Tour de Force

Colin Baird / Consultant in Anaesthesia and Pain Medicine

The Tour de Force is an annual three-week charity ride that almost exactly mirrors the Tour de France route and schedule. It raises money for the William Wates Memorial Trust and is hugely demanding for the amateur riders involved. Colin Baird has been a doctor for the event for the last three years – not just tending to the riders but cycling the whole route alongside them. He has dealt with roadside trauma, staved off starvation with a 10,000 Kcal diet and embraced white lycra.

Col d’Izoard

As I approached the highest point of the 2014 Tour De France route, the 2360m Col d’Izoard, the clouds suddenly cleared to reveal a tantalisingly brief view of the Alpine vista far below. As quickly as they parted however, their all-enveloping presence returned, and I was once more left with the sound of my own breath for company.

Usually, as one completes a climb such as this, the prospect of an enjoyable descent is the incentive to round those last few hairpins. On this occasion however, the thought of the descent filled me with a sense of foreboding. In the 140km I’d ridden that day already I’d suffered more than at any time previously on a bike, due mainly to the unseasonably cold conditions combined with heavy rain and sleet. Before sunrise we had descended 18km from the ski station in Chamrousse in freezing conditions. Many had struggled to hold the handlebars due to shivering, and two members of our group had abandoned already that day. The descent of the Col d’Iozard may take two hours – two hours of added wind-chill and reduced exertion, negotiating tight corners in wet conditions, where a moment’s distraction could result in significant injury to both body and bike.

The sight of one of our support vans at the summit lifted my spirits, and in the back I found half a dozen of our cyclists warming up before the descent, with Ian the mechanic and ‘barista extraodinaire’ providing steaming sweet coffee. The elder statesman of our party, a charming 68 year old gentleman, casually informed me that he’d decided to climb into the sweeper van for the day when his beta-blocked heart rate dipped below 30bpm. I congratulated him on his common sense.

The Tour De Force

The Tour De Force is an experience like no other. For three weeks an eclectic mix of amateur enthusiasts cycle that year’s Tour De France route, seven days ahead of the actual tour. They follow almost exactly the same route, with exceptions only being made where the open roads prevent safe passage on a bicycle. They do follow exactly the same itinerary, with identical starts and finishes. Many towns and villages are preparing for Le Tour seven days later, and the iconic Alpine and Pyrenean passes are playing host to camper vans from across Europe.

The Team

There are approximately 40 ‘Lifers’ doing the whole route, and another 120 or so ‘Tour Tasters’ doing sections of between 3 and 10 days. The riders are supported by an entourage of mechanics, physiotherapists, massage therapists, route signers, logistical staff, and volunteer medics – of which I was one. Cyclists quickly enter the ‘Tour bubble’, cycling between 160km and 240km most days. All navigation, accommodation, transfers, luggage transport, food (lots of food), mechanical support and even the occasional beer is provided, leaving the participant free to concentrate solely on turning the pedals and following the arrows. For many, this distillation of life into the routine of ‘eat, sleep, ride, repeat’ is one of the events great attractions.

Underpinning the event is the charity for which all participants are raising money. The William Wates Memorial Trust is a family-run charity, providing grants to assist projects aimed at helping disadvantaged young adults, often through the mediums of sport and the arts. The Tour De Force is the charity’s main fundraiser and was then in its third year. To date it has raised over £2,000,000, and this year’s event alone raised £500,000.

The medical support consisted of two volunteer doctors who, unlike the rest of the support staff, were cycling the event as well. It was my third year of involvement. In 2012, I cycled the final 8 stages. In 2013, I completed the entire route, so 2014 was my second ‘Lifer’ experience. When my friend Sarah Perry, the event organiser, had asked me to be involved in 2012 I had leapt at the chance. I had only just discovered cycling. Like many people on the wrong side of 35 (particularly anaesthetists for some reason) I had embraced the sport and its rich heritage with a child-like enthusiasm. Prior to embarking on a career in anaesthetics and pain medicine I had worked as a registrar in emergency medicine both in the UK and Australia. Since then I had also been involved with pre-hospital event medical cover at music concerts and sporting events.

There was no ‘fitness test’ for participants, only a pre-event medical questionnaire signed by their GP. The event was deliberately as inclusive as possible, which certainly added to its appeal, and great efforts were made to try to ensure that everyone completed what they had set out to do. The medical input was very much along these lines, and our primary role was to support riders along the way for as long as they wished to continue. As with the Tour De France itself riders learnt to ‘recover’ from injuries while continuing to ride, adapting their techniques and calling on the support of others in the peloton when necessary.

