environmental Medicine Journal. 2015;26(1):2935.CrossRefGoogle Scholar
Krabak, B. J., Waite, B., Schiff, M. A. Study of Injury and Illness Rates in Multiday Ultramarathon Runners. Medicine and Science in Sports and Exercise. 2011;43(12):23142320.CrossRefGoogle ScholarPubMed
Schwabe, K., Schwellnus, M., Derman, W., Swanevelder, S., Jordaan, E. Medical Complications and Deaths in 21 and 56 Kilometer Road Race Runners: A 4-Year Prospective Study in 65,865 runners – SAFER study I. British Journal of Sports Medicine. 2014;48(11):912918.CrossRefGoogle Scholar
Scheer, B. V., Murray, A. Al Andalus Ultra Trail: An Observation of Medical Interventions During a 219-Kilometer, 5-Day Ultramarathon Stage Race. Clinical Journal of Sports Medicine. 2011;21(5):444446.CrossRefGoogle ScholarPubMed
Vernillo, G., Savoldelli, A., Torre, A. L., Skafidas, S., Bortolan, L., Schena, F. Injury and Illness Rates During Ultratrail Running. International Journal of Sports Medicine. 2016;37(7):565569.Google ScholarPubMed
Sewry, N., Schwellnus, M., Boulter, J., Seocharan, I., Jordaan, E. Medical Encounters in a 90-Kilometer Ultramarathon Running Event: A 6-year Study in 103 131 Race Starters – SAFER XVII. Clinical Journal of Sports Medicine. 2021.CrossRefGoogle Scholar
Yanturali, S., Canacik, O., Karsli, E., Suner, S. Injury and Illness Among Athletes During a Multi-Day Elite Cycling Road Race. The Physician and Sportsmedicine. 2015;43(4):348354.CrossRefGoogle ScholarPubMed
Haeberle, H. S., Navarro, S. M., Power, E. J., Schickendantz, M. S., Farrow, L. D., Ramkumar, P. N. Prevalence and Epidemiology of Injuries Among Elite Cyclists in the Tour de France. Orthopaedic Journal of Sports Medicine. 2018;6(9):2325967118793392.CrossRefGoogle ScholarPubMed
Sillén, K., Wallenius, V. Rates and Types of Injuries During the Three Consecutive Years 2016 to 2018 of the Vätternrundan: One of the World’s Largest and Longest Bicycle Races. Traffic Injury Prevention. 2019;20(7):749752.CrossRefGoogle ScholarPubMed
Decock, M., De Wilde, L., Vanden Bossche, L., Steyaert, A., Van Tongel, A. Incidence and Aetiology of Acute Injuries During Competitive Road Cycling. British Journal of Sports Medicine. 2016;50(11):669672.CrossRefGoogle ScholarPubMed
Pommering, T. L., Manos, D. C., Singichetti, B., Brown, C. R., Yang, J. Injuries and Illnesses Occurring on a Recreational Bicycle Tour: The Great Ohio Bicycle Adventure. Wilderness Environ Med. 2017;28(4):299306.CrossRefGoogle ScholarPubMed
Boeke, P. S., House, H. R., Graber, M. A. Injury Incidence and Predictors on a Multiday Recreational Bicycle Tour: The Register’s Annual Great Bike Ride Across Iowa, 2004 to 2008. Wilderness and Environmental Medicine Journal. 2010;21(3):202207.CrossRefGoogle ScholarPubMed
Kotlyar, S. Cycling Injuries in Southwest Colorado: A Comparison of Road vs Trail Riding Injury Patterns. Wilderness and Environmental Medicine Journal. 2016;27(2):316320.CrossRefGoogle Scholar
Harris, K. M., Creswell, L. L., Haas, T. S., et al. Death and Cardiac Arrest in U.S. Triathlon Participants, 1985 to 2016: A Case Series. Annals of Internal Medicine. 2017;167(8):529535.CrossRefGoogle ScholarPubMed
Gosling, C. M., Forbes, A. B., McGivern, J., Gabbe, B. J. A Profile of Injuries in Athletes Seeking Treatment During a Triathlon Race Series. American Journal of Sports Medicine. 2010;38(5):10071014.CrossRefGoogle ScholarPubMed
Yang, H.-R., Jeong, J., Kim, I., Kim, J. E. Medical Support During an Ironman 70.3 Triathlon Race. F1000Res. 2017;6:1516.CrossRefGoogle ScholarPubMed
Dawadi, S., Basyal, B., Subedi, Y. Morbidity Among Athletes Presenting for Medical Care During 3 Iterations of an Ultratrail Race in the Himalayas. Wilderness and Environmental Medicine Journal. 2020;31(4):437440.CrossRefGoogle ScholarPubMed
