Medical and other risks

The Mount Abu International Trail Marathon is one of the most physically challenging events and participation in it presents numerous medical risks, many of which can be extremely serious or on rare occasions fatal.


Participation in this event is at the runner’s own risk. Although Run Management has experienced medical personnel at various points along the course, the inaccessibility of much of the trail may make it difficult or impossible for medical assistance to reach the runner immediately. Each runner is encouraged to consult with his or her own personal care physician regarding any physical or medical limitations before attempting the Run.


It is important for each entrant to recognize the potential physical and mental stresses which may evolve from participation in this Run. Runners may be subjected to extremes of heat and cold. They may develop hypothermia, hyperthermia, dehydration, hypoglycemia, hyponatremia, disorientation and mental and physical exhaustion. Run Management and the medical staff strive to work with runners. Adequate physical and mental conditioning prior to the Run is mandatory. If you have not been able to prepare properly, do not attempt to run!


Runners should appreciate the risks associated with participation in this event. Actions may have to be taken on your behalf under extreme time constraints and adverse circumstances. We will make reasonable efforts to give assistance whenever possible. Ultimately and primarily you are in charge, and you are likely to be solely responsible for creating your own crisis that we must then respond to. Be careful, be responsible, and do not exceed your own abilities and limitations. IN THE EVENT THAT A RUNNER REQUIRES EMERGENCY EVACUATION BY GROUND or HELICOPTER-AMBULANCE, THE RUNNER ASSUMES ALL FINANCIAL OBLIGATIONS CONNECTED WITH THIS SERVICE. RUN MANAGEMENT IS NOT RESPONSIBLE FOR ANY DEBTS INCURRED.


Some of the main risks of the Run, but certainly not all of them, are listed here. These should be understood and remembered by all runners, before and during the event. Please note that death can result from several of the risk conditions discussed below or from other aspects of participation in the Mount Abu Ultra.


1. Renal Shutdown: Cases of renal shutdown (acute renal failure) have been reported in other ultramarathons. Renal shutdown (known technically as acute kidney injury or AKI) occurs from muscle tissue injury which causes the release of the protein myoglobin into the blood. Myoglobin is cleared from the blood by the kidneys and will look brownish-colored in the urine, but it is also a toxin to the kidneys and can cause acute vasospasm in the small arteries that supply the kidneys leading to AKI as a result of rhabdomyolysis. Appropriate training is key to prevention of AKI from rhabdomyolysis, and adequate hydration is key to both prevention and treatment of AKI, a syndrome which can be worsened by the use of NSAIDs. Three Western States runners have required a series of dialysis treatments, and others have been hospitalized several days with IV fluids to correct partial renal shutdown. While usually reversible in healthy people, AKI may cause permanent impairment of kidney function. IT IS CRUCIAL TO CONTINUE HYDRATING FOR SEVERAL DAYS FOLLOWING THE RUN OR UNTIL THE URINE IS LIGHT YELLOW AND OF NORMAL FREQUENCY. 


2.  Heat Stroke/Hyperthermia: Your muscles produce tremendous amounts of heat when running up and down hill. The faster the pace, the more heat is produced. In addition to the generation of heat from metabolism, environmental heat stress can be significant during the Run. In 1989, radiated heat off the rocks measured at 114 degrees F. Heat stroke can cause death, kidney failure and brain damage. It is important that runners be aware of the symptoms of impending heat injury. These include but are not limited to: nausea, vomiting, headache, dizziness, faintness, irritability, lassitude, confusion, weakness, and rapid heart rate. Impending heat stroke may be preceded by a decrease in sweating and the appearance of goose bumps on the skin, especially over the chest. Heat stroke may progress from minimal symptoms to complete collapse in a very short period of time. A light-colored shirt and cap, particularly if kept wet during the Run, can help. Acclimatization to heat requires approximately two weeks. We recommend training 90 minutes in 90 degree F heat or greater for at least two weeks prior to the Run if at all possible. If signs of heat exhaustion occur, we recommend rapid cooling by applying ice to the groin, neck and armpits.


