The Little Rock Marathon is in it's 6th year. The event this year takes place on Sunday March 2nd. I participated the first three years, finishing each year in less than 6 hours (as I once told Dr Val, I'm a not fast, more of a plodder). I walked/jogged the first year and then just walked the next two. Since then I have switched over to being part of the medical volunteer crew. My first year, I asked Dr Kent Davidson if there were any articles that I could read that would better prepare me. We both felt I would be okay with the blistered feet, the sprains, etc. So he gave me some information on exercise-associated collapse (see reference below). I kept the article and review it each year.
In addition, he gave me the Medical Protocols for the LR Marathon. These are Dr Davidson's guidelines for us. He has managed to recruit physicians, nurses, physical therapists (who do the muscle stretching and massages), EMT's and lay volunteers (who do some of the clerical work). It is a nice summary for anyone like me who volunteers, but is not in the sports medicine specialty.
EXERCISE-ASSOCIATED COLLAPSE (EAC)
- Mental status--lightheaded, dizzy, brief loss of consciousness
- Rectal temp--below 102.5 degrees Farenheit
- Blood pressure--Orthostatic hypotension, improving with recumbancy (within 30 minutes)
- Pulse--Tachycardia, improving with leg elevation
- Lab--Normal serum sodium and glucose
- Head down position on stretcher or cot with foot elevated 6 in
- Monitor BP and pulse (check every 15 minutes)
- Oral hydration
- Expect recovery in 15-30 minutes
- Appropriate cool-down -- continue moving (walking) after race
- Encourage those that feel faint to lie down with legs elevated
- Assess rectal temperature on admission and every 15 minutes
- If rectal temp is greater than 104 with alteration of mental status, then cover athlete with towels and water or immerse and begin IV with NS.
- For heat stroke initiate the above measures and prepare to transport when rectal temp less than 104 and vital signs (VS) are stable.
- Offer oral fluids when athlete is able.
- Discontinue passive cooling when rectal temp less than 102.
- May discharge when temp has normalized, taking oral fluids, neurologic exam and cognitive function is normal.
- For residual symptoms, eg. CNS, vascular, renal -- transfer to emergency facility for evaluation.
- Passive stretching
- Oral hydration
- Indications for IV fluid therapy
- Athlete is unable to drink
- Persistent cramping despite stretching and oral hydration
- Signs of severe dehydration, eg. dry mucous membranes, sunken eyes, inability to spit, persistent hypotension and tachycardia
- Alteration of mental status--uncoordination, lightheadedness, seizures, coma
- Edema of hand and fingers -- rings fitting tight, weight gain during race
- Serum sodium less than 130 mmol/L
- If alert and serum sodium is more than 130 mmol/L, moniter and await spontaneous diuresis. Do not give IV fluids.
- If serum sodium is less than 125 mmol/L and /or semi-comatose or comatose, transfer to emergency department. Treatment includes use of low dose diuretics and hypertonic saline.
- Towel used for cooling or wiping athletes must not be reused.
- Use Universal Precautions -- wear gloves
- Sharps containers and medical waste bags are to be used for contaminated materials
- Hand washing between patients.
Exercise-Associated Collapse: Postural Hypertension, or Something Deadlier?; Dale B Speedy MD, Timothy D Noakes MD, Lucy-May Holtzhausen MBChB; The Physician and Sportsmedicine, Vol 31, No 3, March 2003
Marathon Racing & Medical Tips (Hyponatremia and Blister Care); Sports Injury Prevention Newsletter, Issue #2 (click on the PDF file)
Marathon Medicine by Dan Tunstall Pedoe; Royal Society of Medicine Press; 1 edition (2000)