Medical management in mass participation 2.0.pptx

Medical management in mass participation events is crucial for ensuring the health and safety of all participants. These events, such as marathons, triathlons, and large public gatherings, require a comprehensive plan that includes pre-event health screenings, on-site medical facilities, and a coordinated response team. Effective medical management involves strategic placement of medical stations, availability of emergency medical services, and the presence of trained medical personnel throughout the event. Additionally, communication systems must be established to quickly address any medical emergencies. Proper planning and execution of medical management protocols can significantly reduce the risk of injuries and ensure a prompt and efficient response to any health-related incidents, thereby safeguarding the well-being of participants.
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1. Medical management in mass participation Presenter- Amit Prashar BPT,MPT(Sports)

2. MASS PARTICIPATION SPORTS INTRODUCTION The popularity and quantity of endurance sporting events involving a large number of participants have increased significantly in recent decades. These events come in various forms, spanning from small-scale 5-kilometer run-walks at the local level, where participants are mainly recreational or non-athletes, to prominent international marathons and triathlons featuring professional athletes. [1] Definition- “ A mass-participation sporting event can be loosely defined as any endurance competition that has the potential to generate a significant number of casualties due to the large number of participants or the potential injury risk .” [1]

3. TYPES OF MASS PARTICIPATION EVENTS Marathons and Half Marathons: These are long-distance running races, with marathons covering 26.2 miles (42.195 km) and half marathons covering 13.1 miles (21.0975 km ). [2] Major city marathons attract thousands of participants. Triathlons: Triathlons involve three sequential disciplines: swimming, cycling, and running. Various distances cater to participants of different fitness levels, including Sprint, Olympic, Half Ironman, and Ironman. Cycling Events: Mass participation in cycling events can include road races, mountain bike races, and gran fondos (long-distance cycling events). These events often cover challenging terrains and attract cyclists of varying skill levels.

4. 4. Mud Runs and Obstacle Course Races: Events like Tough Mudder , Spartan Race, and Warrior Dash involve running through mud and navigating various obstacles. They focus on teamwork and physical challenges . 5. Walkathons: These events are typically shorter in distance and designed to be more accessible to a broader range of participants. They often promote health, fitness, and fundraising for charitable causes . 6. Ultra-Endurance Events: Events like ultramarathons(distance 56 km) [2] , ultra cycling races, and long-distance swims cater to participants seeking extreme physical challenges and pushing the limits of endurance. Events that exceed 6 hours.

5. 7. Swimming Events/Marathon Swimming- Marathon swimming sees athletes take on a 10km course in open water environments such as the sea, rivers and lakes  8. Skiing and Snowboarding Events: Mass participation in skiing and snowboarding events, such as the "Ski Week" or downhill races, brings enthusiasts together to enjoy winter sports in a communal setting. 9. Rowing Events: Mass rowing events, such as regattas or long-distance rowing races, bring rowers together to compete on rivers, lakes, or coastal waters. 10. Inline Skating and Rollerblading Events: These events include marathons and recreational skates, where participants cover long distances on inline skates or rollerblades. 11. Equestrian Endurance Rides: Long-distance horse riding events, known as endurance rides, test both the rider and the horse's stamina over challenging terrains. SOURCE- https://worldathletics.org/our-sport

6. PARA EVENTS OF MASS PARTICIPATION Wheelchair Racing Events: Wheelchair racing events, including marathons and road races, provide opportunities for para-athletes to showcase their skills in racing wheelchairs. Major marathons often include wheelchair racing categories. Hand cycling Races: Hand cycling involves using a hand-operated crank to propel a three-wheeled cycle. Mass participation events, such as road races and gran fondos , increasingly include categories for hand cyclists. Adaptive Adventure Races: Some organizations host adaptive adventure races that combine various activities like trail running, hand cycling, and kayaking. These races are designed to accommodate individuals with a range of abilities. Para-Cycling Events: Para-cycling competitions cater to individuals with physical disabilities, visual impairments, or other impairments. Mass participation events may include para-cycling categories alongside traditional cycling categories.

