Road Race Medicine

Paving the Way for Heat Safety in Athletes, Warfighters, and Laborers

Yuri Hosokawa, PhD, ATC

Vice President of Communication and Vice President of Education

 

Every October, members of KSI travel to Washington D.C. to volunteer at the Marine Corps Marathon medical tent. This year’s trip was also a special one because we were able to continue our efforts from last year in building relationships and exchange ideas with the National Oceanic and Atmospheric Administration (NOAA), Uniformed Services University of the Health Sciences (USUHS), the Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH).

 

On Thursday, October 19th, KSI had the honor of gathering representatives from federal sectors that regulate heat activity modification guidelines or study implications of heat in the welfare of warfighters and laborers. The meeting was sponsored by the National Integrated Heat Health Information System (NIHHIS: https://toolkit.climate.gov/nihhis/), whose mission is to understand global health threat from extreme heat, develop a robust and science-informed response, and build capacity and communication networks to improve resilience. Participating agencies of NIHHIS include: Office of the Assistant Secretary for Preparedness and Response (ASP), Centers for Disease Control and Prevention (CDC), United States Environmental Protection Agency (EPA), the Federal Emergency Management Agency (FEMA), NIOSH, NOAA, OSHA, and the Substance Abuse and Mental Health Services Administration (SAMHSA).

 

KSI has a good history in working collaboratively with the occupational and military sectors, however, it was not until last year that we were able to gather representatives from all three sectors– athletic, occupational, and military­– to convene at single location and exchange ideas for future collaborations. Integration of climate and weather data from NOAA is also critical in making data driven decision to enhance the policies and guidelines for the people in these settings who are often exposed to extreme heat. Participants of this year’s meeting are currently working on a manuscript that gathers current consensus regarding heat activity modification guidelines for the physically active population (athletes, warfighters, and laborers), which we hope to release next year.

 

 

On the following day, we attended the IIRM Sports Medicine Conference hosted by the International Institute for Race Medicine, MedStar Sports Medicine, and MedStar National Rehabilitation Network. The meeting was attended by many medical providers and students who were also volunteering at the Marine Corps Marathon. At the meeting, Dr. Douglas Casa gave a presentation regarding wearable technologies in sport. Despite the recent advancement in wearable technology, his presentation warned that there is yet to be reliable, real-time, noninvasive hydration and internal body temperature assessment devices on the market. As the field of wearable technology continues to grow, researchers and clinicians must stay up-to-date with the technology advancement while also acknowledging the technological limitations to make the best-informed decisions about using data from these devices.

 

 

Later in the afternoon of the conference, we also participated in a workshop that was designed to review various treatment algorithms for medical conditions commonly seen at race medical tents in the form of problem-based-learning scenarios.  Exercise-associated collapse, cardiovascular arrest, exertional heat stroke, exertional hyponatremia, exercise associated muscle cramping and bleeding-control were covered in the workshop, all lead by the content experts. The hands-on workshop provided opportunities for young professionals to practice the skills for the first time and stimulated the exchange of various experiences from the veteran providers.

 

 

KSI was stationed at the Aid Station 9 on the day of the race, which was located between mile-21 and 22. The wet bulb globe temperature reading one-hour past the start of the race was in the mid-60’s, but quickly reached the high 70’s by noon, placing this year’s race as one of the warmer race in the history of the Marine Corps Marathon. The coordination of work among the corpsmen, athletic trainers, nurses, physical therapists, and physicians at the aid station was great. We also treated several exertional heat stroke patients on-site, where we made sure to cool the patients below 39°C before transport.

