Medical Pointers for Participation at International Events

author : AMSSM

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Knowing where the fluids are, how they will fit on your bike, how much to reach for, and when to reach for it should be understood prior to ever setting foot on the course.

Benjamin A. Hasan, MD
Member AMSSM

In serving as volunteer physicians for endurance events both here and overseas, we see a variety of levels of medical preparedness by local sports medicine teams. Here are a few pointers I suggest from my work with the USA team at the World Duathlon Championships in Barcis, Italy:

1. There are generally plans made for the most serious conditions.

These may include local medical triage of the injured athlete and plans for transport to area hospitals or emergency rooms. The Italian medical team facility consisted of a hospital tent situated at a point along the race course that was easily accessible, but not near the finish line. Transportation of athletes and spectators by one of the many ambulances on the scene appeared to be quite efficient. The paramedics were professional, and their technical expertise was very good. One physician handled serious medical cases in the main tent. The local team was prepared to transfer any athlete who was thought to have a questionable diagnosis, who had prolonged symptoms of any kind, or who was medically unstable. American physicians and USA Triathlon staff were allowed inside the main hospital tent to assist with US athletes. The altitude of the mountain bicycle course added to hydration challenges.

In the United States, the finish line is seen as the site of greatest need medically. Larger races have numerous paramedics and ambulances on the scene for any medical issues on the course, including those involving spectators and staff. Local events overseas are generally staffed by people with limited experience of medical coverage for duration events. The physicians in US Sports Medicine organizations that work local races specifically train and practice in Sports Medicine settings and usually have broader coverage experience. This experience can be critical to successful event coverage.

2. Triathlons offer the Sports Medicine teams that volunteer for duty a great variety of medical issues.

In any warm weather endurance race, however, fluid balance issues in general, and dehydration in particular, are the most common medical problems faced by triathletes. It is critical to plan ahead for post-race rehydration. We expected the mountains of Italy to be cool at race time, and traveled with cool weather clothing. Instead, the Dolomite Mountain region experienced high temperatures that were quite unusual for spring, resulting in a greater need for fluids. We discovered that there is not always oral hydration provided sufficiently at the finish line. While medical coverage teams in the states generally have plans in place that emphasize fluid availability over the course as well as at the finish line, the finish area in Barcis had little capacity for assisting with hydration. Plan ahead to have an adequate supply for yourself or your team. Know where sources of safe bottled water are before temperatures rise.

3. Water provided on the course may not be in suitable containers for your bike.

Think about getting available fluids into bottles that you know will fit well. Plan to have enough containers available. Know the rules for assistance in the race. These rules were very strictly enforced at the ITU Worlds.

4. For triathletes going to an international event, it could be critical to have your own plan for assistance at the finish line.

These plans must include basic hydration and personnel. If you are with a large group, this may come in the form of a prepared medical team and staff. If you are on your own, have a plan with family or friends so that there is no guessing about the location and quick availability of both fluids and assistance if you should need it.

5. Replacing carbohydrates is one of the keys to safe triathlon racing.

When the event ends, fuel replacement is vital to avoid post-race hypoglycemia. Know who has the solutions and foods you need and where they will be.

6. The potential risk of low blood sodium (called hyponatremia) that exists in especially long distance races can be a difficult concept for many athletes.

During and after a four hour race in the 90 degree heat, the most common problem limiting athletes' ability to finish, or limiting their competitiveness, is loss of body fluid – not low blood sodium. During conditions like this it is important to continue to drink fluids. In contrast, slow racers during very long events in cooler conditions can over-hydrate, causing hyponatremia. In extreme temperatures with fast athletes, any attempt to limit fluids contributes to more rapid dehydration, cramping, and poor performance or even failure to finish. Training allows motivated athletes to better tolerate the fuel demands, fluid shifts, and body pH changes of distance events. Failure to replace fluids sufficiently can minimize the benefits of all the hard work and long hours of training.

Knowing where the fluids are, how they will fit on your bike, how much to reach for, and when to reach for it should be understood prior to ever setting foot on the course.

Benjamin A. Hasan, MD
Family Medicine and Sports Medicine @ Ridge Family Physicians
Park Ridge, IL
Member AMSSM

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date: October 2, 2005