ENDURANCE AND SPORTS MEDICINE The Journal of the International Institute for Race Medicine VOLUME 3, NUMBER 3 FALL/WINTER 2019 In this Issue: n Lessons Learned from Experiencing Heat at the Boston Marathon n A Running Coach Reflects on Working with Injured Runners n Revised Medical Algorithms Unveiled at Conference n Students Present Posters on Sports Medicine Topics n Nutrition Resources for the Medical Professional Endurance and Sports Medicine FOUNDER William O. Roberts, MD IIRM NEWS EXECUTIVE BOARD Special Offer for Individual Members Rebecca Breslow, MD George Chiampas, DO For a limited time, if you refer someone to the IIRM and he/ John Cianca, MD, Board Chair she signs up as an “Individual Member,” we will add six Pierre d’Hemecourt, MD months to your annual membership. When registering, the Cathy Fieseler, MD individual must answer the “referral question” for you to Matthias Krüll, MD receive credit. This offer expires on January 31, 2020. William O. Roberts, MD Martin Schwellnus, MD Matthew Sedgley, MD Sanjay Sharma, MD Ui May Tan, MD Stuart Weiss, MD Fumihiro Yamasawa, MD CONTENTS ADVISORY BOARD Letter from Leadership • 3 Paolo Emilio Adami, MD Douglas J. Casa, PhD, ATC John Cianca, MD Rob Galloway, MD Timothy Good Combatting Extreme Heat: Boston Marathon 2012 • 5 Mark A. Harrast, MD Katerina Lin; Aaron L. Baggish, MD; Sophia Dyer, MD; Chris Troyanos, ATC; Dave McGillivray Pierre d’Hemecourt, MD; and Lyle J. Micheli, MD Francis G. O’Connor, MD, MPH P.Z. Pearce, MD Managing an Injured Runner: A Coach’s Perspective • 10 Catherine Ayoub, PT, DPT, MPH RESEARCH BOARD Kate Ackerman, MD Protocol Overhaul: An Opportunity to Review, Revise, and Reflect • 13 Aaron L. Baggish, MD Korin Hudson, MD and COL(R) Francis G. O’Connor, MD, MPH Sam Cheuvront, PhD, RD Maria Hopman, MD, PhD Ohio University Students Enjoy Learning Experience • 15 Kourtney Kipps, MD Daniel E. Lieberman, PhD Sports Nutrition Resources: Where to Look for Credible Information • 16 Anthony Luke, MD Nancy Clark, MS, RD, CSSD Stephen Mears, PhD Feeling the Pulse of the TCS New York City Marathon • 18 EXECUTIVE DIRECTOR Chris Troyanos, ATC Brett G. Toresdahl, MD EDITOR-IN-CHIEF Cathy Fieseler, MD Book Review: The Durable Runner: A Guide to Injury-Free Running • 19 MANAGING EDITOR Barbara Baldwin, MPH Cathy Fieseler, MD JOURNAL COMMITTEE Barbara Baldwin, MPH Follow the IIRM on Social Media Cathy Fieseler, MD Pierre d’Hemecourt, MD Daniel E. Lieberman, PhD Stephen Mears, PhD Fred L. Miller, III, PhD William O. Roberts, MD Martin Schwellnus, MD EDITORIAL ADVISORY BOARD* Nancy Clark, MS, RD The mission of the International Institute for Race Medicine (IIRM) is to promote the health Thomas C. Michaud, DC and safety of athletes participating in endurance events through education, research, and the development of medical best practices. GRAPHIC DESIGN Fritz Partlow Design Opinions expressed in Endurance and Sports Medicine are not necessarily endorsed by the IIRM. *If you are interested in being considered for Address editorial, membership, and advertising information to Barbara Baldwin, MPH, the Editorial Advisory Board, please write to IIRM (Satellite Office), 14520 Clopper Road, Boyds, MD 20841, Email: [email protected], [email protected]. TEL: 240-271-1657, www.racemedicine.org. LETTER FROM LEADERSHIP Dear IIRM Members and Friends: am currently flying to Valencia, Spain, to serve as faculty for the WORLD ATHLETICS-IIRM Race Emergency Medicine Workshop I(November 9th). I’ll be presenting on dehydration and hyponatremia. IIRM Advisory Board Member Douglas Casa, PhD, ATC, will also be part of the presenting faculty. This collaboration is a great example of how the IIRM is extending its reach to race medical directors and their medical teams, and ultimately race participants. It has been part of our organization’s mission since its inception, and this prompts me to reflect on our journey over the years. As you may have previously learned, the American Road Race Medical Society (ARRMS) was formed in the late spring of 2003 at the annual meeting of the American College of Sports Medicine. At that time, Bill Roberts, MD, convened a group of interested medical professionals to discuss forming ARRMS. The group moved forward and affiliated with the American Running Association (ARA) which became the host organization. ARRMS then became a division of ARA alongside its professional division, the American Medical Athletic Association (AMAA). Based near Washington, DC, the ARA supported ARRMS through its early years. At the inaugural meeting of ARRMS, held at the Chicago Marathon in October 2003, over 40 people Endurance medicine experts gather at the WORLD ATHLETICS-IIRM Race attended including members of the Association of Emergency Medicine Workshop in Valencia, Spain. Included from left are Frederic Gerrandes, PhD; Luis Cort, MD; Paolo Emilio Adami, MD; Patrick International Marathons and Distance Races (AIMS) Baset, MD; John Cianca, MD; and Luke Hodgson, MD. and the United States Association of Track and Field (USATF). Discussion