Hållmarker, U., Michaëlsson, K., Arnlöv, J., James, S. Cardiac Arrest in a Long-Distance Ski Race (Vasaloppet) in Sweden. J Am Coll Cardiol. 2012;60(15):14311432.CrossRefGoogle Scholar
Rabb, H., Coleby, J. Hurt on the Hill: A Longitudinal Analysis of Obstacle Course Racing Injuries. Orthopaedic Journal of Sports Medicine. 2018;6(6):2325967118779854.CrossRefGoogle Scholar
Alquthami, A. H., Pines, J. M. A Systematic Review of Noncommunicable Health Issues in Mass Gatherings. Prehospital and Disaster Medicine. 2014;29(2):167175.CrossRefGoogle ScholarPubMed
Anikeeva, O., Arbon, P., Zeitz, K., et al. Patient Presentation Trends at 15 Mass-Gathering Events in South Australia. Prehospital and Disaster Medicine. 2018;33(4):368374.CrossRefGoogle ScholarPubMed
Bledsoe, B., Songer, P., Buchanan, K., Westin, J., Hodnick, R., Gorosh, L. Burning Man 2011: Mass Gathering Medical Care in an Austere Environment. Prehospital Emergency Care. 2012;16(4):469476.CrossRefGoogle Scholar
Schwabe, K., Schwellnus, M. P., Derman, W., Swanevelder, S., Jordaan, E. Less Experience and Running Pace Are Potential Risk Factors for Medical Complications during a 56 km Road Running Race: A Prospective Study in 26,354 Race Starters – SAFER study II. British Journal of Sports Medicine. 2014;48(11):905911.CrossRefGoogle Scholar
Sewry, N., Schwellnus, M., Borjesson, M., Swanevelder, S., Jordaan, E. Pre-Race Screening and Stratification Predicts Adverse Events: A 4-Year Study in 29,585 Ultra-Marathon Entrants, SAFER X. Scand J Med Sci Sports. 2020;30(7):12051211.CrossRefGoogle Scholar
Killops, J., Sewry, N. A., Schwellnus, M., Swanevelder, S., Janse van Rensburg, D., Jordaan, E. Women, Older Age, Faster Cycling Speed and Increased Wind Speeds Are Independent Risk Factors for Acute Injury-Related Medical Encounters During a 109 km Mass Community-Based Participation Cycling Event: A 3-Year Study in 102,251 Race Starters – SAFER XII. Injury Prevention. 2021;27(4):338343.CrossRefGoogle Scholar
Knechtle, B., Nikolaidis, P. T. Physiology and Pathophysiology in Ultra-Marathon Running. Front Physiol. 2018;9:634.CrossRefGoogle ScholarPubMed
Rubio-Arias, J. Á., Ávila-Gandía, V., López-Román, F. J., Soto-Méndez, F., Alcaraz, P. E., Ramos-Campo, D. J. Muscle Damage and Inflammation Biomarkers After Two Ultra-Endurance Mountain Races of Different Distances: 54 km vs 111 km. Physiol Behav. 2019;205:5157.CrossRefGoogle ScholarPubMed
Yoon, J. H., Park, Y., Ahn, J., Shin, K. A., Kim, Y. J. Changes in the Markers of Cardiac Damage in Men Following Long-Distance and Ultra-Long-Distance Running Races. Journal of Sports Medicine and Physical Fitness. 2016;56(3):295301.Google ScholarPubMed
Khodaee, M., Spittler, J., VanBaak, K., Changstrom, B. G., Hill, J. C. Effects of Running an Ultramarathon on Cardiac, Hematologic, and Metabolic Biomarkers. International Journal of Sports Medicine. 2015;36(11):867871.Google ScholarPubMed
Da Ponte, A., Giovanelli, N., Antonutto, G., et al. Changes in Cardiac and Muscle Biomarkers Following an Uphill-Only Marathon. Research in Sports Medicine. 2018;26(1):100111.CrossRefGoogle ScholarPubMed
Christensen, D. L., Espino, D., Infante-Ramírez, R., et al. Transient Cardiac Dysfunction But Elevated Cardiac and Kidney Biomarkers 24 h Following an Ultra-Distance Running Event in Mexican Tarahumara. Extreme Physiology and Medicine. 2017;6:3.CrossRefGoogle ScholarPubMed
Christensen, D. L., Espino, D., Infante-Ramírez, R., et al. Normalization of Elevated Cardiac, Kidney, and Hemolysis Plasma Markers Within 48 h in Mexican Tarahumara Runners Following a 78 km Race at Moderate Altitude. American Journal of Human Biology. 2014;26(6):836843.CrossRefGoogle Scholar
