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5 MASS PARTICIPATION EVENTS

Scott W Pyne, MD, FAAFP

GOALS

• Mass participation events are those sporting events in
  which many people participate and are generally
  spread out over several miles and variable terrain.


• Advanced planning and preparation are critical to
  successfully accommodate the medical needs of the
  event participants.


• The medical director has numerous responsibilities of
  planner, communication, and organizer in addition to
  the care of injured athletes.

MEDICAL COVERAGE

• The needs of the athletes competing must be consid-
  ered well prior to the event.


• Specific considerations of the type of event, number
  of participants, course peculiarities, and environmen-
  tal predictions are all very important in determining
  the medical coverage required.

SAFE ENVIRONMENT

• As a key advisor to the Event Director, the medical
  director must ensure that the event is conducted with
  the safety of the competitors being of utmost impor-
  tance. Often this is furthest from the minds of race
  organizers especially with competing priorities of
  sponsor, financial and community concerns.


• In extreme conditions the race may need to be can-
  celled or rescheduled. It is best that these possibilities

and contingency plans be discussed and prepared

prior to the race day.

• It is often necessary to review the course for any
  potential trouble-spots and hazards that could cause
  injury. The start and finish are common sites of med-
  ical concern. The start area should be on a large level
  surface devoid of obstacles, thereby allowing the ath-
  letes to more easily accommodate the surge that
  invariably occurs. The finish area should also be large
  enough to prevent the athletes from bunching up and
  being forced to stand in one place. It should also have
  necessary facilities and resources to allow the athletes
  to properly cool down and recover after the event and
  easy access to medical treatment areas.
  •Biking, swimming, and skiing events carry additional
  risk elements (Mayers and Noakes, 2000), such as
  water safety and trauma potential associated with high
  speeds. Water temperature, sea conditions, road condi-
  tions, transition, acceleration and deceleration areas,
  and protective equipment must be carefully scrutinized.

EPIDEMIOLOGY

INJURY RATE

• Running (42 km) 1–20%, running (<21 km) 1–5%,
  triathlon (225 km) 15–30%, nordic skiing (55 km) 5%,
  triathlon (51 km) 2–5%, cycling (variable) 5%
  (Roberts, 1989).


• Injury rate increases with increased distance and envi-
  ronmental temperature. (Holtzhausen and Noakes, 1997;
  Hiller et al, 1987)

PREDICTING INJURY RATE

• Previous years’ experience is very helpful in planning
  for subsequent years. This also stresses the impor-
  tance of a reliable injury data tracking system.
  •Similar events in similar elements can be used in the
  initial planning and preparation stages.
  •Fortunately the risk for exertional death in marathons
  is quite small. (Maron et al, 1996)

MEDICAL PHILOSOPHY

LEVEL OF CARE

• The level of medical care that will be available on the
  course must be defined and agreed on between the med-
  ical director and the event director early in the planning
  stage.

20 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE