Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions

Abstract

Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.

Accidental hypothermia in recreational activities in the mountains: A narrative review

“…Ultra‐endurance events present a particularly challenging situation for preventing and managing medical conditions given the race distances, extreme weather conditions and remoteness of many events . Strict regulating bodies, such as those in organized sport, do not exist for these events.…”

“…12 Ultra-endurance events present a particularly challenging situation for preventing and managing medical conditions given the race distances, extreme weather conditions and remoteness of many events. 83,86,89,97,98 Strict regulating bodies, such as those in organized sport, do not exist for these events. There have been efforts, however, to outline general recommendations for the provision of medical support for ultra-endurance events or adventure races in remote environments.…”

Hurt on the Hill: A Longitudinal Analysis of Obstacle Course Racing Injuries

“…OCR has gained international attention, as seen by the increasing number of global participants, event types, diverse event locations, and television coverage. 2 , 14 , 20 , 24 With an estimated 5.3 million global participants in 2016 and an overall estimated revenue of US$323 million in North America alone in 2015, it is quickly becoming a flourishing sport. 19 Created on the foundations of military exercises, OCR events challenge participants’ mental and physical strength through a combination of trail running and obstacles.…”

“… 16 While the purpose of these races is to challenge participants in a novel environment, these events have led to several recorded deaths internationally. 2 , 6 , 13 , 14 , 17 , 22 – 24…”

“…As an emerging sport, OCR still lacks the medical research necessary to appropriately assess the unique risks posed by the rugged terrain and challenging obstacles. 3 , 4 , 9 , 14 , 24 The majority of OCR events are currently not officially regulated by governing bodies, and there are no established international or national standards for the medical provision of care at events. 8 , 16 The Fédération Internationale de Sports d’Obstacles has recently been formed to address these issues and is in the process of establishing international guidelines.…”