Żebrowska, A., Waśkiewicz, Z., Nikolaidis, P. T., et al. Acute Responses of Novel Cardiac Biomarkers to a 24-h Ultra-Marathon. Journal of Clinical Medicine. 2019;8(1):57.CrossRefGoogle ScholarPubMed
Hoffman, M. D., Fogard, K. Demographic Characteristics of 161-km Ultramarathon Runners. Research in Sports Medicine. 2012;20(1):5969.CrossRefGoogle ScholarPubMed
Turris, S. A., Jones, T., Lund, A. Mortality at Music Festivals: An Update for 2016–2017 – Academic and Grey Literature for Case Finding. Prehospital and Disaster Medicine. 2017:32(1);5863.CrossRefGoogle Scholar
Holtzhausen, L. M., Noakes, T. D. The Prevalence and Significance of Post-Exercise (Postural) Hypotension in Ultramarathon Runners. Medicine and Science in Sports and Exercise. 1995;27(12):15951601.CrossRefGoogle ScholarPubMed
Kercher, M. Chafing And Running: How To Prevent It And Deal With It [Internet]. 2021. https://marathonhandbook.com/chafing-and-running/. Accessed October 16, 2021.Google Scholar
Rooney, D., Sarriegui, I., Heron, N. “As Easy as Riding a Bike”: A Systematic Review of Injuries and Illness in Road Cycling. BMJ Open Sport and Exercise Medicine. 2020;6(1):e000840.CrossRefGoogle ScholarPubMed
Scheer, B. V., Reljic, D., Murray, A., Costa, R. J. S. The Enemy of the Feet: Blisters in Ultraendurance Runners. Journal of the American Podiatric Medical Association. 2014;104(5):473478.CrossRefGoogle ScholarPubMed
Worthing, R. M., Percy, R. L., Joslin, J. D. Prevention of Friction Blisters in Outdoor Pursuits: A Systematic Review. Wilderness and Environmental Medicine Journal. 2017;28(2):139149.CrossRefGoogle ScholarPubMed
Lipman, G. S., Sharp, L. J., Christensen, M., et al. Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II). Clinical Journal of Sports Medicine. 2016;26(5):362368.CrossRefGoogle ScholarPubMed
Hart, R. Blisters. Wilderness Medical Society Magazine. 2015. wms.org/magazine/1140/Blisters-Part-1. Accessed September 20, 2023.Google Scholar
Lipman, G. S., Krabak, B. J. Foot Problems and Care. In: Auerbach’s Wilderness Medicine. 7th ed. Philadelphia: Elsevier; 2016. pp. 533549.Google Scholar
Blog, N. How to Prevent and Treat Blisters [Video] [Internet]. 2015. https://blog.nols.edu/2015/07/21/how-to-prevent-and-treat-blisters-video. Accessed October 16, 2021.Google Scholar
Britton, R. What to Eat in an Ultra Marathon – Men’s Running UK [Internet]. Men’s Running. 2017. https://mensrunninguk.co.uk/training/eat-ultra-marathon/. Accessed December 6, 2021.Google Scholar
Pillay, S., Schwellnus, M. P., Grant, C., Jansen, V. A. N, Rensburg, A., Swanevelder, S., Jordaan, E. Longer Race Distance Predicts Gastrointestinal Illness-Related Medical Encounters in 153,208 Endurance Runner Race Starters – SAFER XVI. Journal of Sports Medicine and Physical Fitness. 2021.CrossRefGoogle Scholar
Wilson, P. B. “I Think I’m Gonna Hurl”: A Narrative Review of the Causes of Nausea and Vomiting in Sport. Sports (Basel). 2019;7(7):E162.CrossRefGoogle ScholarPubMed
Peters, H. P., Bos, M., Seebregts, L., et al. Gastrointestinal Symptoms in Long-Distance Runners, Cyclists, and Triathletes: Prevalence, Medication, and Etiology. American Journal of Gastroenterology. 1999;94(6):15701581.CrossRefGoogle ScholarPubMed
Costa, R. J. S., Snipe, R., Camões-Costa, V., Scheer, V., Murray, A. The Impact of Gastrointestinal Symptoms and Dermatological Injuries on Nutritional Intake and Hydration Status During Ultramarathon Events. Sports Medicine – Open. 2016;2:16.CrossRefGoogle ScholarPubMed
Parnell, J. A., Wagner-Jones, K., Madden, R. F., Erdman, K. A. Dietary Restrictions in Endurance Runners to Mitigate Exercise-Induced Gastrointestinal Symptoms. Journal of the International Society of Sports Nutrition. 2020;17(1):32.CrossRefGoogle ScholarPubMed
