The Red Tent
If your race is going well, you probably don’t even notice the red tents along the way. Filled with cheering, expectant volunteers often wearing red, they are tucked in separate from water or GU stations, right along the path every few miles, especially near that steep hill and the finish line. Normally you’ll run right by these without a second thought, but if you need the tents, you’ll be happy they’re there.
I’ve had the honor to work at medical tents and help plan the medical coverage of numerous half marathons, marathons, ultramarathons, and triathlons. Second only to getting a PR at a race you’ve been training hard for, helping numerous others do the same can be incredibly satisfying. During an average day on the course we don’t do much: we spend the day cheering like any other volunteer or spectator along the course, and hope that our advanced expertise is not needed. We are ready, however, with extensive plans, skills, equipment, experience, and infrastructure set up to give you your best chance to either finish this race, or recover and heal so you can finish the next. The medical tent’s captain is usually a doctor or highly experienced nurse, and members of the team can be everything from doctors to medical or nursing students, to physical therapists and athletic trainers, to podiatrists and massage therapists. We all have different areas of expertise and skill sets, but together we are equipped to handle everything from true medical emergencies such as heart attacks and heat stroke, to bumps and bruises, and scrapes and cramps. Given this, I wanted to share a few pointers on how to both avoid having to use the medical aid stations, and also what to do if you do need our help.
- Prepare: The most important way to avoid having a medical problem during a race is to train and be prepared for the race you are doing. This means that you know ahead of time how to hydrate yourself and what clothing and shoes you can wear without chafing or getting blisters. It also means having the appropriate fitness to complete the race you signed up for, at your intended pace. Be aware of your surroundings and have an emergency plan or meeting spot with your friends and family. If conditions are much hotter, or at higher altitude, then you are accustomed, allow some time to acclimatize before the race.
- Advise: If your race is set up for this, fill out any health questionnaires ahead of time. More and more races are incorporating electronic records so that medical personnel can easily access medical history if you are unable to tell someone yourself. Failing this, write any important medical conditions (diabetes, allergies, heart conditions) on the back of your bib or on a wrist band, along with an emergency contact.
- Medications: Do not take ibuprofen before a race! There is increasing evidence that taking NSAIDS such as ibuprofen, Motrin, Advil, or Aleve before a hard aerobic effort can increase your likelihood of having kidney damage or problems with hyponatremia (low sodium) during a race. Tylenol is generally considered safer, but even that is not clear. Besides, if you are really so sore that you need medications before you even start, is it really wise to be doing it? Its ok to take these types of medications after a race as long as you are urinating ok and do not have any other major metabolic problems. Don’t expect to get any medications from the medical tent – sometimes we’ll carry Tylenol, but not always.
- Be smart: If you come up to me either before the race or in the early miles and say something on the order of, “My knee is injured, my doctor told me not to run, but I want to, is that ok?” Be prepared for the answer “NO!” Your doctor has had far better opportunities to do a complete evaluation of your injury, and I’m not going to contradict his or her advice. No one is going to disqualify you for pain in your knees that we don’t know about, so if you are planning on running the race anyway despite your doctor’s advice, why are you asking me??
- Blisters and Chafing: In the red tents, we will often be ready with popsicle sticks smeared with Vaseline for you to grab and smear on your underarms, between your legs, or wherever else you are chafing. Don’t double dip (remember you are not the only one using the Vaseline), and the best treatment is prevention and knowing what clothing works for you.
- Icing: On a hot day, especially at the finish line, we get tons of people stopping by to get ice for their knees or other joints, or just to put on their necks. While it certainly is true that ice will reduce inflammation and hence pain caused by heavy use, at the medical tent we have to ration our ice, and our time. Our main job is to treat serious, potentially life threatening conditions, and ice can play an essential role in this if someone develops heat stroke (when body temperatures soar upwards of 103 and lead to confusion, coma, and sometimes death if we can’t get the temperature down in a timely fashion). To do this we need A LOT of ice, and if we use it all wrapping people’s sore knees, we could be in trouble when people really need it. Each tent and race is different, but in general its not going to make much difference if you start icing within five feet of the finish line, or wait an hour until you get into your home or hotel room. So if you can wait, please do. And if the medical staff seems busy treating medical emergencies, please don’t get upset if we can’t give you ice. Similarly, IcyHot or other cold sprays are extra and may feel good but don’t actually make any serious medical difference, so try to understand if we seem to disregard your request for cold spray on your knees while dealing with the asthma attack in the cot next to you.
