WILDERNESS & ENVIRONMENTAL MEDICINE, 26, S47–S54 (2015)

CARE OF THE ATHLETE Medical Clearance for Desert and Land Sports, Adventure, and Endurance Events

Peter E. Sedgwick, MD; George C. Wortley, MD; Justin M. Wright, MD; Chad Asplund, MD, MPH; William O. Roberts MD, MS; Saif Usman, MD

From Central Maine Sports Medicine (A Clinical Division of CMMC), Lewiston, Maine (Dr Sedgwick); the Lynchburg Family Medicine Residency, Lynchburg, Virginia (Dr Wortley); the Department of Family and Community Medicine, Paul L. Foster School of Medicine, El Paso, Texas (Dr Wright); Family Medicine, Georgia Regents University, Augusta, Georgia (Dr Asplund); the Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota (Dr Roberts); and Primary Care Sports Medicine, Marymount University, MedStar Medical Group, Arlington, Virginia (Dr Usman).

Endurance events are increasing in popularity in wilderness and remote settings, and participants face a unique set of potential risks for participation. The purpose of this article is to outline these risks and allow the practitioner to better guide the wilderness adventurer who is anticipating traveling to a remote or desert environment. Key words: wilderness medicine, environmental medicine, hyponatremia, endurance events, spelunk- ing, adventure , desert, , preparticipation

Introduction Definitions Endurance events are increasing in popularity in wilder- To better understand the factors involved with clearance ness and remote settings, and participants face a unique for participation, it will be important to define some set of potential risks for participation. The purpose of commonly used terms. this article is to outline these risks and allow the What is an “Endurance Event”? There is no clear practitioner to better guide the wilderness adventurer definition, but guidelines include: who is anticipating traveling to a remote or desert environment. 1. Events in which the majority of participants will take over 2 to 4 hours to complete. 2. Any event in which the athlete must eat during the event to finish or compete effectively. Methods The following databases were searched: MEDLINE and Endurance events can be divided into competitive Cochrane Database of Systematic Reviews. Articles events and recreational activities. were limited to those printed in English between 1980 and 2014. Key terms included preparticipation physical COMMON COMPETITIVE ENDURANCE EVENTS examination. The initial process yielded 96 articles. The manuscripts and references, as well as text books, were 1. : running (eg, an , defined reviewed for use in this article. as any distance greater than 26.2 miles) These typically involve distances of 50 K, 50 miles, 100 The authors report no conflicts of interest. K, or 100 miles. May involve multiday staged events This article appears in a “Care of the Wilderness and Adventure of much longer distances such as the of the ” Athlete special issue, jointly published by Clinical Journal of Sport Sands or “RacingThe Planet” type events. Some Medicine and Wilderness & Environmental Medicine. Corresponding author: Peter E. Sedgwick, MD, Central Maine involve individual speed attempts on long distance Sports Medicine (A Clinical Division of CMMC), Lewiston, ME such as the Appalachian Trial, Pacific Crest 04240 (e-mail: [email protected]). Trail, or Long Trial in Vermont. Long-distance S48 Sedgwick et al

and “bushwhacking” (crosscountry with- obstacles. There may also be significant water out a specific trail) events, such as regaining, are also exposures. Like caving, evacuation for illness or increasing in participation. injury can be very difficult. 2. Biking: road events such as the RAM (transconti- Environmental Considerations nental road bike race) or mountain bike events of While some significant endurance events occur in areas various long distances (100 miles) or duration (24- of relatively comfortable environments with close access hour races). There include multiday mountain bike to medical care, many land-based and desert adventure races such as the Tour Divide in which participants activities involve remote and often hostile conditions, race unsupported from Banff, Canada, to the Mex- which are not readily accessible to medical services. An ican border along the Continental Divide. understanding of the conditions will help assess and 3. Multisport: involving several disciplines such as determine the risk to the participant. triathlon (swim/bike/run). These can be any distance, but distances of “Iron” distance (swim 2.4 miles/bike DESERTS 112 miles/run 26.2 miles) or those beyond, so-called “Ultradistance ” are common examples. Many adventures take place in the desert or in environ- Variations on traditional triathlons can be on road ments of extreme heat. Protection from heat and hydra- or the more challenging off road events involving tion are the primary concerns for desert events, and the trail running and mountain biking. preparticipation screening needs to address medication, is a multisport event typically involving running, hydration plan, and medical issues addressed in further mountain biking, orienteering, water sports, and/or detail below. Adequate water may not be available to the climbing. Events can be of “short” duration (4 hours) athlete in all circumstances, or water may be of dubious up to multiday expedition length events covering quality. In addition, local flora and fauna may present hundreds of miles of difficult and remote terrain. unusual problems such as cactus spines and scorpion 4. Obstacle courses: these involve 10 to 12 mile courses stings. with team and individual participants. The Tough Mudder series (multiple event locations) is one such CAVES example. Courses are often designed to be physically Many adventure races or wilderness excursions take place and emotionally challenging. In 2013, there were 3.5 in environments where caves or subterranean conditions million participants worldwide.1 Many of these may exist. These factors may present problems for those events are less than 4 hours of duration and there is with claustrophobia or panic disorders. Exposure to unusual close medical supervision at most obstacles. Despite pathogens (histoplasmosis) may present problems to this, there have been serious injuries and even deaths immune-suppressed individuals. Some patients with asthma at these events. may have significant respiratory difficulty with high mold 5. Snow-based races: these include nordic skiing and exposure. Furthermore, caves may be home to large snow-shoeing races at extended distances, as well as colonies of bats. The Centers for Disease Control and assisted events such as dog- events such as Prevention (CDC) has included spelunkers among their list the Iditarod in Alaska. of high-risk activities for rabies, recommending pre- exposure rabies prophylaxis. Fortunately, rabies is very rare among cavers. RECREATIONAL ENDURANCE EVENT ACTIVITIES NORMAL CLIMATOLOGIC VARIABLES Examples include but are not limited to: As demonstrated by the 2007 Twin Cities and Chicago , even urban, well-controlled endurance events 1. and , ranging in distance and can have significant morbidity and mortality associated duration from a day hike to 6 months on the with unexpected conditions.2 While there are established Appalachian trail. guidelines for staging mass events in hot temperatures, 2. Caving/spelunking can involve long hours or even many other environmental variables do not have such days in difficult remote terrain with unique environ- guidelines. Some endurance events are deliberately mental exposures, including fungi, bacterial patho- performed under harsh conditions, where consideration gens, and rabies. may be not given to canceling the event due to 3. Canyoneering involves traversing (climbing and “inclement” weather. Therefore, it is imperative that rappelling) narrow canyons with steep terrain and participants be familiar with the typical climate Download English Version: https://daneshyari.com/en/article/2614001

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