Medical report - Berghaus Dragon's Back Race 2015
First of all, the medical team would like to offer hearty congratulations to all competitors whether or not they finished the whole course. You will be sent psychiatric referrals later! Actually we were so inspired that we have all thought of entering the next Berghaus Dragon’s Back Race™ as runners.
The medical team had four regular members but were lucky enough to be able to call upon other members of the support team for help or advice. The day generally began with “clinics” in the tent starting at 0500 and as the first runners departed the team then split, leaving two medics at camp, and two mobile or located at the midway support point. The mobile team joined the camp based medics at the new camp after the last runners had left the midway support point. The mobile team did have off road capability and this was used to evacuate one runner off the mountain rather than call for Mountain Rescue support. The mobile team helped at the midway support point, and the camp team also helped the taking down and putting up of the camp. Once established at the new camp, clinics started again at about 1800 and usually continued until 0100 or later. We did get snoozes during the day!
Macerated feet. This occurs when the skin is saturated for long periods of time and leads to the over-hydrated skin becoming soft and easily damaged. © Berghaus Dragon’s Back Race™ Competitor
I’m giving a quick breakdown of the sort of troubles the runners gave to the medical team and trying to avoid specifics or identify individuals.
Of the 128 starters only 27 did not attend the medical tent ie 80% did!
29 people retired, usually of their own choice: 11 after Day 1, 14 after Day 2 and a further 4 after Day 3.
Medical retirements were obvious – the runners couldn’t go on even if they wanted to!
Five competitors and one member of the event team were sent to hospital, although one was sent the day after the race had finished. What caused us to send these people to hospital?
Two were for nasty cuts that could not really be treated properly in our limited facilities; although we could have sewed up these wounds, it was much more appropriate for them to be cared for in a clean environment. Two were for more severe bony and soft tissue injuries, which we could not help with – these were obvious medical retirements. One of these was a broken limb, luckily not too serious.
The last hospitalisation was probably the most serious and should be a lesson to all involved in these multi-day events. The runner had nasty blisters and severe shin pain related to soft tissue damage of the tendons and muscles. He was probably still not fully hydrated after 5 days of running (and unlike some of you, hadn’t rehydrated with copious amounts of beer at the finish camp!). His swollen shins and blistered feet were so troublesome that he was kept in hospital for several days to treat the swelling and the infection that his blisters had let in. One of the dangers of prolonged exercise like this is that the muscles can become so swollen that they can become compressed within their fibrous sheaths: the muscle can die and release nasty chemicals into the blood stream which can then go on to damage the kidneys. Not being fully hydrated can worsen this situation. Left unchecked, it is possible that a runner could die, so no wonder the staff at the hospital were keen to hold onto our friend for a few days.
You’ll be glad to know that the majority of visits to the medical tent were for soft tissue injuries of a less threatening nature! By far and away the commonest were for blisters – more of that later. Next was sore shins or ankles with inflamed tendons and tender muscles. Uncomfortable and troublesome but not life threatening – unless ignored. Soft tissue injuries of the foot, ankle and knee happened, all of which were treated with sympathy, blue tape and perhaps a tablet or two. You know it’s going to hurt, that’s why do it!
We saw a number of heat-related incidents. Of these, eight were problems relating to too much heat (cramps, exhaustion or early heat stroke) and six were cold related (exposure, usually in those returning very late after a very long day in the hills). There is a message here: do not skimp on safety equipment if you are going for a long run.
Severe shin pain related to soft tissue damage of the tendons and muscles led to this competitor being hospitalised for many days. © Berghaus Dragon’s Back Race™ Competitor
Luckily infection was not a real problem. We had one runner with infected toe- nails which, truth be known, were probably infected before the DB. We felt that it was not appropriate to open these infected toenails with several days of running through mud and sheep sh*t still to come. We had a couple of ticks to deal with too.
There were a number of unusual things that people came with (or were brought to us with). Some of these are related to running. Ladies (and gents), symptoms of cystitis (frequent urge to pee, painful, perhaps mildly blood-stained urine) are not uncommon. The bladder bounces around inside your pelvis and the uterus or your bowels can knock against it causing damage to its delicate lining. But it is one of those things not to ignore either. Talking of bowels (yes we do) upsets are not uncommon in endurance events as I’m sure you all know: you usually find your own coping strategies but sometimes things don’t always work out. Nausea and sickness can be a problem too. We saw all of these things – inconvenient usually but could be serious. Don’t ignore things that aren’t expected.
But blisters are expected aren’t they? Judging from the number of you coming to show us your manky feet you would think that blisters are badge of honour. Actually, blisters should not be common but they certainly were. At least a quarter of the runners attended the medical tent for repeated treatment of blisters: it took upwards of 30 minutes per foot to treat most of these people and caused a significant drain on the ability of the team to look after the more serious problems. We were unable to spend time visiting folk in their tents as we would have liked but luckily another member of the support team did this for us. Blister treatment should start for the competitors at least six months before the event by preparing your feet – that means choosing socks, shoes and removing old callus. Treat your feet like royalty. Learn to do preventative taping if you are prone to blisters. In camp wash and dry your feet (have you ever smelt some-one else’s feet after they have been in wet sheep shit-laden trainers for 12 hours!) and dress your own blisters. If you’re having trouble doing it, ask your tent mates. If the blisters are so bad that you need to see the medics, then really you should be thinking of retiring.
Now that has got you thinking about the next running of the Berghaus Dragon’s Back Race™!
We look forward to dealing with you in 2017!
The Medical Team
Race Director’s comment
The challenge that the medical team faced at the Berghaus Dragon’s Back Race™ this year was the sheer volume of patients asking for treatment, and it is interesting to consider how closely this reflects the challenges faced by the NHS. By this I mean, that by offering a first class, ‘free at the point of delivery’ service we really struggled to keep up with demand and the medics worked very hard as a result.
Incredibly, I actually dealt with a few complaints from competitors who were unhappy that they had to queue for treatment, or that there was no one available at 0500 sharp to dress a blister!
After some consideration and discussion with the medical team we are going to introduce a triage system for the next Dragon’s Back Race™ in 2017, much like you would see at an Accident and Emergency hospital and insist that competitors take primary responsibility for their own foot care. This will mean:
1) Patients will be assessed in a triage system prior to treatment with the most needy being treated first, regardless of the how long others may have already queued.
2) We will not assess anyone’s feet unless they have been washed and are presented in a clean, mud free condition.
3) We will expect minor blisters to be treated by competitors themselves.
4) At triage assessment, advice will be given as to whether a blister is ‘minor’ and how to treat it if required.
5) Competitors must have their own blister treatment kit and this is part of the mandatory kit list for the event.
I will of course provide more details on these procedures as we prepare for the 2017 event (and this process will be part of the Cape Wrath Ultra™ medical provision in 2016). It is important to emphasise that the medical team will be there to help and provide advice and if competitors have any questions about the seriousness of a blister, then you should always seek the opinion of the medical team. However, we will be shifting the primary responsibility for dealing with minor blisters to the competitors.
Shane Ohly
Race Director