3. Risks Associated With Low Blood Sodium: Low blood sodium concentrations (hyponatremia) in ultramarathon runners have been associated with severe illness requiring hospitalization and several deaths among participants of shorter events. Generally, those individual who are symptomatic with hyponatremia have been overhydrating. But, hyponatremia may occur with weight gain and weight loss, so weight change is not helpful in making the diagnosis. Because of the release of stored water when you metabolize glycogen stores, you should expect to lose 3-5% of your body weight during the run to maintain appropriate hydration. It is important to note that hyponatremia may in fact worsen after the Run, as unabsorbed fluid in the stomach can be rapidly absorbed once you stop exercising. Signs and symptoms of hyponatremia may include bloating, nausea, vomiting, headache, confusion, incoordination, dizziness and fatigue. If left untreated, hyponatremia may progress to seizures, pulmonary and cerebral edema, coma and death. The best way to avoid developing symptomatic hyponatremia is to not overhydrate. There is no evidence that consuming additional sodium or using electrolyte-containing drinks rather than water is preventative of exercise-induced hyponatremia. If symptoms develop, one needs to assess whether they are due to over hydration. If that is the case, then stop fluid intake until you remove excess fluid through urination. If severe symptoms present, this is a medical emergency. The runner should be treated with intravenous hypertonic saline and transported to a hospital. Since the typical fluid used for intravenous hydration (referred to as normal saline) can exacerbate exercise-associated hyponatremia, we try to avoid such treatment at the Run unless we are certain that the individual is not hyponatremic.


4. Wildlife Hazards: Sloth bears, leopards and other potentially hazardous forms of wildlife live on the course and willsurprise you any time. Keep alert and be careful where you place your feet and hands.


5. Injuries from Falling: Falling is an ever-present danger on the Trail, with potentially serious consequences. Much of the trail is narrow, uneven and rutted.


6. Rhabdomyolysis: It has been found that some degree of muscle cell death in the legs occurs from participation in the Run. The recovery can take several months. This seems to be a bigger problem in runners who have exerted themselves beyond their level of training.


7.  Overuse Injuries: Obviously, innumerable overuse injuries can occur, especially in the knee and the ankle. Sprains and fractures can easily occur on these rough trails.


8. Common Fatigue: One of the dangers you will encounter is fatigue. Fatigue, combined with the effects of dehydration, hypothermia, hyperthermia, hyponatremia, hypoglycemia, sleep deprivation and other debilitating conditions can produce disorientation and irrationality.


9.  Difficulty in Gaining Access to or Locating Injured Participants: Much of the trail is remote and inaccessible by motor vehicle. Accordingly, in spite of the many layers of safety precautions instituted by Run Management (including radio communications, foot patrols, mounted search and rescue personnel and other emergency services and medical personnel at many checkpoints), there is absolutely no assurance that aid or rescue assistance will arrive in time to give you effective assistance should you become sick, incapacitated or injured


10. Getting Lost: Although Run Management endeavors to mark the course; it is definitely possible to lose the trail. If you believe at any time that you may not be on the correct trail, do not attempt to find your way cross country. If you are sure of your route, backtrack to where you last saw a trail marker and try to find other markers showing the direction of the trail. If you are unable to find your way, stay where you are! Wandering randomly will likely take you farther from the trail and reduce your chances of being found. If you do become injured, exhausted or ill, STAY ON THE TRAIL. You will be found there either by another runner, the Safety Patrol, or by the Sweep Riders of the Sierras, who monitor the progress of runners during the event. If you feel dizzy, disoriented or confused, do not risk falling. Sit or lie down on the trail until you recover or are found. An unconscious runner even a few feet off the trail could be impossible to find until it is too late. If you are assisted by individuals who are not associated with Run Management and you elect to leave the trail, you MUST notify the official at the nearest checkpoint of your decision to withdraw and surrender your official wristband and pull-tag.


Although medical and other personnel will assist you when possible, remember that you are ultimately responsible for your own well-being on the trail. Only you will know how your body and mind feel at any given time. Monitor yourself during the entire Run, and prepare yourself to drop out at the nearest check-point if you find it just isn’t your day. As you continue past each medical checkpoint, be aware of the number of miles to the next one, realizing that getting rescue vehicles into these areas can be difficult, if not impossible.

                                   

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