TY - JOUR
AU1 - USA, Paul F. Pasquina, MC
AU2 - BAS, Sarah C. Griffin,
AU3 - BA, Victoria C. Anderson-Barnes,
AU4 - USN, Jack W. Tsao, MC
AU5 - USA, Francis G. O'Connor, MC
AB - ABSTRACT A number of long-distance running events are held each year in the United States; the Army Ten Miler (ATM) is one such race held annually in Washington, DC. The purpose of the present study was to retrospectively analyze medical encounters for runners participating in the ATM from 1998 to 2004. Of the estimated 91,750 runners over the 6-year period, 73,100 participants finished the race and were included in the data analysis. Demographic and injury data were collected from medical records of participants who received medical care while participating in the ATM, and injury-related factors were assessed. The most common category of injury was musculoskeletal (44%), followed by medical-related problems (27%) and dermatological injuries (27%). Similar to marathon and ironman races, ATM injury rates correlate with race-day temperature and dew point. Overall, however, the injury rates observed at the ATM were relatively low compared to those reported for longer distance events. Finally, we detail the medical coverage provided at the ATM, as this coverage could be used as a guide for similarly distanced races. INTRODUCTION The growing popularity of long-distance running in recent years has led to an increase in the number of races held each year. In the United States, the number of mid- and long-distance races with over 3,000 runners has more than doubled in the past decade.1 One of the largest 10-mile races in the world is the Army Ten Miler (ATM), an open invitational event held in Washington, DC, that draws over 20,000 participants each October. Conducting a mass-participation running event requires significant coordination and planning to ensure appropriate administration, security, and medical support. Medical professionals and volunteers prepare for the race months in advance to ensure proper care for race-day injuries and emergencies.2 Knowledge of the incidence and types of injuries sustained during long-distance running events, as well as the risk factors associated with such injuries, is crucial in informing race administrators on the necessary medical coverage. A review of the literature reveals a handful of studies that report common injuries seen in marathons. A 12-year retrospective review of injuries sustained during the Twin Cities Marathon reports exercise-associated collapse (EAC) as the most common injury, followed by skin problems and musculoskeletal problems.3 On the other hand, similar studies examining long-distance running events have reported musculoskeletal injuries as the most prevalent type of injury.4,5 Most studies examining race-day injuries rely on data obtained from local emergency rooms (ERs) or postrun questionnaires rather than on-site medical records.3,5,6 However, two studies were found to have prospectively monitored the occurrence of injuries associated with a running event.7,8 Macera et al7 studied 583 runners to better characterize the types of injuries sustained in road races and the risk factors involved in these injuries. The study concluded that injuries to the lower extremities are best predicted by (1) running experience (2) previous injury, and (3) running distance. Similarly, Walter et al8 examined a cohort of 1,680 runners over a 12-month period to conclude that previous injury and running distance were the best predictors of injury. Finally, Nguyen et al9 reported that the primary reasons runners sought medical care during a marathon consisting of multiple running events (a 5-km run, 26.2-mile marathon, four-person relay) were medication request (26%), musculoskeletal injuries (18%), dehydration (14%), and dermal injuries (11%). Race-day weather conditions have also been found to affect injury rates. Roberts3 found evidence that heat and humidity contribute to 72% of the risk for moderate to severe EAC in runners, whereas Ely et al10 observed that increased race-day temperature, but not cloud cover or low solar load, corresponds with a decline in performance among all runner populations.11 Although the literature contains