Schütz, U. H. W., Billich, C., König, K., et al. Characteristics, Changes and Influence of Body Composition During a 4486 km Transcontinental Ultramarathon: Results from the TransEurope FootRace Mobile Whole Body MRI-Project. BMC Med. 2013;11:122.CrossRefGoogle ScholarPubMed
Tiller, N. B., Roberts, J. D., Beasley, L., et al. International Society of Sports Nutrition Position Stand: Nutritional Considerations for Single-Stage Ultra-Marathon Training and Racing. Journal of the International Society of Sports Nutrition. 2019;16(1):50.CrossRefGoogle ScholarPubMed
Mielgo-Ayuso, J., Calleja-González, J., Refoyo, I., León-Guereño, P., Cordova, A., Del Coso, J. Exercise-Induced Muscle Damage and Cardiac Stress During a Marathon Could Be Associated with Dietary Intake During the Week Before the Race. Nutrients. 2020;12(2):E316.CrossRefGoogle ScholarPubMed
Pasternak, A. V., Fiore, D., Islas, A., Toti, S, Hoffman, M. D. Treatment with Oral Ondansetron for Ultramarathon-Associated Nausea: The TOO FUN Study. Sports (Basel). 2021;9(3):35.CrossRefGoogle ScholarPubMed
Costa, R. J. S., Snipe, R. M. J., Kitic, C. M., Gibson, P. R. Systematic Review: Exercise-Induced Gastrointestinal Syndrome: Implications for Health and Intestinal Disease. Alimentary Pharmacology & Therapeutics. 2017;46(3):246265.CrossRefGoogle ScholarPubMed
Drobnic, F., Fonts, S., García-Alday, I., et al. A Pilot Study on the Efficacy of a Rational Combination of Artichoke and Ginger Extracts with Simethicone in the Treatment of Gastrointestinal Symptoms in Endurance Athletes. Minerva Gastroenterol Dietol. 2022;68(1):7784.Google Scholar
Schwellnus, M., Swanevelder, S., Derman, W., Borjesson, M., Schwabe, K., Jordaan, E. Prerace Medical Screening and Education Reduce Medical Encounters in Distance Road Races: SAFER VIII Study in 153,208 Race Starters. British Journal of Sports Medicine. 2019;53(10):634639.CrossRefGoogle Scholar
Hoppel, F., Calabria, E., Pesta, D., Kantner-Rumplmair, W., Gnaiger, E., Burtscher, M. Physiological and Pathophysiological Responses to Ultramarathon Running in Non-elite Runners. Frontiers in Physiology. 2019;10:1300.CrossRefGoogle ScholarPubMed
Magrini, D., Khodaee, M., San-Millán, I., Hew-Butler, T., Provance, A. J. Serum Creatine Kinase Elevations in Ultramarathon Runners at High Altitude. The Physician and Sportsmedicine. 2017;45(2):129133.Google ScholarPubMed
Hoffman, M. D., Badowski, N., Chin, J., Stuempfle, K. J., Parise, C. A. Determinants of Recovery from a 161-km Ultramarathon. Journal of Sports Sciences. 2017;35(7):669677.CrossRefGoogle ScholarPubMed
Hoffman, M. D., Weiss, R. H. Does Acute Kidney Injury from an Ultramarathon Increase the Risk for Greater Subsequent Injury? Clinical Journal of Sports Medicine. 2016;26(5):417422.CrossRefGoogle ScholarPubMed
Hoffman, M. D., Stuempfle, K. J., Rogers, I. R., Weschler, L. B., Hew-Butler, T. Hyponatremia in the 2009 161-km Western States Endurance Run. International Journal of Sports Physiology and Performance. 2012;7(1):610.CrossRefGoogle ScholarPubMed
Bird, S. R., Linden, M., Hawley, J. A. Acute Changes to Biomarkers as a Consequence of Prolonged Strenuous Running. Annals of Clinical Biochemistry. 2014;51(Pt 2):137150.CrossRefGoogle ScholarPubMed
Pradas, F., Falcón, D., Peñarrubia-Lozano, C., Toro-Román, V., Carrasco, L., Castellar, C. Effects of Ultratrail Running on Neuromuscular Function, Muscle Damage and Hydration Status. Differences According to Training Level. International Journal of Environmental Research and Public Health. 2021;18(10):5119.CrossRefGoogle ScholarPubMed
MartÍnez-Navarro, I, Collado, E, Hernando, C, Hernando, B, Hernando, C. Inflammation, Muscle Damage and Post-Race Physical Activity Following a Mountain Ultramarathon. Journal of Sports Medicine and Physical Fitness. 2021.CrossRefGoogle Scholar
