It is that time of year when triathletes from all over the world begin to focus on what is happening on a 4,000 square mile island among the United States Hawaiian archipelago in the Central Pacific ocean. It is here where the Ironman World Championship takes place. A true championship race that requires obtaining a coveted entry slot through a top-place finish in selected Ironman races during the preceding year. Besides those athletes who are competing there are many others who make the trip to Kailua - Kona, Hawaii in early October. Many want to see the event unfold in person and others use it as their own training vacation to name just two examples. I on the other hand made the trip one year to volunteer in the medical tent. You see most of what I do revolves around triathlon and endurance sports. Whether it be as a coach, an exercise physiologist, a lifelong athlete or even as a physician assistant. If I can use any of my 4 roles to better the others I do just that. Not to mention the fact that triathlons of any kind or distance simply cannot take place without an army of volunteers. So since I have a service I can provide I prefer to volunteer in the medical tent.
As one might expect taking care of Ironman athletes in any race is unique simply because of the distance of the race. The Hawaii Ironman poses other caveats because it is typically a hot and humid race. The average daily temperature and humidity in Kona during early October is 86 degrees with 80% humidity. You see as we sweat our skin relies on air to evaporate moisture thereby keeping us cool. Higher humidity reduces our effectiveness of sweating to keep us cool by reducing the rate of evaporation of moisture from the skin. The distance and climates and how an athlete manages them can cause an athlete problems when racing. Extremes at any end exacerbate the problems. Although athletes at the World Championship are typically well trained and experienced it is asking a lot from one's body to compete in more than one Ironman distance event in a given year. Combine that with the weather that many are not acclimatized to and how they fuel themselves because of it and it is not surprising that 1/3 of the race participants are treated in the medical tent on race day.
The Ironman medical tent is impressive to say the least. It is consistently busy and on my shift between 3pm and 10 pm on that particular race day I was never without a patient. Most athletes walk into the tent on their own and others are brought in on a stretcher or transferred from an ambulace or mobile medical van from the race course. Every athlete who is brought in as a patient is evaluated by a doctor and then either placed in an area for rest, "admitted" for further treatment, or transferred to the hospital. The nearest hospital is approximately a 60 minute drive or so on race day due to some of the race logisitics, therefore they try to treat most conditions in the medical tent and are equipped to do so. If they are admitted for further treatment a chart is made for them that includes their pre-race weight, their present weight, medications they are currently taking, their medical history and their vital signs. Prior to Ironman races all athletes are required to have their weight measured and the are required to fill out a medicall history for just this purpose. They have the capabilities of performing an electrocardiogram, pulse oximetry, assessing core temperatures, checking electrolytes, checking glucose levels, starting intravenous fluids, and administering certain medications. The medical staff I had the pleasure of working with on my "team" included doctors, nurses, other physician assistants and medical students. Like in most things in life each one brought their own experience and skills that complemented each other's allowing us to learn from one another and provide a high level of care.
The conditions treated range from scrapes, bruises and clavicle fractures due to bike crashes, and to severe life threatening conditions. The most common being hyponatremia which also happens to be the most common condition treated in the tent. Hyponatremia is classified as low levels of sodium in the blood and is often caused by over drinking fluids. Heat stroke is less common, but of extremely high concern because it is even more deadly when treatment is delayed. This is classified as having a rectal temperature greater than 104 degrees F. Dehydration is a common concern and an athletes pre-race weight and post-race weight provides a ton of information in diagnosing severe dehydration. Hypoglycemia (low blood sugar) is another condition commonly treated and often due to under fueling. All of these conditions present with signs and symptoms that I will not mention here as this is not intended to be a medical article. As I mentioned earlier I always had a patient in my 7 hours of working in the tent and they ranged from these exact conditions and one patient with a history of ischemic colitis who was having severe abdominal pain. Ischemic colitis is inflammation of the large colon due to inadequate blood supply. Needless to say we had to transfer her to the hospital.
What I have learned from this experience especially at this high level is that an athlete's training is not the limiting factor for a successful performance. It is the athlete who manages the environmental conditions best and is meticulous about their hydration and nutrition that set themselves up for the best chance to succeed. An athlete must match their carbohydrate loss, fluid loss, and sodium loss. They can do so through a combination of sports drinks, gels, energy chews, energy bars, and salt tablets. There are average losses for endurance athletes that are a good starting point, but it is most important that athletes replace losses correctly and to do this they should know their sweat rate. Once they know this a schedule can be established as to when to eat and drink in order to match fluid intake with sweat loss in order to avoid the conditions mentioned above. It is important to stick to one's plan, practice it religiously in training and never change anything on race day.