 

Our trip to Washington D.C. is a true demonstration of our mission statement– to provide research, education, advocacy and consultation to maximize performance, optimize safety and prevent sudden death for the athlete, warfighter and laborer. Whether we are treating marathon runners from exertional heat stroke or optimizing the regulations for worker safety in the heat, the physiological premise and impact of exertional heat stress is the “same” across athletes, warfighters, and laborers. Integration of minds across disciplines, such as the NIHHIS meeting, and continued advocacy to provide evidence based exertional heat stroke care are some of the core missions we will continue to carry forward from KSI.  #Strive2Protect

2017 Summer Intern KSI Fellowship Experience

Miwako Suzuki, KSI Intern Fellow

My name is Miwako Suzuki, and I am an Athletic Training student at Indiana State University. Gratefully, I was chosen to receive the opportunity to intern at the Korey Stringer Institute in the Summer Fellowship Program. I am originally from Japan, and I studied Athletic Training there as well. While receiving my education in Japan, I found it necessary to learn more about prevention and management of emergency conditions, and this sense of mission brought me to the United States. I became aware of the KSI four years ago when I was still in Japan through Dr. Yuri Hosokawa, Vice President of Education and Communication at the KSI, and I have been attracted to the KSI since then. The past two months and ten days that I spent with the KSI members were full of great experiences and learning.

Among the several projects that I worked on during the summer, the main focus was placed on the Athletic Training Locations and Services (ATLAS) Project. The aim of the ATLAS Project is to determine the extent of current athletic training services provided in the secondary school setting, and it was launched in January 2016 with these goals:

  • Create a real-time database of athletic training services in secondary schools
  • Create a directory for each state’s athletic training association and high school athletics association
  • Assist states in moving toward full-time athletic training services
  • Provide useful data to each state’s athletic training association and high school athletic association
  • Identify common factors associated with increased athletic training services across the country
  • Provide data to assist with legislative efforts to improve healthcare for high school athletes

 

At the beginning of the summer, the ATLAS Project was at the stage of figuring out the extent of athletic training services in the last 10% of high schools that we had been unable to reach. To reach those schools, I have tried multiple methods such as making phone calls, writing emails to athletic directors, and searching their website for athletic trainer’s information. Even though I made some progress with these strategies, the most effective method was reaching out to athletic trainers of the neighboring high schools of the unknown schools for help. From this experience, I have learned firsthand that ATLAS is not only a great database but also a very useful communication tool. While interacting with high school athletic trainers throughout the nation, many of them showed their appreciation and support for this study. I am very grateful to be one of the members to propel this important project forward. I would like to thank Dr. Robert Huggins for including me in this project and always guiding me. I also would like to thank Sarah Attanasio, ATC, for teaching me and providing help whenever I asked.

Testing for the Falmouth Road Race study began in mid July. We conducted a modified heat tolerance test on recreational runners of a wide range of ages who are participating in the New Balance Falmouth Road Race on August 20th, 2017. Although the study will not be completed until the race day, collecting data on individuals’ physiological responses to exercise in the heat was a great learning opportunity for me. I believe that the wide distribution of demographics of this study allowed me to encounter various responses among the subjects. With regard to conducting a laboratory test, I observed the effort of the KSI members to make the study robust. I was very fortunate to learn from such experienced and passionate colleagues. I would like to express my deepest gratitude to Dr. Yuri Hosokawa and Kelsey Rynkiewicz, ATC, for their effort to involve me in this study.

 

On August 20th, which will be my last day as a KSI fellow, I will be at the New BalanceFalmouth Road Race and will serve as a medical volunteer with the KSI staff. The Falmouth Road Race has been recognized for its high incidence rate of exertional heat illnesses because of the environmental conditions and its short duration (7.1 miles), which allows runners to maintain relatively high intensity throughout the entire duration of the course. According to a previous study from the KSI, this race has saved multiple exertional heat stroke patients each year. Since I have never encountered a real exertional heat stroke case, I would like to take this opportunity as a great hands-on learning experience.

 

I appreciate every aspect of the activities that I had the opportunity to take part in at the KSI. The KSI was an even greater place than I expected. All the members are making a great effort for their projects with the strong passion and commitment for the KSI’s mission. I believe that this is the reason why the KSI has been successfully leading our profession. Lastly, I would like to thank Dr. Douglas Casa for providing such a great opportunity. I fully enjoyed summer 2017 with such great colleagues.