Belli, T., Macedo, D. V., de Araújo, G. G., et al. Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury. Frontiers in Physiology. 2018;9:1368.CrossRefGoogle ScholarPubMed
Bruso, J. R., Hoffman, M. D., Rogers, I. R., Lee, L., Towle, G., Hew-Butler, T. Rhabdomyolysis and Hyponatremia: A Cluster of Five Cases at the 161-km 2009 Western States Endurance Run. Wilderness and Environmental Medicine Journal. 2010;21(4):303308.CrossRefGoogle Scholar
Chlíbková, D., Knechtle, B., Rosemann, T., Žákovská, A., Tomášková, I. The Prevalence of Exercise-Associated Hyponatremia in 24-Hour Ultra-Mountain Bikers, 24-Hour Ultra-Runners and Multi-Stage Ultra-Mountain Bikers in the Czech Republic. Journal of the International Society of Sports Nutrition. 2014;11(1):3.CrossRefGoogle ScholarPubMed
Cairns, R. S., Hew-Butler, T. Proof of Concept: Hypovolemic Hyponatremia May Precede and Augment Creatine Kinase Elevations During an Ultramarathon. European Journal of Applied Physiology. 2016;116(3):647655.CrossRefGoogle ScholarPubMed
Wollseiffen, P., Schneider, S., Martin, L. A., Kerhervé, H. A., Klein, T., Solomon, C. The Effect of 6 h of Running on Brain Activity, Mood, and Cognitive Performance. Experimental Brain Research. 2016;234(7):18291836.CrossRefGoogle Scholar
Freund, W., Faust, S., Birklein, F., et al. Substantial and Reversible Brain Gray Matter Reduction but No Acute Brain Lesions in Ultramarathon Runners: Experience from the Transeurope-Footrace Project. BMC Med. 2012;10:170.CrossRefGoogle ScholarPubMed
Poussel, M., Laroppe, J., Hurdiel, R., et al. Sleep Management Strategy and Performance in an Extreme Mountain Ultra-Marathon. Research in Sports Medicine. 2015;23(3):330336.CrossRefGoogle Scholar
Hurdiel, R., Pezé, T., Daugherty, J., et al. Combined Effects of Sleep Deprivation and Strenuous Exercise on Cognitive Performances During the North Face® Ultra Trail du Mont Blanc® (UTMB®). Journal of Sports Sciences. 2015;33(7):670674.CrossRefGoogle Scholar
Huang, M.-K., Chang, K.-S., Kao, W.-F., et al. Visual Hallucinations in 246-km Mountain Ultra-Marathoners: An Observational Study. Chinese Journal of Physiology. 2021;64(5):225231.CrossRefGoogle ScholarPubMed
Krogh, J., Speyer, H., Gluud, C., Nordentoft, M. Exercise for Patients with Major Depression: A Protocol for a Systematic Review with Meta-Analysis and Trial Sequential Analysis. Systematic Reviews. 2015;4:40.CrossRefGoogle ScholarPubMed
Kvam, S., Kleppe, C. L., Nordhus, I. H., Hovland, A. Exercise as a Treatment for Depression: A Meta-Analysis. Journal of Affective Disorders. 2016;202:6786.CrossRefGoogle ScholarPubMed
Méndez-Alonso, D., Prieto-Saborit, J. A., Bahamonde, J. R., Jiménez-Arberás, E. Influence of Psychological Factors on the Success of the Ultra-Trail Runner. International Journal of Environmental Research and Public Health. 2021;18(5):2704.CrossRefGoogle ScholarPubMed
Brace, A. W., George, K., Lovell, G. P. Mental Toughness and Self-Efficacy of Elite Ultra-Marathon Runners. PLoS One. 2020;15(11):e0241284.CrossRefGoogle ScholarPubMed
Buck, K., Spittler, J., Reed, A., Khodaee, M. Psychological Attributes of Ultramarathoners. Wilderness and Environmental Medicine Journal. 2018;29(1):6671.CrossRefGoogle ScholarPubMed
Hoffman, M. D., Krouse, R. Ultra-Obligatory Running Among Ultramarathon Runners. Research in Sports Medicine. 2018;26(2):211221.CrossRefGoogle ScholarPubMed
Hoffman, M. D., Goulet, E. D. B., Maughan, R. J. Considerations in the Use of Body Mass Change to Estimate Change in Hydration Status During a 161-Kilometer Ultramarathon Running Competition. Sports Medicine. 2018;48(2):243250.CrossRefGoogle ScholarPubMed