We had kit to deal with minor injuries, a selection of oral analgesics including tramadol, antibiotics and gastrointestinal medications, all aimed at allowing riders to continue if at all possible. The excellent physiotherapists in our group supported us in this aim. In the event of significant trauma or a serious medical condition the local emergency services would be involved, and we were not expected to provide immediate roadside assistance. It would not have been practical with the event format as it stood.

A typical day began with breakfast at around 6am, aiming to start cycling at 7.30am. The signing car would have departed hours earlier, putting up distinctive yellow TDF arrows at all appropriate points along what could be a 200km+ route. Four feedstops would be planned along the route; each with its own distinctive character, and gargantuan amounts of food and drink were available.

Everyone would regroup at the first feedstop, allowing the initial part of the day to be relaxed and an often very sociable warm-up in anticipation of what was to follow. Beyond that, folk could cycle at their own pace meaning groups of like-minded individuals naturally formed and reformed along the way. On long days, the most ‘relaxed’ cyclists might not have arrived at the next hotel until quite late at night but despite that, all efforts were made to eat as a group. In the evening, there was a briefing about the following day’s logistics and cycling followed by two awards – the chapeau for showing generally good character and helping a fellow cyclist and the moustache for sullying the good name of the tour (getting lost, wearing white lycra and other crimes…)

A mere 9670 kcal

The days certainly revolved around food – for some more than others perhaps – and this was hardly surprising when one considered the energy expended in covering each day’s cycle. The cumulative distance this year was 3664km and the total ascent of classified climbs alone was 21,125m, with many more unclassified bumps along the way. On one of the days I kept a food diary, noting every morsel to pass my lips in a 24hr period. An astonishing 9670 kcal was consumed, and this was perhaps an underestimate as my portion sizes were notoriously large! Despite such feats of gluttony, I still lost a couple of kilos over the three-week period.

Doctor and cyclist

My dual role as doctor and cyclist was both challenging and rewarding. The personal challenge for me, beyond simply completing the event, was to remain strong enough to look after my own needs and those of the other riders. That meant being able to adapt my cycling during the day, pushing on at pace when called upon and hanging back for stragglers at other times. I suffered my fair share of aches and pains, as well as sustaining a heavy crash while descending in the rain. That particular incident brought home to me the importance of wearing a helmet, as I would certainly have sustained a significant head injury without one. As it was, I was required to purchase a new helmet the next day – a small price to pay.

Although the doctors carried mobile phones, reception was often erratic, so messages would be relayed via feedstops regarding anyone requiring medical assistance. In that way, one of the doctors could be with a casualty relatively quickly given the circumstances. Most medical input along the way was supportive and to provide simple analgesia.

Crashes

Thankfully there were only two serious crashes during the Tour, both of which involved collisions with motor vehicles. The first, a 55 year-old male, resulted in generalised abrasions, concussion and clinically fractured ribs. Our other doctor happened to be on the scene and facilitated his rapid transport to hospital by ambulance. He was discharged that evening, and a medical assessment at the hotel concluded that he would be fit to continue cycling (as he strongly wished to do).

He required regular analgesia (co-codamol, ibuprofen plus PRN tramadol) for the first few days and was significantly slower than the rest of the group over mountain passes. On a number of stages he would finish in the dark with only the lights of the sweeper van to guide him, and be met by a round of applause as he joined everyone for dinner, still adorned in wet cycling gear. By the final week however, he’d largely recovered and managed to finish strongly. To me, this wonderfully exemplified the inclusive nature of the event.

The second serious incident involved one of our cyclists straying onto the wrong side of the road during a high-speed alpine descent, and colliding with a vehicle travelling in the opposite direction. Fellow cyclists called the emergency services and he was airlifted from the hillside. Incredibly, his physical injuries were such that he to was also discharged the same day. The experience had left him very shaken however, and we agreed that he shouldn’t try to continue cycling and instead would be transported back to the UK. He joined us again at the finish in Paris, almost fully recovered and smiling again.

As with all other areas of the event’s organisation, the medical role has evolved in light of each year’s experiences. My learning points from this year’s event related to the type of medical kit taken and how it represented the type of medical support being provided. Given the relatively limited roadside assistance offered by the current setup, was there any place for carrying trauma kit at all? That and other questions will be discussed further prior to TDF 2015.

Vive Le Tour!

As a cycling enthusiast, there can be few more fulfilling and challenging experiences than cycling the Tour De France route. The event runs like clockwork and that is due entirely to the incredible leadership and wonderful teamwork shown by the Tour De Force staff. It was a privilege to work alongside them.

To complete the Tour De France route in roughly the same timescale as the actual Tour gives an insight, however slight, into what it must be like to actually participate in what is widely regarded as the hardest sporting event out there. Vive Le Tour!