Marine Corps Marathon Weekend

By Gabrielle Giersch, MS, Assistant Director of Education, Assistant Director of Athlete Performance and Safety

 

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KSI in the White House

 

Thursday October 27th through Sunday October 30th a group of KSI staff traveled to Washington D.C. to present at the American Medical Athletic Association’s 25th Annual Sports Medicine Symposium and worked in the medical tent at the 42nd Marine Corps Marathon (MCM). While in D.C., the KSI staff got to explore the city, tour the White House, enjoy some of the museums on Constitution Avenue, visit Arlington National Cemetery and view the changing of the guards.

 

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Tomb of the Unknown Soldiers

 

We had a great showing at the American Medical Athletic Association 25th Annual Sports Medicine Symposium at the Marine Corps Marathon at Georgetown University Friday October 28th. Brendon McDermott Ph.D., ATC, alumnus of University Connecticut and also one of KSI’s medical and science advisory board member, and his colleague, Cory Butts M.S., traveled from University of Arkansas and presented Muscle Damage and Renal Function in Athletes with Physiological and Environmental Stress. From KSI, Luke Belval, M.S., ATC, CSCS, presented Changing Guidelines on Exertional Heat Stroke Care: Point of Care to Transport to the ER, and Douglas Casa Ph.D. presented Policy Changes Save Lives in all Levels of Sport: New Evidence and Successes. All three of these presentations helped to illustrate the important role of athletic trainers and medical staff at races, and show successes that KSI has had in treating exrtional heat strokes and changing policies to reduce the prevalence of sudden death in sport.

On Saturday, the staff had a “play day” in D.C. that consisted of visiting museums and playing Escape the Room D.C. Both KSI teams escaped (photo below) with the better team just beating the losing team by a few minutes!

 

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On Sunday the real fun began. The staff was up bright and early to make it to Aid Station #9 at mile marker 21 of the MCM! We evaluated and treated several athletes who were experiencing exercise associated muscle cramps and dehydration. Our Medical Advisor, Dr. John Jardine also played a critical role in treating exertional heat stroke patients.

 

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MCM KSI Medical Tent

 

The annual trip to D.C./MCM is a great way for the staff to learn, use their expertise, and bond.

Back in Falmouth

By Yuri Hosokawa, MAT, ATC, Director of Communication and Education

IMG_8657Twenty-seven research and medical volunteers from the Korey Stringer Institute, EC Lee Lab and University of Connecticut joined the 44th New Balance Falmouth Road Race in Falmouth, MA on August 21st. This was the fourth consecutive year in which KSI conducted a field research study at the race in conjunction with working in the medical tent treating exertional heat stroke patients. In this year’s study, we aimed to (1) investigate runner’s knowledge on heat and hydration and behaviors on race day and (2) investigate the use of real time gastrointestinal temperature feedback in altering runner’s behavior during the race. We also assessed participants’ readiness to exercise in the heat by measuring their cardiovascular fitness and their response to heat stress in our environmental chamber.

 

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KSI’s Rebecca Stearns, PhD, ATC and Luke Belval, MS, ATC also spoke at the Medical Symposium hosted by the Falmouth Hospital, which was attended by many medical volunteers and local healthcare professionals. Dr. Stearns’ presentation, The Tale of Two Heat Strokes, introduced case studies of two runners who suffered from exertional heat stroke at the same race with distinctly different prognosis due to the different treatment they received. Belval’s presentation, The Fluid Needs for Today’s Athletes, provided evidence-based suggestions on hydration. At the Health & Fitness Expo, William Adams, PhD, ATC spoke on Optimizing Safety and Maximizing Performance During Running the Heat, which was attended by many runners who were going to be racing the following day.

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We would like to thank the Falmouth Road Race Board of Directors for their continued support and partnership with the Korey Stringer Institute in supporting our mission to educate runners and continue our research in ways to optimize their performance and safety during warm weather road races such as Falmouth Road Race.

 

 

 

Colby Concussion Summit and Beach to Beacon Road Race

By William Adams, PhD, ATC, Vice President of Sport Safety

This past weekend, KSI’s Vice President of Sport Safety William Adams, PhD, ATC and Director of Communication and Education Yuri Hosokawa, MAT, ATC were in attendance at the first annual concussion summit held at Colby College, hosted by the Concussion Institute at Colby College. They joined representatives from the National Athletic Trainers’ Association, as well as faculty members from the University of New Hampshire, University of Pittsburgh, Colby College and others.