Knechtle, B., Knechtle, P., Wirth, A., Alexander Rüst, C., Rosemann, T. A Faster Running Speed Is Associated with a Greater Body Weight Loss in 100-km Ultra-Marathoners. Journal of Sports Sciences. 2012;30(11):11311140.CrossRefGoogle ScholarPubMed
Rüst, C. A., Knechtle, B., Knechtle, P., Wirth, A., Rosemann, T. Body Mass Change and Ultraendurance Performance: A Decrease in Body Mass Is Associated with an Increased Running Speed in Male 100-km Ultramarathoners. The Journal of Strength and Conditioning Research. 2012;26(6):15051516.CrossRefGoogle ScholarPubMed
Hoffman, M. D., Stuempfle, K. J. Hydration Strategies, Weight Change and Performance in a 161 Ultramarathon. Research in Sports Medicine. 2014;22(3):213225.CrossRefGoogle Scholar
Landman, Z. C., Landman, G. O., Fatehi, P. Physiologic Alterations and Predictors of Performance in a 160- Ultramarathon. Clinical Journal of Sports Medicine 2012;22(2):146151.CrossRefGoogle Scholar
Martinez, S., Aguilo, A., Rodas, L., Lozano, L., Moreno, C., Tauler, P. Energy, Macronutrient and Water Intake During a Mountain Ultramarathon Event: The Influence of Distance. Journal of Sports Sciences. 2018;36(3):333339.CrossRefGoogle ScholarPubMed
Kao, W.-F., Hou, S.-K., Chiu, Y.-H., et al. Effects of 100- Ultramarathon on Acute Kidney Injury. Clinical Journal of Sports Medicine 2015;25(1):4954.CrossRefGoogle ScholarPubMed
Lipman, G. S., Krabak, B. J., Waite, B. L., Logan, S. B., Menon, A., Chan, G. K. A Prospective Cohort Study of Acute Kidney Injury in Multi-Stage Ultramarathon Runners: The Biochemistry in Endurance Runner Study (BIERS). Research in Sports Medicine. 2014;22(2):185192.CrossRefGoogle ScholarPubMed
Scheer, V., Tiller, N. B., Doutreleau, S., et al. Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review. Sports Medicine. 2021;116.CrossRefGoogle Scholar
Hew-Butler, T., Sharwood, K., Boulter, J., et al. Dysnatremia Predicts a Delayed Recovery in Collapsed Ultramarathon Runners. Clinical Journal of Sports Medicine 2007;17(4):289296.CrossRefGoogle ScholarPubMed
Costa, R. J., Teixeira, A., Rama, L., et al. Water and Sodium Intake Habits and Status of Ultra-Endurance Runners During a Multi-Stage Ultra-Marathon Conducted in a Hot Ambient Environment: An Observational Field Based Study. Nutrition Journal. 2013;12:13.CrossRefGoogle Scholar
Knechtle, B., Chlíbková, D., Papadopoulou, S., Mantzorou, M., Rosemann, T., Nikolaidis, P. T. Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review. Medicina (Kaunas). 2019;55(9):E537.CrossRefGoogle ScholarPubMed
Lipman, G. S., Burns, P., Phillips, C., et al. Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running. Clinical Journal of Sports Medicine 2020.CrossRefGoogle Scholar
Martínez, S., Aguiló, A., Moreno, C., Lozano, L., Tauler, P. Use of Non-Steroidal Anti-Inflammatory Drugs among Participants in a Mountain Ultramarathon Event. Sports (Basel). 2017;5(1):E11.CrossRefGoogle Scholar
Chlíbková, D., Ronzhina, M., Nikolaidis, P. T., Rosemann, T., Knechtle, B. Non-Steroidal Anti-Inflammatory Drug Consumption in a Multi-Stage and a 24-h Mountain Bike Competition. Frontiers in Physiology. 2018;9:1272.CrossRefGoogle Scholar
Lipman, G. S., Shea, K., Christensen, M., et al. Ibuprofen Versus Placebo Effect on Acute Kidney Injury in Ultramarathons: A Randomised Controlled Trial. Emergency Medicine Journal. 2017;34(10):637642.CrossRefGoogle ScholarPubMed
Page, A. J., Reid, S. A., Speedy, D. B., Mulligan, G. P., Thompson, J. Exercise-Associated Hyponatremia, Renal Function, and Nonsteroidal Antiinflammatory Drug Use in an Ultraendurance Mountain Run. Clinical Journal of Sports Medicine 2007;17(1):4348.CrossRefGoogle Scholar
Rotunno, A., Schwellnus, M. P., Swanevelder, S., Jordaan, E., Janse, Van Rensburg, D. C., Derman, W. Novel Factors Associated with Analgesic and Anti-Inflammatory Medication Use in Distance Runners: Pre-Race Screening Among 76 654 Race Entrants-SAFER Study VI. Clinical Journal of Sports Medicine 2018;28(5):427434.CrossRefGoogle Scholar