focused on the need for a national registry of adverse medical events at road races as well as a unified depository of weather and participation data. Dr. Roberts also called for the need for education and proper preparation of marathon participants. And so our journey as an organization began. Over the next several years ARRMS met regularly at marathons around the country and in 2012, transitioned to the World Road Race Medical Society (WRRMS) when it expanded its focus to include international races. We then incorporated the following goals into our organizational plan: 1. Promote the safety of endurance events through education of medical professionals, emergency management agencies, hospitals, event administrators, public safety agencies, and other professionals providing medical care at road races, triathlons, and charity walks. 2. Promote the sharing of information as it pertains to all medical aspects and concerns when preparing for athletic endurance events. Endurance and Sports Medicine • Fall/Winter 2018 3 3. Promote research and improvements in clinical care for participants in road races and mass participation running events. 4. Develop collaborative relationships with public safety groups. 5. Establish reliable logistical matrixes that can be followed by events of all sizes. 6. Provide event safety recommendations to event medical teams and race administrators. 7. Establish liaisons to various groups, corporations and organizations that will assist with promotion of our mission. Not too long after we expanded our international focus, key organizational leaders met with Tim Good of the Matthew Good Foundation and changed our name for the third—and hopefully final—time. We then became the International Institute for Race Medicine (IIRM). Through the support of the foundation, Tim helped us rebrand our website and with tremendous help from Loughborough University, we published the “IIRM Medical Care Manual.” This 91-page resource is available on the IIRM website for members (under Publications/Resources). Douglas Casa, PhD, ATC, (kneeling on right) leads a hands-on training lab on exertional heat stroke at the WORLD ATHLETICS-IIRM Race Emergency The last few years have been very busy for us with Medicine Workshop in Valencia, Spain. new affiliations and a renewed relationship with our first partner as we subsumed the membership of the American Medical Athletic Association and added AMAA Board President Cathy Fieseler, MD, to the IIRM Executive Board. To carry on a component of the AMAA mission, we maintained the Boston and Marine Corps Marathon conferences but have given them a slight adjustment. Each learning activity is now a one-day format consisting of didactic lectures and hands-on workshops. As many of you know, we continue to work with AIMS and have had IIRM representatives present at their annual meetings, the most recent being Dr. Roberts who spoke at their meeting in Rio de Janeiro in 2016. We also formed a partnership with the World Athletics, formerly known as the International Association of Athletics Federation (IAAF). Through this partnership, we have been able to expand our educational efforts worldwide. To date, the IIRM with World Athletics have provided educational programs in Tokyo, Japan; Doha, Qatar; and as mentioned, Valencia, Spain. We are grateful for the opportunity to expand our educational efforts internationally. On the horizon we are also exploring an affiliation with China and their vast suite of marathons. This will bring us much greater exposure and open up even more opportunities to educate race medicine professionals and endurance athletes. I am now serving as IIRM chairman of the board; this is my second stint in the lead position of the organization. In this role, I will collaborate with IIRM board members to continue working toward goals outlined Endurance and Sports Medicine • Fall/Winter 2018 4 in our mission and growing the organization. I would also like to work with members to be sure we are benefiting you, as well. Please contact me with any feedback you may have regarding our mission statement, educational programs and materials, the journal, our website, etc. It is important for us to hear from you to be sure we are on the right track! You can reach me at [email protected]. We have a few imperatives to achieve in the next one to three years. First and foremost, we must achieve financial sustainability. To date, we have relied on a patchwork of memberships, grants, and We currently have sponsorships. The former needs to become more robust. The latter visibility with many two are not reliable enough for us to build a sustainable organization. My first goal of this term as chairman will be to achieve financial marathons but also sustainability. I ask for the assistance from you—our members—in creating ideas and developing them into a reliable foundation for us to need to expand operate. Therefore, if you have ideas and/or leads for sponsorships, our reach to ultra- please write to me at the email address provided above.