 

The purpose of the meeting was to discuss the diagnosis and management of concussion and to establish the next steps that are needed from a research perspective to enhance clinician’s objective assessment of concussion in athletes.  The meeting concluded with an action plan to examine specific areas of concussion diagnosis and management to continue to add to the body of scientific literature surrounding the validity and reliability of tools that clinicians can use in their toolbox for concussion management.

Colby Concussion Summit 16

 

Following the concussion summit, KSI traveled south to Portland, Maine for the Beach to Beacon Road Race. The race weekend began with the medical symposium, where both William Adams and Yuri Hosokawa were two of the invited speakers. Adams spoke on hydration in today’s athletes while Hosokawa presented a case series examining the treatment and management of two exertional cases recently published by Stearns et al. in Current Sports Medicine Reports. The symposium was a huge hit and was extremely well received by all of the attendees.

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The road race occurred on Saturday in Cape Elizabeth, Maine. For those unfamiliar, Beach to Beacon is a 10-kilometer (6.1 mile) road race finishing at the picturesque Portland Headlight Lighthouse in Fort Williams. KSI staff members William Adams, Yuri Hosokawa and Samm Scarneo had the opportunity to volunteer as medical staff during the race. The day finished off with roughly 6,500 runners finishing the race and the medical volunteers providing excellent care to those needing it, including four individuals who had suffered exertional heat stroke. The best part of the race weekend were the new friendships that were made with the other physicians, nurses and athletic trainers who were also volunteering in the medical tent.

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2015 New Balance Falmouth Road Race

Falmouth Group Picture

By Yuri Hosokawa, Director of Communication and Education

Korey Stringer Institute had another successful year working with the Falmouth Road Race, which took place on Sunday August 16th. KSI and the Falmouth Road Race expanded their collaboration together even further this year. On August 13th, William Adams, Director of Sports Safety Policies, Yuri Hosokawa, Director of Communication and Education, and Rachel Katch, Assistant Director of Research, presented at the 1st Annual New Balance Falmouth Road Race Sports Medicine Symposium, with Dr. John Jardine, Chief Medical Advisor of KSI. This was the first time that Falmouth Road Race hosted a medical symposium for local medical professionals and volunteers who have traveled across the country to work at the medical tent on race day. At the symposium, Adams presented on evidence based prevention, treatment, and care of exertional heat stroke, Hosokawa presented on emerging topics on sudden cardiac arrest in runners, and Katch presented on exertional hyponatremia and best practices for hydration. On August 15th, Dr. Robert Huggins, Vice President of Research and Elite Athlete Health and Performance, spoke at the EXPO on maximizing athletic performance in the heat.

 

Huggins and Meb

Also during race weekend, we had the opportunity to invite professional videographers to film interviews with Richard Dodakian, one of the exertional heat stroke survivors from the Falmouth Road Race, and Huggins. As they recalled the same event from 2013’s race, it was incredible to hear their stories from different perspectives—exertional heat stroke victim/survivor and the rescuer. The interview is currently under production. Please follow our social media and webpage for the video release. Their words will change the way you view medical care provided at the road race for thousands of runners. Remember, exertional heat stroke is 100% survivable with prompt recognition and appropriate care: cool first, transport second.

Richard Interview

This year’s race was very warm and humid, setting a perfect storm for exertional heat illness risk. To counter that, the road race organizers came prepared with rows of cold water immersion tubs and stations, with close to 200 medical professionals volunteering on the race day. KSI primarily assisted in the care of exertional heat stroke patients, educating the medical volunteers who are unfamiliar with the condition at the pre-race medical meeting and serving as leaders at each cooling station.

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We were also fortunate to have representatives from our corporate partners, Kestrel and MissionAthlete Care, to join us at the race as volunteer. It was their first time to experience the intensity of a road race medical tent and see the treatment of exertional heat stroke cases.