7. General epidemiology of medical encounters[2,3,4,5] Weather (abnormally hot and humid or cold and damp weather increases encounters) Participant acclimatization ( eg , heat and humidity, altitude) Event type (more strenuous races increase encounters) Distance and pace of race Participant health and fitness Safety preparations ( eg , hydration strategies, medical triage, course evacuation)

8. [ 2,3,4,5,6] The primary discovery of this research revealed that among every 1000 race participants, there were 18.9 medical incidents, with the most frequent being exercise-related collapse (11.3), followed by skin issues (4.1), and musculoskeletal problems (3.4). Additionally, the occurrence of cardiac arrest and sudden death was recorded at 1.2 per 100,000 runners, equating to 1 occurrence in every 83,333 runners . [2]

9. WEATHER- The incidence of medical casualties in endurance races is significantly influenced by weather conditions. Typically, a rise in the wet-bulb globe temperature (WBGT), which considers ambient temperature, radiant heat, and humidity, is correlated with increased occurrences of medical encounters, race withdrawals (both pre-race and during the event), as well as cases of exertional heat stroke (EHS) and exercise-associated hyponatremia (EAH). This association is particularly pronounced among participants who lack proper acclimatization .[6]

10. Participant acclimatization ( eg , heat and humidity, altitude) - Proper acclimatization is a key strategy to minimize the risk of medical encounters in mass participation sports. Acclimatized individuals are better equipped to handle the physiological challenges posed by environmental stressors, leading to improved performance and a decreased likelihood of experiencing adverse health effects during and after events . Distance and pace of race - In mass participation events, longer distances can lead to fatigue, dehydration, and musculoskeletal strain, increasing the risk of medical encounters. Faster paces elevate physiological stress, potentially causing overexertion and cardiovascular issues. Adequate preparation, hydration, and medical support are crucial to mitigate these risks and promote participant well-being.

11. Sudden cardiac arrest and mortality  — Deaths related to events are infrequent, typically stemming from sudden cardiac arrest (SCA), exertional heat stroke (EHS), or exercise-associated hyponatremia (EAH). Drowning incidents during triathlons, though even rarer, may occur. Swift recognition and immediate treatment of EHS or EAH can result in participants recovering without lasting consequences .[7] Japanese scientists documented comparable results over 15 years, noting rates of sudden cardiac arrest (SCA) at 2.0 and 2.5 per 100,000 participants for the marathon and half marathon, respectively. Among the 63 individuals experiencing cardiac arrest, approximately half survived. While SCA is most prevalent near the finish line, it can potentially occur at any point along the course .[14]

12. Medical encounters according to event type - The most serious medical problems encountered include SCA, acute coronary syndrome, EHS, EAH, anaphylaxis, and insulin reaction (acute hypoglycaemia). Exercise-associated collapse (EAC ), or exercise-associated postural hypotension (EAPH), is the most common medical condition in endurance events. It accounted for 60% of total medical encounters and 90% of non-musculoskeletal or skin-related issues at the Twin Cities Marathon from 1983 to 1994. EAC continues to be the leading cause for evaluation in the finish-line medical tent .[2,8] In warm, humid conditions, exertional heat illness is relatively common in endurance events. A study of nearly 100,000 10-km race finishers revealed about 25% of roughly 600 medical encounters were heat-related. Most incidents occurred among participants in the top and bottom quintiles. Despite 94 cases of exertional heat stroke requiring onsite cooling, there were no cardiac arrests or fatalities .[6] Musculoskeletal injuries in endurance events often involve acute sprains and strains. Chronic conditions like stress fractures may worsen during races. While most issues in running races are predictable, higher-velocity activities (cycling, skating) can lead to severe trauma-related injuries. High-speed collisions may cause internal injuries, and accidents with motor vehicles can result in serious harm or death .[10] Skin-related problems during endurance sporting events consist mainly of blisters and abrasions. Trauma during higher-velocity activities can cause deep abrasions .[9]  

13. The length of stay for mild EAC was 5–30 min and for moderate to severe EAC was 10–120 min

14. Medical management It involves a comprehensive approach to ensure the health and well-being of participants in events that attract large numbers of people . Pre-Event Preparation On-Event Medical Support Health Monitoring and Surveillance Post-Event Medical Care Continuous Improvement

15. PRE EVENT PREPARATION Medical Team Formation: - Assemble a multidisciplinary medical team comprising physicians, nurses, paramedics, physiotherapists, and other healthcare professionals . Headed by Medical director who is physician - Ensure that the medical team members have experience in sports medicine and are familiar with the specific demands of mass-participation events. Medical Supplies and Equipment: - Stock and organize medical supplies, including first aid kits, medications, defibrillators, and emergency medical equipment. - Ensure that medical facilities are strategically located along the course and at the event venue. Communication and Coordination: - Establish effective communication channels between medical teams, event organizers, and emergency services. - Coordinate with local hospitals to streamline the transfer of patients if needed. Participant Education: - Provide participants with information on medical support services available during the event. - Encourage participants to disclose relevant medical information during registration.