- Keep moving at the finish line: One of the most common ailments we see at finish line tents is called exercise associated collapse. This scenario usually plays out right after the finish, when you’ve been pushing your hardest through that final few feet and then you suddenly stop, often bent over at the waist, breathing heavily (of note – most heart attacks occur right BEFORE the finish line, so in general medical staff will be much more concerned about a collapse before the finish line rather than after). This can be quickly followed by fainting – you’ll feel light headed and collapse to the ground. By the time bystanders or medical personnel are at your side, often you will be awake but feeling miserable, nauseated, and lightheaded. The treatment for this collapse is to get into a cool place with your legs above your heart, and allow you to rest for a few minutes. This is usually not dangerous, and is caused by the sudden stop in activity. While you are running or pushing hard, the veins in your legs are actively pumping blood back up to your heart and brain, and the hormones involved with keeping you pushing (epinephrine) are keeping your veins contracted. When you finish, all that stops at once and the blood pools in your legs, limiting the amount of blood that can get to your brain and causing you to faint. Simply by keeping moving after you race by forcing yourself to keep walking will usually keep this from happening. Hence the long walk after finishing a race before you can get your medal, water, treats, and meet your family.
- Hydration/hyponatremia: During a long endurance race, most people are focused on staying well hydrated. We sweat hard in the heat and common sense says that to avoid getting heat illness, you need to drink. While this can be true up to a certain degree, if you drink too much you can end up with a serious condition called hyponatremia: low sodium in your blood. Basically you drink so much, and are sweating out liquid that has lots of sodium in it, that you are diluting the sodium in your blood. This can cause you to feel puffy, with swollen hands and feet and face, and get nauseated, confused, and weak. If severe, it can cause seizures and coma and even death. The best way to avoid this, especially if you are out on a course for a long time, is to only drink if you feel thirsty. If you are running a marathon, the people that are at highest risk are on the course for more then 4 hours, and drink large amounts at every water stop. Drinking Gatorade or other electrolyte supplements (at least the commercially available ones) doesn’t make much difference, because you will still be drinking a liquid that has significantly less sodium in it compared to your blood. If you have access to a scale (especially on an ultra race), you should be losing weight, not gaining, during the run. If you or your friends are feeling puffy, gaining weight, or getting confused or having difficulty walking in a straight line, get medical help!
- What to do if someone around you is in trouble: The big things to worry about are heat illness, heart attacks, hyponatremia, asthma attacks, strokes, and trauma (especially if bikes are involved). During a race, these things can happen at times in the middle of the course, and racers are reliant on their fellow racers for help if it is not readily available from the race staff. Keep your eyes open for people in trouble, and take the extra time to lend a hand if it is needed – you could save a life, and there will always be more races for you! It pays to take a local first aid class and be familiar with current recommendations for CPR, which include starting chest compressions if there is no pulse, and getting an AED (automatic external defibrillator) as soon as possible. If someone is bleeding, hold pressure on the site that is bleeding. If someone is stumbling, or vomiting, or walking the wrong way on the course, spend the 15 seconds it takes to figure out if they need help. Ask for help from other participants or bystanders and send someone to call 911 or contact race officials or the nearest medical tent if you need it.
- Respect: Keep in mind that most of the medical volunteers are just that, volunteers. We understand that you have been training hard, paid good money for your race, and are putting out incredible efforts during the race and your focus is on your goal, but please treat us with respect. We do this because we love it.
Stay safe and strong!