 

Kestrel

Lastly, Hosokawa and Katch conducted the third field research study at the Falmouth Road Race, looking into the inflammatory response observed in runners completing the race. The study started 4 weeks before race, where the participants were asked to log their training. In addition, researchers invited the participants to the University of Connecticut campus to complete VO2max and lactate threshold testing to examine their fitness level prior to the race. Hosokawa is also working in collaboration with the EC Lee Lab, lead by Dr. Elaine Lee, at the University of Connecticut, to investigate potential genetic markers that may explain the variations of heat tolerance observed in runners. Our hope is to provide evidence-based recommendations for runners who are participating in the summer races and assist the Falmouth Road Race to become one of the safest summer road races in the world.

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Falmouth Road Race weekend is by far the busied but most exciting weekend for KSI. We hope that our collaboration with the race will continue to grow in future years and hopefully inspire other races to have similar partnerships with KSI.

Ironman Lake Placid

Lake Placid Team KSI

By William Adams, Director of Sport Safety Policies

A few representatives from KSI traveled to Lake Placid, NY for the annual Ironman Lake Placid race on July 26th. For those that are unfamiliar with an Ironman race, it involves a 2.4-mile swim, 112-mile bike ride, and a 26.2-mile run. Competitors have 17 hours to complete the race and if successful can be proud to call themselves an Ironman.

Ironman Village

This year’s race was unique in a number of ways; 1) there were no professional triathletes that raced, allowing the overall male and female finisher to be an amateur athlete and 2) the environmental conditions became very hot (above normal for Lake Placid) halfway through the bike portion of the race, making the race much more stressful than anticipated, and 3) this year’s race saw an athlete suffer from exertional heat stroke which is normally an uncommon sight at a race of this length and duration.

Kestrel at Mirror Lake

KSI’s trip to Lake Placid for the 2015 race was to volunteer to assist in the medical tent at the finish line to treat the athletes that became injured during the race. This year’s race saw a variety of injuries that came to the medical tent throughout the day. Injuries that were treated inside the medical tent included dehydration, hyponatremia, musculoskeletal injuries, and many others.

Medical Tent

The most fortunate part of this experience was being able to see medical providers from various fields of expertise, from various geographical locations and settings come together to provide top-notch medical care for the 2,600 athletes participating in this year’s race. Without these volunteers, the race would not have been a success.

KSI at the Vermont City Marathon & Relay

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By Andrea Fortunati, Assistant Director of Elite Athlete Health and Performance

Korea Stringer Institute was represented for the first time at the 27th annual People’s United Bank Vermont City Marathon & Relay that was held on May 24th, 2015 in Burlington, VT. The race included 8,000 participants and began promptly at 8:00am with the Wheelchair participants, followed by the runners at 8:03am.

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Members of the KSI, William Adams, Yuri Hosokawa, Luke Belval, and Andrea Fortunati worked in the main medical tent located at the finish line as well as at medical tents located at the midpoint of the race.

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This year, there were approximately 150 medical visits seen throughout the day with a total of six athletes transported to the University of Vermont Medical Center.

Four cases of exertional heat stroke were seen and treated at the marathon. During all of these cases at least one member of KSI was present and aided in the treatment process. One case was treated at the medical tent located at mile 13 and the other three cases were treated in the main medical tent at the finish line. In the critical care tent there were two cold-water immersion tubs and members of KSI ready to implement proper protocols and procedures that have been profoundly researched to treat EHS. Treatment for the cases in the critical care tent where done with cold water immersion, which is found to be the quickest and most effective way to cool the body, and rectal thermometers were used for the body temperatures assessment, which is critical in assessing the body temperature in people who are suffering from exertional heat stroke. Once the athletes had been properly cooled, all EHS cases were transported to the UVMMC following the medical organizer’s protocol for a follow-up examination.

This is the second of several marathons KSI will be involved with this year, the first being at the Boston Marathon. Other road races KSI are attending include the Lake Placid Ironman, the Falmouth Road Race, New Haven Road Race, the Marine Corps Marathon, and more.

This is the second of several marathons KSI will be involved with this year, the first being at the Boston Marathon. Other road races KSI are attending include the Lake Placid Ironman, the Falmouth Road Race, New Haven Road Race, the Marine Corps Marathon, and more.