16. STEPS OF PRE EVENT PREPARATION- 1. Strategies and plans for race safety and injury reduction 2. Survey of the race course, with an emergency action plan for events that occur anywhere along the course 3. Medical protocols to standardize care for anticipated common and serious medical conditions

17. MEDICAL PLANNING(Pre event)- Be aware of and plan for the potentially catastrophic risks to participants like, sudden cardiac arrest (SCA), exertional heat stroke (EHS), exercise-associated hyponatremia (EAH), high-speed collision, and drowning. Be aware of and plan for the common medical problems likely to require care at medical aid stations. Ensure that adequate personnel and resources are available to manage these conditions. Coordinate with community emergency medicine leaders and organizations. Notifying area hospitals long in advance allows them time to increase staffing on race day to accommodate anticipated increases in patient volume. Local emergency medical services (EMS) systems must be prepared to transport casualties from the course, and the logistics for such transport must be prepared in advance. Develop or adopt standardized medical management protocols for common and important medical conditions likely to occur. Educate all medical personnel, local emergency clinicians, and race volunteers so all are using the same protocols and have the same expectations.

18. On-Event Medical Support[11] a. Medical Tents: - Set up medical tents along the course and at the finish line to provide immediate care for participants. - Equip medical tents with necessary supplies, beds, and facilities for minor medical procedures. b. First Aid Stations: - Establish first aid stations at regular intervals along the course to address minor injuries and medical issues promptly. c. Ambulance Services: - Have ambulances stationed strategically to respond quickly to emergencies. - Ensure ambulance crews are trained in sports medicine and event-specific scenarios. d. Medical Evacuation Plan: - Develop a plan for the rapid evacuation of participants with serious medical conditions to nearby hospitals. - Coordinate with local emergency services for air and ground evacuation if necessary.

19. Health Monitoring and Surveillance a. Medical Screening: - Implement pre-event medical screenings for participants to identify potential health risks. - Identify participants with pre-existing medical conditions and provide appropriate guidance. b . Temperature and Weather Monitoring: - Monitor weather conditions to address the risks associated with extreme temperatures. - Implement protocols for cooling stations or heated areas as needed. c . Injury Surveillance: - Use medical personnel stationed along the course to identify and manage injuries promptly. - Keep records of medical incidents for post-event analysis and improvement.

20. Post-Event Medical Care a. Recovery Services: - Provide post-event recovery services such as massages, ice baths, and physiotherapy. - Address any lingering medical issues participants may experience after completing the event. b. Medical Debriefing: - Conduct a medical debriefing to evaluate the overall performance of the medical team and identify areas for improvement. - Analyze medical incidents and implement changes in protocols for future events. c. Participant Follow-Up: - Establish a system for following up with participants who sought medical attention during the event to ensure their ongoing health

21. life-threatening medical conditions[12] Exercise-associated collapse (EAC) is one of the conditions most commonly seen by the marathon medical team, with more than 85% of cases among endurance athletes occurring at the finish line . SIGNS& SYMPTOMS- Dizziness Headache Fainting Nausea and/or vomiting Muscle cramps (usually in the large muscle groups) Pallor Excessive sweating EXAMINATION- Assess mental status Determine the site/mechanism/circumstances of collapse or injury Obtain core temperature (by rectal thermometer) Measure blood pressure (at least systolic) Take pulse Note signs of dehydration

22. TREATMENT- Move the patient to a cooler or shaded area Place the patient supine with pelvis and legs raised at least 6 in (15 cm, ie , above the heart) Remove layers of clothing Ice down both legs Massage legs toward the heart Instruct the patient to sit up slowly, dangle the feet, then stand and walk ALGORITHM FOR EAC MANAGEMENT[13]

23. 2. Exertional heat stroke (EHS) is caused by a sudden increase in core temperature (≥ 40°C or 104°F, as measured rectally for precision 12,13 ) during a run. While EHS symptoms may resemble those of EAC, EHS is usually more advanced and certainly more serious, with untreated cases possibly leading to rhabdomyolysis, hepatic failure, arrhythmias, and even death . SIGNS& SYMPTOMS- Central nervous system/brain dysfunction(subtle to severe) Hyperthermia(body core temp > 40 degree) Tachycardia Hyperventilation/tachypnea Hypotension(in 25% pts) Hot, red and dry skin. Absence of sweating Vomiting, Diarrhea