information about common injuries sustained in marathons and the relevant factors involved, these results are mixed. Furthermore, there remains a scarcity of information on the types and incidence of injuries sustained in 10-mile races specifically.3,5,10,13 More research is necessary to inform providers and race planners on the types and frequency of injuries sustained in such events as well as what factors play into these injuries. This information would be useful to the general running community as the results would be applicable to not only 10-mile runs but also to similar distance events, such as the 10-km and the half marathon. Furthermore, this research would help to ensure continued success of the ATM, an important athletic event in the military community, and is, therefore, of high military relevance. We examined the injury rates of approximately 92,000 ATM participants over the 6-year period. The prevalence and types of race-day injuries were documented, along with information pertaining to race-day weather, dew point values, and the necessary medical assets required to provide adequate medical support. MATERIALS AND METHODS Subjects There were 73,100 finishers in the 6 years during which data were collected. The event was cancelled in 2001, following the events of September 11. Although the exact number of starters was only available for 4 of the 6 years, each year the percentage of runners who finished the race was consistently 80%; therefore, based on the total number of finishers, we estimated the total number of starters over the 6 years to be approximately 91,750 runners. Of these starters, medical records of 311 (0.34%) runners were available for review, representing all the runners treated by medical personnel during the 6 years of the event. All injuries were subsequently recorded and analyzed for this article. According to the ATM website, 48% of entrants are male, 52% are female, 64% are between the ages of 25 and 44, and 60% have a military affiliation. Approximately 35% of ATM registrants are active duty service members. The race accommodates a wide variety of participants ranging from very experienced to novice runners. Race Location and Description The ATM is an annual 10-mile race that starts at 8:00 a.m. The race begins and ends at the Pentagon in Arlington, Virginia, and the terrain is generally flat. The race is open to all participants with no prequalification standards. Weather Data Meteorological data were obtained from a local reporting station of the National Weather Service. The average dry bulb temperature, dew point, relative humidity, and wind speed was calculated, utilizing three recorded values of each measure on the day of each race. Recorded values were consistently obtained at 7:51 a.m., 8:51 a.m., and 9:51 a.m. each year. Dew point is the temperature to which air must be cooled to convert water vapor into liquid water; a higher dew point indicates that there is more moisture present in the air. When overheated, the body uses evaporation of perspiration to lower body temperature, where reduction of temperature directly relates to the speed of evaporation. The rate of evaporation depends on the amount of moisture present in the air and its capacity to hold moisture. Therefore, a higher dew point is associated with higher risk of overheating. Runner Data The number of starters and finishers was obtained from ATM race officials. Information such as completion times was determined by computer chips worn by each participant. Medical Area Staff Medical coverage at each event was provided by over 100 volunteers from Walter Reed Army Medical Center, Fort Belvoir, Fort Meade, the Pentagon, the Uniformed Services University of the Health Sciences, the Burke (Virginia) Fire Department, the Arlington (Virginia) Emergency Medical System, and the 229th Army Reserve unit. The medical staff was composed of 11 physicians, 1 podiatrist, 4 nurses, 6 emergency medical technicians (EMTs), 1 physical therapist, and 35 Army medics. The physicians included 1 orthopedic surgeon, 1 cardiologist, 1 anesthesiologist, 1 physiatrist, 1 pediatrician, 3 primary care physicians, and 3 sports medicine fellows. Of the 35 medics, 20 were distributed throughout the course at half-mile intervals; the remaining medics were stationed at the finish line or treatment tents, positioned approximately 50 m from the finish line. Additional EMTs were positioned on medically equipped golf carts, all-terrain vehicles, and bicycles. The treatment tents were divided into a medical tent and a musculoskeletal tent. The medical tent was prepared with multiple cots, intravenous (IV) fluids, and a resuscitation cart equipped with a defibrillator, oxygen, suction, and adult- and pediatric-sized instruments and medications. The medical tent was staffed by a cardiologist, sports medicine physicians, nurses, EMTs, medics, and other primary care physicians. The musculoskeletal tent was equipped with ice bags, splinting material, and wound dressing equipment, and was staffed by a physiatrist, orthopedic surgeon, podiatrist, primary care physicians, physical therapists, and medics. Adjacent to the tents were three fully staffed ambulances, with clear egress access in the event of a necessary evacuation. Each of the spotter medics on the course was prepositioned with a medical aid bag, radio, cell phone, and a prebriefed communication plan to maintain contact with the medical director. Golf carts, all-terrain vehicles, and medic bicycle teams were also positioned along the course and near the finish line. Three additional ambulances were placed along the course in the event of an emergency during the race. Injury Data All providers that worked during the race were instructed to complete a patient encounter form (PEF) for each person requiring medical attention. There were two versions of the PEF, one for medical injuries and one for musculoskeletal injuries. The forms were a single page and allowed the providers to fill in blanks or circle diagnoses. All the providers received the same instruction on how to administer the form, and the same form was used across all 6 years of the ATM. Upon completion by the health care provider, each PEF was then verified by a health care administrator on-site. A total of 346 runners were treated by medical personnel. However, the medical records for 35 racers were incomplete (and therefore were excluded from analyses involving injury type). The remaining 311 racers reported 319 injuries, which were organized by injury type (dermatological, medical, or musculoskeletal), age, and gender. Diagnoses were grouped into 29 different categories (Table I) for the purposes of analysis. TABLE I. Injuries Diagnosis  Frequency (%)  IV Fluids  Transfer to ER  Musculoskeletal Injuries  Achilles Tendonitis  3 (1.0)  0  0  Biceps Tendonitis  1 (0.3)  0  0  Cramps  10 (3.2)  0  0  Hernia  1 (0.3)  0  0  Plantar Fasciitis  4 (1.3)  0  0  Shin Splints  1 (0.3)  0  0  Sprain/Strain (Ankle)  19 (6.1)  0  0  Sprain/Strain (Knee)  39 (12.5)  0  0  Sprain/Strain (Other)  33 (10.6)  0  0  Stress Fracture  1 (0.3)  0  0  Tarsal Tunnel Syndrome  1 (0.3)  0  0  Unknown Musculoskeletal  31 (10.0)  0  0  Medical Injuries  Asthma  4 (1.3)  0  0  Bee Sting  2 (0.6)  0  0  Dehydration  13 (4.2)  6  1  Dog Bite  1 (0.3)  0  0  EAC  50 (16.1)  15  8  Heat Exhaustion  2 (0.6)  1  0  Hemifacial Numbness  1 (0.3)  0  1  Hypoglycemia  3 (1.0)  0  0  Hypothermia  2 (0.6)  0  0  Hyperthermia  1 (0.3)  1  0  Panic Attack  1 (0.3)  0  0  Parasthesia  2 (0.6)  0  0  Urticaria  1 (0.3)  0  0  Dermatological Injuries  Abrasion  27 (8.6)  0  0  Blister  49 (15.8)  0  0  Rash  3 (1.0)  0  0  Unknown Dermatological  5 (1.6)  0  0   Total  311 (100)  23  10  Diagnosis  Frequency (%)  IV Fluids  Transfer to ER  Musculoskeletal Injuries  Achilles Tendonitis  3 (1.0)  0  0  Biceps Tendonitis  1 (0.3)  0  0  Cramps  10 (3.2)  0  0  Hernia  1 (0.3)  0  0  Plantar Fasciitis  4 (1.3)  0  0  Shin Splints  1 (0.3)  0  0  Sprain/Strain (Ankle)  19 (6.1)  0  0  Sprain/Strain (Knee)  39 (12.5)  0  0  Sprain/Strain (Other)  33 (10.6)  0  0  Stress Fracture  1 (0.3)  0  0  Tarsal Tunnel Syndrome  1 (0.3)  0  0  Unknown Musculoskeletal  31 (10.0)  0  0  Medical Injuries  Asthma  4 (1.3)  0  0  Bee Sting  2 (0.6)  0  0  Dehydration  13 (4.2)  6  1  Dog Bite  1 (0.3)  0  0  EAC  50 (16.1)  15  8  Heat Exhaustion  2 (0.6)  1  0  Hemifacial Numbness  1 (0.3)  0  1  Hypoglycemia  3 (1.0)  0  0  Hypothermia  2 (0.6)  0  0  Hyperthermia  1 (0.3)  1  0  Panic Attack  1 (0.3)  0  0  Parasthesia  2 (0.6)  0  0  Urticaria  1 (0.3)  0  0  Dermatological Injuries  Abrasion  27 (8.6)  0  0  Blister  49 (15.8)  0  0  Rash  3 (1.0)  0  0  Unknown Dermatological  5 (1.6)  0  0   Total  311 (100)  23  10  View Large TABLE I. Injuries Diagnosis  Frequency (%)  IV Fluids  Transfer to ER  Musculoskeletal Injuries  Achilles Tendonitis  3 (1.0)  0  0  Biceps Tendonitis  1 (0.3)  0  0  Cramps  10 (3.2)  0  0  Hernia  1 (0.3)  0  0  Plantar Fasciitis  4 (1.3)  0  0  Shin Splints  1 (0.3)  0  0  Sprain/Strain (Ankle)  19 (6.1)  0  0  Sprain/Strain (Knee)  39 (12.5)  0  0  Sprain/Strain (Other)  33 (10.6)  0  0  Stress Fracture  1 (0.3)  0  0  Tarsal Tunnel Syndrome  1 (0.3)  0  0  Unknown Musculoskeletal  31 (10.0)  0  0  Medical Injuries  Asthma  4 (1.3)  0  0  Bee Sting  2 (0.6)  0  0  Dehydration  13 (4.2)  6  1  Dog Bite  1 (0.3)  0  0  EAC  50 (16.1)  15  8  Heat Exhaustion  2 (0.6)  1  0  Hemifacial Numbness  1 (0.3)  0  1  Hypoglycemia  3 (1.0)  0  0  Hypothermia  2 (0.6)  0  0  Hyperthermia  1 (0.3)  1  0  Panic Attack  1 (0.3)  0  0  Parasthesia  2 (0.6)  0  0  Urticaria  1 (0.3)  0  0  Dermatological Injuries  Abrasion  27 (8.6)  0  0  Blister  49 (15.8)  0  0  Rash  3 (1.0)  0  0  Unknown Dermatological  5 (1.6)  0  0   Total  311 (100)  23  10  Diagnosis  Frequency (%)  IV Fluids  Transfer to ER  Musculoskeletal Injuries  Achilles Tendonitis  3 (1.0)  0  0  Biceps Tendonitis  1 (0.3)  0  0  Cramps  10 (3.2)  0  0  Hernia  1 (0.3)  0  0  Plantar Fasciitis  4 (1.3)  0  0  Shin Splints  1 (0.3)  0  0  Sprain/Strain (Ankle)  19 (6.1)  0  0  Sprain/Strain (Knee)  39 (12.5)  0  0  Sprain/Strain (Other)  33 (10.6)  0  0  Stress Fracture  1 (0.3)  0  0  Tarsal Tunnel Syndrome  1 (0.3)  0  0  Unknown Musculoskeletal  31 (10.0)  0  0  Medical Injuries  Asthma  4 (1.3)  0  0  Bee Sting  2 (0.6)  0  0  Dehydration  13 (4.2)  6  1  Dog Bite  1 (0.3)  0  0  EAC  50 (16.1)  15  8  Heat Exhaustion  2 (0.6)  1  0  Hemifacial Numbness  1 (0.3)  0  1  Hypoglycemia  3 (1.0)  0  0  Hypothermia  2 (0.6)  0  0  Hyperthermia  1 (0.3)  1  0  Panic Attack  1 (0.3)  0  0  Parasthesia  2 (0.6)  0  0  Urticaria  1 (0.3)  0  0  Dermatological Injuries  Abrasion  27 (8.6)  0  0  Blister  49 (15.8)  0  0  Rash  3 (1.0)  0  0  Unknown Dermatological  5 (1.6)  0  0   Total  311 (100)  23  10  View Large Data Analysis The Institutional Review Board at Walter Reed Army Medical Center granted approval of this retrospective study with waiver of informed consent. All data were deidentified before analysis. Data were analyzed by age, gender, injury category, diagnosis, weather conditions, treatment, and medical disposition (return home, evacuated to hospital, return to race) using a general linear regression model. Correlation R values were considered very strong if ∣r∣ > 0.8, strong if 0.8 > ∣r∣ > 0.6, moderate if 0.6 > ∣r∣ > 0.4, weak if 0.4 > ∣r∣ > 0.2, and to have no relationship if ∣r∣ < 0.2. RESULTS During the 6 years of the study, there were an estimated 91,750 runners and 73,100 finishers, with a finish rate of 80% for ATM participants. A total of 346 runners sought medical care, indicating an estimated injury rate of 3.8/1,000 entrants. The injuries sustained by runners were analyzed with respect to age, gender, and injury type. Age information was only available for 291 of the 346 individuals treated. Most runners who presented with injuries fell into the age group of 20 to 29 year olds (Table II). The largest group of injured males fell within the age range of 30 to 39 years, whereas the largest group of injured females fell within the range of 20 to 29 years (Table III). Injury type was influenced by age but not gender. Runners with dermatological injuries were an average of 7 years older than runners with either medical or musculoskeletal injuries (p < 0.001 for both). There was no effect of runner's age on the incidence of medical or musculoskeletal injury. TABLE II. Age Distribution by Injury Category (%) for All Participants Injury Category  Age  Total  0–19  20–29  30–39  40–49  50+  Unknown  0 (0)  2 (33.3)  2 (33.3)  2 (33.3)  0 (0)  6  Dermatological  4 (2.0)  23 (29.9)  23 (29.9)  18 (23.4)  9 (11.7)  77  Medical  9 (11.4)  31 (39.2)  29 (36.7)  7 (8.9)  3 (3.8)  79  Musculoskeletal  6 (4.6)  56 (43.4)  43 (33.3)  19 (14.7)  5 (3.9)  129   Total  19 (6.5)  112 (38.5)  97 (33.2)  46 (15.8)  17 (5.8)  291  Injury Category  Age  Total  0–19  20–29  30–39  40–49  50+  Unknown  0 (0)  2 (33.3)  2 (33.3)  2 (33.3)  0 (0)  6  Dermatological  4 (2.0)  23 (29.9)  23 (29.9)  18 (23.4)  9 (11.7)  77  Medical  9 (11.4)  31 (39.2)  29 (36.7)  7 (8.9)  3 (3.8)  79  Musculoskeletal  6 (4.6)  56 (43.4)  43 (33.3)  19 (14.7)  5 (3.9)  129   Total  19 (6.5)  112 (38.5)  97 (33.2)  46 (15.8)  17 (5.8)  291  Numbers are lower than overall injury numbers because of the missing information for 22 racers. View Large TABLE II. Age Distribution by Injury Category (%) for All Participants Injury Category  Age  Total  0–19  20–29  30–39  40–49  50+  Unknown  0 (0)  2 (33.3)  2 (33.3)  2 (33.3)  0 (0)  6  Dermatological  4 (2.0)  23 (29.9)  23 (29.9)  18 (23.4)  9 (11.7)  77  Medical  9 (11.4)  31 (39.2)  29 (36.7)  7 (8.9)  3 (3.8)  79  Musculoskeletal  6 (4.6)  56 (43.4)  43 (33.3)  19 (14.7)  5 (3.9)  129   Total  19 (6.5)  112 (38.5)  97 (33.2)  46 (15.8)  17 (5.8)  291  Injury Category  Age  Total  0–19  20–29  30–39  40–49  50+  Unknown  0 (0)  2 (33.3)  2 (33.3)  2 (33.3)  0 (0)  6  Dermatological  4 (2.0)  23 (29.9)  23 (29.9)  18 (23.4)  9 (11.7)  77  Medical  9 (11.4)  31 (39.2)  29 (36.7)  7 (8.9)  3 (3.8)  79  Musculoskeletal  6 (4.6)  56 (43.4)  43 (33.3)  19 (14.7)  5 (3.9)  129   Total  19 (6.5)  112 (38.5)  97 (33.2)  46 (15.8)  17 (5.8)  291  Numbers are lower than overall injury numbers because of the missing information for 22 racers. View Large TABLE III. Total Injuries by Age and Gender (% of Total Injury Number) Category  Age  Total  0–19  20–29  30–39  40–49  50+  Unknown  0 (0)  0 (0)  2 (66.7)  1 (33.3)  0 (0)  3  Female  8 (7.0)  55 (48.2)  34 (29.8)  13 (11.4)  4 (3.5)  114  Male  11 (6.3)  57 (32.8)  61 (35.1)  32 (18.4)  13 (7.5)  174   Total  19 (6.5)  112 (38.5)  97 (33.2)  46 (15.8)  17 (5.8)  291  Category  Age  Total  0–19  20–29  30–39  40–49  50+  Unknown  0 (0)  0 (0)  2 (66.7)  1 (33.3)  0 (0)  3  Female  8 (7.0)  55 (48.2)  34 (29.8)  13 (11.4)  4 (3.5)  114  Male  11 (6.3)  57 (32.8)  61 (35.1)  32 (18.4)  13 (7.5)  174   Total  19 (6.5)  112 (38.5)  97 (33.2)  46 (15.8)  17 (5.8)  291  View Large TABLE III. Total Injuries by Age and Gender (% of Total Injury Number) Category  Age  Total  0–19  20–29  30–39  40–49  50+  Unknown  0 (0)  0 (0)  2 (66.7)  1 (33.3)  0 (0)  3  Female  8 (7.0)  55 (48.2)  34 (29.8)  13 (11.4)  4 (3.5)  114  Male  11 (6.3)  57 (32.8)  61 (35.1)  32 (18.4)  13 (7.5)  174   Total  19 (6.5)  112 (38.5)  97 (33.2)  46 (15.8)  17 (5.8)  291  Category  Age  Total  0–19  20–29  30–39  40–49  50+  Unknown  0 (0)  0 (0)  2 (66.7)  1 (33.3)  0 (0)  3  Female  8 (7.0)  55 (48.2)  34 (29.8)  13 (11.4)  4 (3.5)  114  Male  11 (6.3)  57 (32.8)  61 (35.1)  32 (18.4)  13 (7.5)  174   Total  19 (6.5)  112 (38.5)  97 (33.2)  46 (15.8)  17 (5.8)  291  View Large The medical reports of 311 runners, with a recorded 319 injuries, were further examined to explore the specific types of injuries that ATM runners incurred. The majority of injuries were minor and easily treatable. The most common category of injury was musculoskeletal (44.3%), followed by medical (26.5%) and dermatological (27.1%). Among musculoskeletal injuries, sprains and strains were the most frequent, followed by unspecified injuries (Table I). EAC was the most common medical injury diagnosis (Table I), with 15 (30.0%) of those diagnosed requiring IV fluids and 8 (16.0%) requiring transfer by ambulance to a local ER for further care. The most common type of dermatological injury was blisters. Although there were insufficient data to show a strong correlation between incidence of medical injury and dew point (Fig. 1; R2 = 0.13), the relative frequency of medical injury (percentage of total injuries reported) demonstrated a very strong correlation with increasing dew point (Fig. 2; R2 = 0.86). FIGURE 1. View largeDownload slide Number of medical injuries with rising dew point at time of race start. FIGURE 1. View largeDownload slide Number of medical injuries with rising dew point at time of race start. FIGURE 2. View largeDownload slide Percentage of medical injuries (medical injuries/total injuries) with rising dew point at time of race start. FIGURE 2. View largeDownload slide Percentage of medical injuries (medical injuries/total injuries) with rising dew point at time of race start. DISCUSSION The injury rate or 3.8 per 1,000 ATM runners is significantly lower than the injury rates reported at the Twin Cities and Houston Marathons (18.9 and 40, respectively),5,12 supporting the observation that shorter duration athletic events tend to produce fewer injuries than longer races.14 Although this relatively low injury rate could also result from the ATM drawing a different running population than other long-distance running events, more information on the demographics of ATM runners is necessary to substantiate this claim. Among ATM injuries, we found the strongest correlation between the relative frequency of medical injury and the race-day dew point. As the dew point increased, a nearly linear increase in the percentage of medical injuries was observed (Fig. 2). We hypothesize that higher dew point slowed the rate of evaporation of sweat, thereby reducing the runners' ability to lower body temperatures, leading to an increased proportion of medical injury such as heat exhaustion. Although our sample size was too small to show a statistically significant association between the incidence of EAC and dew point, our findings revealed a trend comparable to those reported from the Twin Cities Marathon.3 This suggests that increased race-day temperature and humidity contribute to a higher risk of medical injury and EAC. Unfortunately, our medical records were not detailed enough to further classify EAC into hyperthermic, normothermic, or hypothermic, nor were they able to distinguish between mild, moderate, or severe categories of EAC, as has been reported elsewhere.5 Musculoskeletal injuries, which disproportionately affected younger ATM runners, were the largest injury subtype in our study, accounting for 44% of all injuries. This finding is consistent with the previous reports of marathons,4,15 but divergent from the observation of Roberts3 at the Twin Cities Marathon, who reported only 17.6% of race injuries to be musculoskeletal. This discrepancy may be attributable to the relatively faster pace and higher temperatures of the Twin Cities Marathon, contributing to a reported higher relative incidence of EAC. Musculoskeletal injuries sustained during the ATM occurred almost exclusively in the lower extremities, which is also consistent with other reports.12 Knee injuries (12.5%) were the most common, followed by other sprains/strains (10.6%) and ankle injuries (6.1%). Foot problems were relatively rare in ATM runners, despite the reports by Lysholm and Wiklander16 identifying those as more common in long-distance and marathon runners than those were in sprinters and middle-distance runners. Although Achilles and calf muscle pain have been reported as the two most common overuse injuries in a 16-km (9.94-mile) race,17 these conditions only represented 1.0% of the total injuries in ATM participants. This number, however, may be low because of the providers' reporting of such injuries as “other sprain/strain.” Dermatological injuries were the only category of injury that directly correlated with increasing age, indicating that older racers are more likely to develop skin injuries. Musculoskeletal and medical injuries were, in contrast, more common in younger male and female runners, possibly explained by the fact that younger runners may have less experience in pacing themselves during competitive races and therefore overexert to the point of injury.18 Although the focus of this study was to report the incidence and types of injuries observed during the ATM, our data also suggest that previous injury rates and race-day weather forecasts can be used to assist medical planners in supporting similar distance running events. Underestimating the medical support needed for a mass-participation running event may lead to overwhelming local emergency departments and subsequent decreases in access to emergency medical care for the citizens within a community.19 The medical plan, as described above, was sufficient to adequately support a 10-mile running event for 20,000 to 25,000 participants. One of the major strengths of this medical plan was the availability of medical specialists on-site. The orthopedic surgeon tended to any casualties with the concern of trauma or dislocation; the cardiologist tended to patients suggestive of cardiac dysfunction; the anesthesiologist was present in the event of unsuccessful or difficult intubation or IV access in addition to serving as a backup provider for any patient presenting with signs of airway compromise, hypervolemia, or potential shock; and the physiatrist provided overall medical staff coordination. The pediatrician provided care for any child injured either during the pediatric portion of the race (a short run at the end of the race course offered to children) or while attending as a spectator. Although previous studies have reported the need for similar medical specialists,2,3 this is the first report that details the specific numbers of medical staff sufficient for a race of this distance. We recommend these medical staffing ratios be used as a guideline when planning future races of similar distances. We also suggest that the injury risk reduction strategies of environmental monitoring, appropriate fluid replacement, course management, and participant education be employed before and during each race.20 The present research has a number of limitations. In particular, although we know that approximately 35% of all participants in the ATM were active duty military service members, we do not have data regarding the active duty status of the individuals who sought medical care; therefore, no assumptions can be made regarding one's risk of injury based on their military status. Similarly, we did not collect data regarding the running experience or ethnicity of each participant, and therefore, cannot make any determination regarding how these factors may have been associated with potential risk of injury. Furthermore, we did not have access to the completion/race times of ATM participants and, therefore, could not analyze how factors such as dew point related to race-day performance. Further investigation is necessary to better elucidate the factors that may influence both risk of injury and race performance. Finally, it is possible that our data set is incomplete because of the unreported injuries. However, it is unlikely that many injuries went unreported as medics were stationed every half mile throughout the course to intervene in case of injury and medics actively sought out runners at the end of the race who showed any signs of injury. The possibility remains that the relative infrequency of dermatological injuries in part results from their tendency to be less serious and, therefore, remain unreported. CONCLUSIONS Few studies have examined the medical injuries sustained during a 10-mile race. The present article uses data extracted from a medical record over a 6-year period to provide the first detailed injury descriptions for the ATM. Injury rates were analyzed with respect to race-day weather conditions and participant demographics. ATM runners sustained injuries at a lower rate than had been previously reported in other mass-participation running events. Musculoskeletal and medical injuries occurred more commonly than dermatological problems. There was a significant effect of runner age on type of injury; runners with dermatological injuries were an average of 7 years older than runners with either medical or musculoskeletal injuries. Furthermore, the data suggest that an increase in race-day dew point may contribute to a higher relative incidence of medical injuries, including EAC. 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TI - Analysis of Injuries From the Army Ten Miler: A 6-Year Retrospective Review
JF - Military Medicine
DO - 10.7205/MILMED-D-11-00447
DA - 2013-01-01
UR - https://www.deepdyve.com/lp/oxford-university-press/analysis-of-injuries-from-the-army-ten-miler-a-6-year-retrospective-CLV5FOzUVW
SP - 55
EP - 60
VL - 178
IS - 1
DP - DeepDyve
ER -