Race Directors Chances are you feel pretty good about your aid stations and course markings, but how prepared are you to address the following potential medical needs at your event?
- Are you ready for a runner who seizes due to hyponatremia?
- Does your medical staff have hypertonic saline on hand? Do they know how to use it? And do they know what to tell the transport team so that the runner isn’t harmed by their treatment?
- What if one of your volunteers has a heart attack at a remote aid station? Do you know what to do to optimize the outcome?
There are several other potentially serious issues that can occur during an ultramarathon. Are you prepared? If you’re not as confident now as you were when you started this article, you’re not alone.

A fully stocked medical kit is key to preparedness and success.
Runners You’ve trained and prepared for race day and are ready to give it your best effort. Aid/water stations will support your fuel and hydration needs, but will there be medical professionals with training and experience at ultras to address any medical issues you might have?
- What will you do if you are stung by a bee or bitten by a rattlesnake?
- If you fall and break something, who will splint and bandage you up?
- Will you be advised properly about what to do if you are bloated and your weight has increased during the run?
The Paramedic Foundation, which was formed in 2013 as a non-profit organization, realized the need for highly specialized medical teams at ultramarathons. In response to this need, the Paramedic Foundation founded the Ultra Medical Team with experienced ultrarunners in leadership roles. Marty Hoffman, MD, is Chief Medical Officer and paramedic Nick Nudell is the Executive Director. Together they have built a constantly growing team of volunteer medical providers, many of whom are also ultramarathon runners. Ultra Medical Team is composed of physicians, paramedics, nurses, chiropractors, physical therapists and others who are dedicated to the health and safety of the elite population of ultramarathon runners. In fact, many of the medical volunteers have joined Ultra Medical Team after first meeting team members at races while running, crewing or volunteering in other capacities.
Providing a level of consistency and professional competency, not only from one event to another but also one aid station to another, requires specialized medical oversight, training and quality assurance. To that end, each team member receives training and goes through a an accrediting program to assure that providers have a common baseline level of understanding of the unique needs and treatments pertinent to ultramarathon runners.
Much of the training is based on recently generated consensus guidelines from international groups of physician scientists that Dr. Hoffman organized. One paper recently published entitled “Medical services at ultra-endurance foot races in remote environments: medical issues and consensus guidelines” is available upon request from Dr. Hoffman.
The Ultra Medical Team is contracted by race organizers to collaborate in developing a medical plan and to provide in-race medical care. In addition to providing medical coverage at ultramarathons, the mission of the Ultra Medical Team includes education of providers on medical issues at ultramarathons and research into the medical needs at ultramarathons. The goal of the organization is not to displace dedicated medical volunteers who have served ultra events well, but to supplement existing resources or provide an alternative for those events that have not secured adequate medical coverage.

A broken ankle in remote location requires some ingenuity…
Ultra Medical Team members have also been able to use their skills to help fellow runners during training runs and even races. For example, almost six miles into the Old Goats 50 this spring, Ultra Medical Team’s Executive Director Nick Nudell was called into action to assist another runner who had broken her ankle, far from the next aid station. After stabilizing that injury with an improvised splint, he was able to run ahead to advise the rangers, firefighters and EMTs (who were beginning to mobilize to retrieve the injured runner) on the extent of the injury and what supplies and equipment would be needed. Several other runners also helped, giving up their own race to carry the injured runner most of the way up the difficult trail to meet the responders.
The Ultra Medical Team invites physicians, paramedics, nurses, chiropractors, physical therapists and others who are interested in ultra-endurance medicine to visit their website (ultramedicalteam.org) or Facebook page (www.facebook.com/ultramedicalteam) or contact Nick ([email protected] or 760-405-6869) or Marty ([email protected]) for more information. Race directors interested in learning more about their services should also contact them to learn more about their services and areas of expertise.