Hoffman, M. D., Khodaee, M., Nudell, N. G., Pasternak, A. Recommendations on the Appropriate Level of Medical Support at Ultramarathons. Sports Medicine. 2020;50(5):871884.CrossRefGoogle ScholarPubMed
Bennett, B. L., Hew-Butler, T., Rosner, M. H., Myers, T., Lipman, G. S. Wilderness Medical Society Clinical Practice Guidelines for the Management of Exercise-Associated Hyponatremia: 2019 Update. Wilderness & Environmental Medicine. 2020;31(1):5062.CrossRefGoogle ScholarPubMed
McGarvey, J., Thompson, J., Hanna, C., Noakes, T. D., Stewart, J., Speedy, D. Sensitivity and Specificity of Clinical Signs for Assessment of Dehydration in Endurance Athletes. British Journal of Sports Medicine. 2010;44(10):716719.CrossRefGoogle ScholarPubMed
Hoffman, M. D., Stuempfle, K. J., Fogard, K., Hew-Butler, T., Winger, J., Weiss, R. H. Urine Dipstick Analysis for Identification of Runners Susceptible to Acute Kidney Injury Following an Ultramarathon. Journal of Sports Sciences. 2013;31(1):2031.CrossRefGoogle ScholarPubMed
Khodaee, M., Saeedi, A., Irion, B., Spittler, J., Hoffman, M. D. Proteinuria in a High-Altitude 161-km (100-mile) Ultramarathon. The Physician and Sportsmedicine. 2021;49(1):9299.CrossRefGoogle Scholar
Hawkins, S. C. Wilderness EMS. Philadelphia: Lippincott Williams & Wilkins; 2017.Google Scholar
Hawkins, S. C., Williams, J., Bennett, B. L., Islas, A., Kayser, D. W., Quinn, R. Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection. Wilderness & Environmental Medicine. 2019;30(4):S8799.CrossRefGoogle ScholarPubMed
Harmon, K. G., Clugston, J. R., Dec, K., et al. American Medical Society for Sports Medicine Position Statement on Concussion in Sport. British Journal of Sports Medicine. 2019;53(4):213225.CrossRefGoogle ScholarPubMed
Pires, W., Veneroso, C. E., Wanner, S. P., et al. Association Between Exercise-Induced Hyperthermia and Intestinal Permeability: A Systematic Review. Sports Medicine. 2017;47(7):13891403.CrossRefGoogle ScholarPubMed
Roberts, W. O., Armstrong, L. E., Sawka, M. N., Yeargin, S. W., Heled, Y., O’Connor, F. G. ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity. Current Sports Medicine Reports. 2021;20(9):470484.CrossRefGoogle ScholarPubMed
Alhadad, S. B., Tan, P. M. S., Lee, J. K. W. Efficacy of Heat Mitigation Strategies on Core Temperature and Endurance Exercise: A Meta-Analysis. Frontiers in Physiology. 2019;10:71.CrossRefGoogle ScholarPubMed
Joslin, J., Mularella, J., Bail, A., Wojcik, S., Cooney, D. R. Mandatory Rest Stops Improve Athlete Safety During Event Medical Coverage for Ultramarathons. Prehospital and Disaster Medicine. 2016;31(1):4345.CrossRefGoogle ScholarPubMed
Belval, L. N., Casa, D. J., Adams, W. M., et al. Consensus Statement: Prehospital Care of Exertional Heat Stroke. Prehospital Emergency Care. 2018;22(3):392397.CrossRefGoogle ScholarPubMed
Gatterer, H., Dünnwald, T., Turner, R., et al. Practicing Sport in Cold Environments: Practical Recommendations to Improve Sport Performance and Reduce Negative Health Outcomes. International Journal of Environmental Research and Public Health. 2021;18(18):9700.CrossRefGoogle ScholarPubMed
Castellani, J. W., Young, A. J., Ducharme, M. B., et al. American College of Sports Medicine Position Stand: Prevention of Cold Injuries During Exercise. Medicine and Science in Sports and Exercise. 2006;38(11):20122029.CrossRefGoogle ScholarPubMed
Koskela, H. O. Cold Air-Provoked Respiratory Symptoms: The Mechanisms and Management. International Journal of Circumpolar Health. 2007;66(2):91100.CrossRefGoogle ScholarPubMed
