Running Into Trouble

With heat, watch for altered mental status.

Attack One comes on duty at 0500 hours and it's warm already.

That’s typical for the yearly event it’s working today, a 10-kilometer summer race that draws huge crowds to watch the runners. The first race starts at 0700, so crews have to be in place at 0600 hours. This year the Attack One crew is assigned to the runners’ medical tent at the finish line. Other crews are located along the race route through the city to care for the crowds and competitors.

The race includes more than 20,000 runners, so there are always many heat-related illnesses. This year the temperature is already 73ºF, with no breeze and a relative humidity of 70%, so the rescuers and race organizers must prepare for a higher risk of heat emergencies.

The crew members arrive at the tent and meet with the combined medical crew, which includes nurses, physicians, and EMT and paramedic providers. Equipment is specially staged; it includes water-permeable cots and 30-gallon barrels filled with ice water and towels. The crews bring the usual array of cardiac monitors and emergency supplies for runners with more significant problems.

The event’s medical director addresses the group. He has been doing this event for 25 years and is himself an experienced 10K and marathon runner. “We are here to care for the runners, and we will see more than 100 this morning,” he announces. “A few will arrive with blisters, cuts or sprains, and they will be treated by the athletic staff. Most of the victims coming to this tent will be suffering from heat illnesses. They are to be cooled on the cots, rolled on their sides and observed for mental status changes. That is our key indicator of heat illness. As usual, there are no IV fluids in the tent. Unlike marathon runners, there are no indications for intravenous fluids or lines. Anyone who has a significant medical issue, like chest pain, dysrhythmia or asthma, will be placed into an ambulance and receive EMS protocol care en route to a hospital. Those things are very rare in these runners. Cooling is our priority, and we do it with ice-cold towels. When the runner can sit up and has normal mental status, they can take some oral fluids.” The directors then cover some specifics about medical record-keeping and how to get runners reunited with their families.

The senior member of the Attack One crew has participated in this event before and orients the new members to the rest of the operation. The crew will stand at the finish line of the 10K and assist in identifying runners who are in trouble as they arrive. Those runners will be guided, carried or wheeled the few yards to the medical tent, where they will be evaluated and cooled. Attack One’s paramedic member is also leading EMS triage and will assign ambulance crews to runners needing to be transported and manage any other emergencies in the crowd around the finish line.

The first runners arrive within 30 minutes of the race’s start. They are all world-class distance runners, and even they are affected by the morning’s heat and humidity. They are all medically fine, however, and move to the shaded area around the trophy area, where they will be receiving awards in a ceremony that takes place before many of the thousands of other runners even cross the finish line. After the world-class runners, who number about 20 or so, come a lot of runners who have really been running hard to catch the elite athletes. These are where the first casualties are found.

Soon the experienced “spotters” at the finish line are leading exhausted runners into the medical tent. These runners are placed on their sides on the cots, and medical personnel put ice-cold towels under their arms, across their heads and in their groins. Fans blow air across them. The runners are wearing only running shorts and shirts and shoes, so shoes are the only clothing that has to be removed. Every runner who is lucid knows they have to turn in the electronic tag on their shoes, which tracked their running time. A runner who doesn’t ask about their tag is immediately considered to have an altered level of consciousness. Accordingly, a designated member of the race team goes from patient to patient to get the tags as the shoes are removed.

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