Inside a marathon medical tent
The medical tents at the Marine Corps Marathon this Sunday will be crawling with activity from before dawn until long after most runners have gone home. Competitors will be cared for by more than 900 volunteers, directed by Navy medical officers and trained to handle the unique, sometimes quirky needs of distance runners. For tips on how to stay out of the tent, click here.
Click on the runners to follow them into the finish line medical tent:
First stop: Triage
A nurse or other provider evaluates all comers, looking closely for signs of cardiac distress. Names and bib numbers are recorded so race officials can account for everyone and keep family and friends informed. Each runner is then sent to a treatment station, where blood pressure, pulse and respiration rate will be checked. Blood may be tested for sodium levels and other factors in the tent's small lab.
Roving patrols scan the course for trouble. Marine Corps runners are determined, so if one collapses before the finish line or can't walk himself into an aid station, he is assumed to have a serious problem and is taken to a hospital.
Conditions treated here include muscle soreness, cramps, fractures, joint injuries, shin splints, blisters.
Physical therapists, podiatrists and other sports medicine specialists work here, kneading, wrapping, draining and splinting. A calf cramp will be checked to make sure the muscle isn't torn, then it will be stretched and iced. Most people hobble out, but a broken hip, femur or an open fracture requires a ride to the hospital.
What's there: ice, splints, crutches, Ace wraps, knee immobilizers, athletic tape
Conditions treated here include nausea, vomiting, dehydration, dizziness, falls and ''feeling bad.''
Scrapes are bandaged and Tylenol is dispensed. A nauseated runner would be treated and might rest before joining her family. A dehydrated runner gets Gatorade or water if she can drink it and IV fluids if she can't.
What's there: bandages, drinks, IVs, blankets, acetaminophen
Conditions treated here include potential heart problems, blood sugar problems, severe allergic reactions and asthma attacks.
The runner with a cardiac problem -- or with almost any serious condition -- will be stabilized and taken to a hospital. An exception is a person with exercise-associated collapse, a phenomenon in which a runner passes out just beyond the finish line. It happens because he stops suddenly and blood pools in his feet, causing his blood pressure to drop. After half an hour with his feet elevated and some food and water, he can walk out of the tent.
What's there: blood-pressure monitor, IVs, EKG equipment, EpiPen, automated external defibrillator
For heatstroke, when a body's internal temperature tops 104 degrees.
Treating heatstroke is a Marine Corps Marathon specialty because the military crew treats recruits in basic training. Attendants pack ice around the runner's head and massage her legs and torso with ice, while others pour cold water from the pool over her until her temperature drops to 102. She is then given IV fluids and monitored to make sure she continues to cool before being taken to a hospital.
What's there: pools of cold water, ice, stretchers
Map of aid stations
Ten aid station tents dot the course, and five others are dispersed around the finish area and post-race festival. One of those is at the Rosslyn Metro station, where exhausted runners have keeled over on the platforms.
SOURCE: Sources: Capt. Bruce Adams and Capt. Shelly Weinstein of the Marine Corps Marathon; George Banker, the race's historian; Mayo Clinic.
GRAPHIC: Bonnie Berkowitz, Laura Stanton and Kat Downs - The Washington Post. Published Oct. 24, 2011.
How to stay out of a medical tent
Advice from William O. Roberts, co-founder of the American Road Race Medical Society:
To see inside a marathon medical tent, click here.
1. Arrive prepared for the distance and conditions. If it's hotter than you are used to, consider not starting.
2. Don't start if you don't feel well; you probably won't feel better after 26.2 miles.
3. Be careful if you've been sick recently. You could be more susceptible to heat illness.
4. Eat and sleep well two nights before the race.
5. Pay attention to your surroundings. Don't step on an insect nest or into a pothole.
6. Drink only when you're thirsty. Hyponatremia, a sometimes deadly condition in which the body's sodium is diluted, can occur in endurance activities when people drink too much water. Some people will be fine after a salty snack, but extreme cases require a high-sodium IV and hospitalization. Hyponatremia was responsible for one of the six deaths in the 35 years of the race. The rest were due to heart problems.