Dow, J., Giesbrecht, G. G., Danzl, D. F., et al. Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness & Environmental Medicine. 2019;30(4):S4769.CrossRefGoogle ScholarPubMed
Roach, R. C., Hackett, P. H., Oelz, O., et al. The 2018 Lake Louise Acute Mountain Sickness Score. High Altitude Medicine and Biology. 2018;19(1):46.CrossRefGoogle ScholarPubMed
Luks, A. M., Auerbach, P. S., Freer, L., et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update. Wilderness and Environmental Medicine Journal. 2019;30(4S):S318.CrossRefGoogle ScholarPubMed
Boren, C. Ultramarathoner Killed by Lightning Strike During Italian Race. Washington Post. www.washingtonpost.com/sports/2019/07/30/an-ultramarathoner-caught-between-aid-stations-is-killed-by-lightning-italy/. Accessed December 10, 2021.Google Scholar
Davis, C., Engeln, A., Johnson, E. L., et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries: 2014 Update. Wilderness & Environmental Medicine. 2014;25(4):S8695.CrossRefGoogle ScholarPubMed
Hoffman, M. D. Participant Opinions and Expectations about Medical Services at Ultramarathons: Findings from the Ultrarunners Longitudinal TRAcking (ULTRA) Study. Cureus. 2019;11(9):e5800.Google ScholarPubMed
Schwabe, K., Schwellnus, M., Swanevelder, S., Jordaan, E., Derman, W., Bosch, A. Leisure Athletes at Risk of Medical Complications: Outcomes of Pre-Participation Screening Among 15,778 Endurance Runners – SAFER VII. The Physician and Sportsmedicine. 2018;46(4):405413.CrossRefGoogle Scholar
Joslin, J., Hoffman, M. D., Rogers, I., Worthing, R. M., Ladbrook, M., Mularella, J. Special Considerations in Medical Screening for Participants in Remote Endurance Events. Sports Medicine. 2015;45(8):11211131.CrossRefGoogle ScholarPubMed
Sedgwick, P. E., Wortley, G. C., Wright, J. M., Asplund, C., William, O. R., Usman, S. Medical Clearance for Desert and Land Sports, Adventure, and Endurance Events. Wilderness & Environmental Medicine. 2015;26(4):4754.CrossRefGoogle ScholarPubMed
Joy, E., Baak, K. V., Dec, K. L., et al. Wilderness Preparticipation Evaluation and Considerations for Special Populations. Wilderness & Environmental Medicine. 2015;26(4):7691.CrossRefGoogle ScholarPubMed
Larson, H. H., Khalili-Borna, D., Uzosike, E., Sugiyama, D. Medical Coverage of Ultramarathons and Its Unique Challenges. Current Sports Medicine Reports. 2016;15(3):154160.CrossRefGoogle ScholarPubMed
Yao, K. V., Troyanos, C., D’Hemecourt, P., Roberts, W. O. Optimizing Marathon Race Safety Using an Incident Command Post Strategy. Current Sports Medicine Reports. 2017;16(3):144149.CrossRefGoogle ScholarPubMed
Nash, C. J., Richards, C. T., Schwieger, G., Malik, S., Chiampas, G. T. Medical Care at a Large Vertical Running Event. Prehosp Emerg Care. 2018;22(1):2227.CrossRefGoogle Scholar
Hoffman, M. D., Longobardi, C., Burt, C., Nardi, T. GPS Tracker-Enabled Rescue of a Lost Runner During a Wilderness Ultramarathon: A Case Report. Current Sports Medicine Reports. 2018;17(10):332334.CrossRefGoogle ScholarPubMed
Metzler, B. Czech Runner Dies from Falling During UTMB’s TDS Race in Chamonix. Trail Runner Magazine. 2021. www.trailrunnermag.com/people/news-people/czech-runner-dies-from-falling-during-utmbs-tds-race-in-chamonix. Accessed December 7, 2021.Google Scholar
Ross, D. S., Ferguson, A., Herbert, D. L. Action in the Event Tent! Medical-Legal Issues Facing the Volunteer Event Physician. Sports Health. 2013;5(4):340345.CrossRefGoogle ScholarPubMed
Schwellnus, M., Kipps, C., Roberts, W. O., et al. Medical Encounters (Including Injury and Illness) at Mass Community-Based Endurance Sports Events: An International Consensus Statement on Definitions and Methods of Data Recording and Reporting. British Journal of Sports Medicine. 2019;53(17):10481055.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×