24. TREATMENT- Move the patient to a cooler and/or shaded area Administer rapid cooling via immersion in cold water (1°C – 15°C, ie , 35°F – 59°F) or application of ice water–soaked towels and/or cold packs, only if immersion is not available Monitor vital signs Provide IV fluids, provided serum sodium is measured at 135 mEq /L or greater, and avoiding fluid overload Arrange for rapid transport to a medical facility, once the patient is stabilized ALGORITHM[13]

25. MANAGEMENT OF HEAT STROKE

26. 3. Dehydration may occur in the endurance athlete, especially during hot weather (whether dry or humid), 11 but not as frequently as one might expect. Severe dehydration increases the risk of EAC and EHS during and immediately after the marathon. Dehydration can affect physical and mental performance, increase cardiovascular strain, and decrease heat tolerance. SIGNS AND SYMPTOMS- Thirst Loss of appetite Dry skin* Skin flushing Dry mucous membranes Sunken eyes Decreased skin turgor Dark- colored urine Fatigue, weakness Chills

27. TREATMENT Move the patient to a cooler and/or shaded area Provide oral fluids, such as a sports drink or water, in slow, small sips Monitor vital signs Provide IV fluids ( eg , normal saline), once severe dehydration and hyponatremia have been ruled out Arrange for rapid transport to a medical facility ALGORITHM [13]

28. HOW MUCH AND WHAT TO DRINK Drinking to thirst- is adequate for exercise lasting less than 1-2 h in cool environments . Planned drinking- adequate in events lasting >90 mins in hot environment Be aware of overhydration - could lead to “ hyponatremia ”, (an imbalance of the salts in the body) that can be more severe than dehydration and even result in death. Simple techniques- Methods like measuring body mass pre and post-exercise or assessing urine colour in the morning (first void) can aid athletes in gauging fluid losses from sweating. These approaches help estimate hydration requirements and assess hydration status. WHAT TO DRINK- For exercises over 1 hour, especially for heavy sweaters, sodium supplementation is recommended. Include 30–60 g/h of carbohydrates in drinks for shorter performances and up to 90 g/h for longer events. Post-heat training, recovery drinks should contain sodium, carbohydrates, and, if needed, protein.

29. 4. HYPONATREMIA - defined as a serum sodium level below 135 mEq /L, is caused by excessive fluid consumption and increased secretion of salt-regulating hormones (arginine vasopressin, antidiuretic hormone), reducing the kidneys’ ability to excrete and leading to low sodium concentrations relative to total body water. SINGS AND SYMPTOMS Altered mental status Nausea or vomiting Normal or slightly elevated core (rectal) temperature Peripheral edema (hands and fingers) Light headedness , dizziness Fatigue Malaise Inability to recall pertinent information, such as address or phone numbers

30. TREATMENT- Move the patient to a cooler and/or shaded area Monitor vital signs Avoid IV fluid replacement in the field If the patient is conscious, administer one “fast food”–sized packet of salt Arrange for rapid transport to a medical facility ALGORITHM[13]

31. PREPARATION BY MARATHON RUNNERS

32. BEAT THE HEAT [15] When resting in temperate environmental conditions: - core body temperature in humans is around 37ºC - muscle temperature is approximately 35ºC - skin temperature is approximately 31ºC During physical exertions such as running, muscle contractions produce a considerable amount of heat, inducing a large increase in muscle temperature, which drives an increase in core body temperature.

33. HOW DOES HEAT AFFECT PERFORMANCE- High body core temperature in hot conditions negatively impacts endurance events by increasing cardiovascular strain, intensifying the perception of effort, and ultimately reducing exercise capacity and speed during longer durations. While it may benefit short explosive events, prolonged exposure to heat progressively impairs performance in endurance activities . HOW TO PREPARE IN SUCH SITUATION- To adapt to heat, engage in repeated exercise in elevated temperatures through acclimatization or acclimation methods. The preferred adaptation period is 14 days, with optimal results within 7-10 days. Athletes should train in a similar environment to the competition for two weeks before the event. An initial heat acclimatization camp can speed up adaptation, and conducting it weeks before the target event may enhance the process in a subsequent pre-competition camp.

34. NUTRITION AND MARATHON 14

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