In this article Dr Constance Osborne and Dr Rebecca Webb share their experiences of working as race medics at Montane’s Summer Spine ultramarathon. From extreme foot care to asthma and hypoglycaemia, the race medic needs to be prepared to support runners with minimal resources at their disposal. Here, Constance and Rebecca share some of their highlights and insights from a challenging but rewarding race.
The runner came through the door of our medical room in the small hours of the morning, guided by a concerned volunteer. She had been picked up on the side of the trail, battling nausea and exhaustion. A warm blanket placed around her shoulders, mug of tea in hand, the limited medical assessment could begin.
The history was unremarkable aside from several vomiting episodes. No trauma or predisposing medical conditions. Pulse and blood pressure within an acceptable range, temperature and blood sugar equally normal. What could be causing this overwhelming nausea? We made a makeshift bed out of a roll mat and continued to question her.
“I don’t know why I feel so awful,” she said, “I’ve drunk at least 10 litres of water today.”
Our new differential diagnosis: hyponatraemia secondary to overzealous adherence to the pre-race medical briefing warning against dehydration. After giving an anti-emetic, we observed her for half an hour and advised some rest after dinner. She emerged from the camp bunk bed three hours later feeling much better. We safety-netted her and then she was on her way again. Off running into the night.
The Montane Summer Spine Race
The Montane Summer Spine is a legendary course amongst trail runners. Starting in the bucolic town of Edale, athletes will navigate the full length of the Pennine way over six and a half days. From the Peak District to the Yorkshire Dales, across Northumberland National Park to the finish line at Kirk Yeltholm in the Scottish Borders, they will encounter some of the most difficult terrain in the UK. No section of this race is forgiving, but each is breath-taking. The full course is 268 miles and inevitably not everyone crosses the finish line. There are shorter, though no less arduous, iterations of the route that occur alongside the main event: the ‘Sprint’ and ‘Challenger’ races.
Participants range from first timers to seasoned trail runners. Each determined to test their mettle against the unforgiving elements. But even the most experienced runner may need some help along the way. This is where local volunteers and the medical team from Beyond the Ultimate (BTU) step in. BTU organises a growing repertoire of multi-stage foot-races and it is through them that we applied for medical volunteer roles in late June 2022.
Day to Day
The job of an ultramarathon medic is to ensure that runners are safe to continue racing. We are there to treat emergencies, which fortunately are rare. Occasionally a medic has the unenviable role of balancing a participant’s determination to finish the race with their health needs and the risks inherent to an endurance event. Prior to the event all medical personnel were briefed comprehensively on the contents of the kit bags and emergency protocols. These requirements were reiterated at each check-point to the runners. We had a clear chain of command and access to senior support at all hours.
Common things are common
The bread and butter of a race medic’s day is foot care. We became quickly acquainted with the nuances of K-Tape (a multi-purpose flexible tape used in high-performance sport). Musculoskeletal issues were frequent, ranging from twisted ankles to tendonitis. When assessing runners, we looked for features of stress fractures or signs that indicated the need for an x-ray. Anything that warranted further investigation meant withdrawal from the race. Inexplicable nausea and vomiting was also a routine complaint, something which often resolved with half an hour’s rest. Hypoglycaemia, asthma exacerbations, insect bites, lacerations and chafing all made their way to the medical team. However, where safe, athletes were encouraged to self-manage their issues. Occasionally this in itself led to difficulties with a few runners deciding to ignore the pre-race brief to avoid NSAIDs during the event due to recognised complications such as renal impairment and hyponatraemia.
The Race Environment
The effective management of an ultramarathon runner must incorporate a consideration of their surroundings. The continuous slog through a variety of weathers and landscapes leads to an equally varied range of pathologies. Uneven, rocky surfaces lead to falls and head injuries. Wet weather can lead to foot maceration. The Summer Spine is not always sunny despite its name and wind chill, rain and running through the night meant that hypothermia and its sequelae were important differentials. This year’s race featured some exceptionally hot days, with runners having to traverse exposed moors and trails for hours. The sustained nature of the exertion combined with high ambient temperatures can affect the thermoregulatory mechanisms of even the most experienced athlete. That said, we only saw a couple of cases of heat exhaustion towards the end of the race and thankfully none of heat stroke.
Weird and Wonderful
In the final days, we saw a couple of cases of ‘the ultramarathon lean’. This is when a runner leans anywhere up to 90 degrees to one side, leading to a banana-like posture. Another runner had such bad neck fatigue that he could not lift his head for the last 14 hours of the race. These issues were treated with an hour’s sleep where possible and an encouraging word or two as they continued onwards. Towards the end of the race, the cocktail of exhaustion and continuous stimulation sometimes led to hallucinations. Tree trunks, roots and rocks can take on a life of their own for an ultramarathon runner in these conditions.
How to get involved
Our experience as medic volunteers was unforgettable, not just the impressive blisters, but because of the athletes themselves. Being a medic allows a unique insight into the highs and lows of each person’s race experience, along with the chance to become a unique part of their story. The jubilation felt watching a runner that you have patched together cross the finish line is hard to describe. However this is not a volunteering role to take lightly. It is a tiring event with long and unpredictable hours. Most of the volunteers were there during their annual leave and returned to work more tired than when they left.
As junior doctors seeking experience in expedition medicine, this was the perfect opportunity for us to develop some prehospital skills. That said, anyone seeking to volunteer at this event below ST3 level may run into indemnity issues. The BTU medical team will assist you in arranging indemnity through a private broker, but this can take weeks, so please keep that in mind when applying.
Food and accommodation are provided throughout the event. Each volunteer is issued with a certificate of attendance. As it is a Montane race, opportunities for merchandise and a personal discount code are available. Fuel expenses are reimbursed and a further £100 contribution made for additional costs such as indemnity (rising to £350 if you do four or more days).
You can read more about the variety of events organised by Beyond the Ultimate here.
If you would like to inquire about volunteer opportunities, contact the team via email: firstname.lastname@example.org. Please have a CV prepared.
All photos included in this article were used with the owner’s permission. All medical photography has been included with the featured patient’s permission.