Some little while ago I was discussing supporting ultramarathon races with some of my ham radio friends. The specific scenario discussed was operating a checkpoint for the Plain 100, and the specific issue was that my friends wanted to know what stuff they should bring along beyond just their radio gear. Foremost in their mind was what they’d need to offer aid to a runner who is in bad shape and needs help. (note that in the case of the Plain 100, runners who accept help are disqualified, so you know the runner who asks for help is in a pretty bad way)
So what we’re discussing is stuff to help deal with a runner who arrives at the checkpoint ready to drop but in need of care until/while transported back to the race HQ. My ham friends said that if they just had a list, they’d be happy to just buy the stuff and bring it along.
Well, I run ultramarathons. So here are my thoughts on what to have on hand at a checkpoint and why, along with some thoughts about what to do for runners who are in bad shape.
When a runner who has been going for a long time and going even modestly hard is at a point where they are ready to drop, the issues he/she faces are:
- they will get cold very quickly, as they can no longer generate much body heat. They may also arrive suffering from hypothermia. Or, if the weather is warm or the course doesn’t provide much cover from the sun, they might be overheated and need to be cooled down.
- They will likely be behind on hydration - dehydrated, perhaps very dehydrated.
- they will likely be behind on calorie intake, possibly very far behind.
- they may have taken a fall while running. Scrapes, bruises, strained and sprained joints, particularly ankles, wrists, elbows, shoulders.
- all of this tends to lower the runners IQ to the level of a carrot. It’s entirely possible they arrive and can’t form articulate sentences, let alone say what is wrong and what they need.
So patching them up is basically an exercise in fixing those problems as much as possible before/while transporting them somewhere where more extensive care is available.
The goal for nutrition is to jam calories into a hurt/exhausted/strung out runner as quickly as possible. You need a bunch of options because a runner in that condition may well be unable to eat without vomiting immediately unless you can find the one magic food they can keep down. For the purposes of this exercise all calories are good calories and there’s no such thing as bad calories.
So I would have:
- carbohydrate gels - basically sugar in a runny gelatin base - the brand I prefer is Gu but there are many others and the actual brand does not matter so much. Hammer nutrition, Spring Energy, Honey Stinger all are just fine. Runners might have trouble with any particular flavor so a variety of flavors is a good idea. Some will have caffeine, which might be useful if a runner is particularly strung out or sleep deprived.
- If you will have a way to heat water, instant mashed potatoes. You can get them in cardboard cups, butter and salt flavor is nice. It sounds improbable but hot salty mashed potatoes are a wonder food.
- meat sticks - any decent brand that you would be willing to eat will be fine. I like the Landjaeger ones but the goal is to get fat into the runner so pretty much anything will do.
- nut butter, peanut or almond or hazelnut. Nutella is great. Just hand the jar and a spoon to the runner.
- Candy bars. I like Snickers but anything will do. Milky Way, Almond Joy, whatever. Remember calories in is the goal.
- soda is a great source of calories and also fluids, except for diet soda. NO DIET SODA. What is needed is carbonated sugar water.
- salty fat loaded crackers like Ritz. Fine just by themselves but perhaps also with nut butter.
- hard ginger candies to suck on in case of an upset stomach
If a runner is dehydrated every other problem is magnified. Getting them hydrated is key. Probably until you get some electrolytes and fluid into them getting calories in will be a problem.
So I would have:
- Electrolyte replacement drink. I like the Hammer Endurolyte fizz - tablets that you drop into a bottle of water that fizz like Alka Seltzer, giving you a flavored drink loaded with salts. Lemon/Lime flavor is a good bet, as is grape and Cola. Any well known brand like Nuun, Gu, etc. would be fine. Pedialyte would be fine.
- Ginger ale, both unopened still carbonated, and flat with all the bubbles out. If the runner has an upset stomach Ginger Ale may well be the wonder drink, as it will help settle the upset and get calories in all at once.
- Plain water.
- Carbohydrate drink - I like Tailwind, a powder you can mix with water, but any simple sugar sports drink will do. Gatorade is fine.
- coke - like ginger ale, can perform miraculous restoration. Flat and fizzy both.
Runners who are exhausted will have trouble with thermal regulation even if the air temp is warm. Just wrapping them in insulation won’t help, they need a source of heat.
I would want to have on hand:
- chemical hand warmers, a lot of them. Fire’em up, put them inside clothes or inside a hat. I like Hot Hands but they all work the same way so it probably doesn’t mattter.
- some way to make hot drinks would be great. Instant coffee, tea, probably doesn’t matter what as long as it’s drinkable and not too hot to drink. Cocoa sounds brilliant, sugar and warm.
- large aluminized mylar emergency blankets.
- an aluminized mylar bivvy sack to be used if it’s windy and/or raining
- warm dry outerwear to replace or cover. Fleece hoodies, puffy jackets. Maybe some large fleece pants, as runners may well be wearing just shorts.
- dry woolen socks big enough for really big feet
- extra large mittens
Any reasonable first aid kit will do. In addition to a basic first aid kit I would include:
- a couple of SAM splints and vet wrap in case of a sprain or dislocation.
- Stuff to help a runner who has fallen while running and is banged and scraped up:
- An irrigation syringe and clean water (or even better, normal saline) for getting dirt out of road rash and cuts.
- Tweezers to pick debris out of road rash or cuts.
- Pain relief like ibuprofen or naproxen sodium as a very last resort.
Runners have been pushing their body pretty hard, so giving them pain relief is far riskier than you might think. For any runner who is at the limit, pain relief is a last resort. NO TYLENOL. All the runners have signed up to be very uncomfortable/in pain for an extended period of time, and pain relief is hard on an already stressed body, so if you can avoid it, avoid it. NO TYLENOL. If they are unable to urinate or the urine they pass is very dark (possible rhabdomyelosis I would not give them any pain relief. NO TYLENOL. If a doctor is available I would consult with them before giving pain relief of any kind.
If a runner is overheated you will want to cool them off. Pouring water on them is a good way. A wet bandana is great and will stay wet for a while. Ice water on their head is effective at cooling them off AND generating a brain reset.
Questions? Please don’t hesitate to ask.