Safety

Runner Safety

This is a serious ultra marathon and runner safety is paramount. While the course is often not far from the road, there are large sections with poor or no access for emergency vehicles. Despite relatively mild weather at this time of the year, exposure is still a potential hazard for a tired, depleted and (especially) injured runner. This coastline is directly exposed to the southern ocean and can carry wild storms in from the south. Such conditions can be dangerous if you have inadequate gear to keep warm. Remember if you injure yourself, it may be hours in potentially stormy conditions before assistance can reach you so you need to be prepared. With this in mind, a fairly basic mandatory gear list is required. While we do not wish to be the "trail police" we may do spot checks in the interests of runner safety and fairness.

There is a long way between checkpoints (average 20 kilometres) and there are very few freshwater streams in between. Runners cannot rely on these and should carry a minimum of 1 litre of water when leaving each checkpoint and up to 2 litres when leaving Johanna. In hot weather the Johanna to Gables section can stretch a runners water supply. It is not uncommon to see runners reaching the unmanned water drop situated at Moonlight Head out of water.

Runners must follow directions from run officials. Checkpoint captains or the medical director will have the authority to withdraw a runner if they deem the runner unfit to continue or if the runner is outside the cut-off time. Cut-off times are strictly enforced.

All runners must carry the mandatory night gear (light, back-up light and reflective vest) from the start and wear their safety vest on the road from: Johanna Beach to Milanesia Beach and the Princetown road section and 12 Apostles carpark to the finish line. The reflective vest should be worn at all times from dusk. In short: vest on for all road sections day or night and at all times from dusk.

When running on roads runners must give way to all traffic and follow designated signage, flagging or witches hats on where to cross or run. Where there is marshalling any direction MUST be adhered to.

If you encounter another runner who is sick or injured you are required to render assistance until relieved by the sweeps or medical team. Time compensation will be given for lost time.

A mobile phone must be carried. The emergency number if your network does not have coverage is 112 (this is like dialling 000 but only if there is coverage for another network).

Ambulance and Insurance

The ambulance is not a free service in Victoria, and is also not covered by GOW100s insurance. If not a subscriber, it is important to check with your health insurer, or consider joining or taking out travel insurance to ensure you have coverage.

GOW100s has public liability insurance through AURA but this does not cover individual runners in the event they suffer an injury. It is the runners responsibility to have their own accident and ambulance cover. If race organisers think you need an ambulance, we will call it regardless of whether you have ambulance cover or not, and you will be responsible for any costs.

Hydration and Electrolytes

hyponatremia warning (please download and read articles at the bottom of page)

Key points:

do not pre-hydrate - maintain normal fluid intake in the days prior
do not over-hydrate during the event
do not drink to a schedule or plan
electrolytes won't protect you from hyponatremia
salt supplements can increase thirst and lead to overhydration
DRINK TO THIRST - keep it simple!

Additionally: Please also note that salt tabs and salt supplementation have not been found to be effective or necessary in the prevention of exercise-associated hyponatremia. The most important treatment is to avoid drinking too much and if you are not thirsty, then don't drink. Low sodium tends to happen because of overhydration not because of heavy sweating.

Maintaining proper fluid and calorie intake is a personal responsibility, and runners should already be competent in this area. All runners should be aware of the dangers of EAH-Exercise Associated Hyponatremia. Loss of balance, control of your limbs, nausea, water aversion, headache, and seizures are all potential signs that you have exercise-induced hyponatremia. This is life threatening and should not be treated with normal (isotonic) saline IV fluids (which could be fatal), but 3% hypertonic saline should be used. Sodium levels must be checked (by a blood test) in any runner who is suspected of having rhabdomyolysis before IV fluids are given.

Probably the best explanation on this whole subject is available on the Western States website

http://www.wser.org/medical-and-other-risks/

From WS100 website: 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. 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 (and swollen hands).

Hyponatremia may occur with weight gain and weight loss, so weight change is not helpful in making the diagnosis. If left untreated, hyponatremia may progress to seizures, pulmonary and cerebral edema, coma and death. The best way to avoid developing 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 have been overhydrating. 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.

Pain relief and NSAIDS

such as Ibuprofen (please read articles bottom of page)

The use of non-steroidal anti-inflammatory drugs (eg ibuprofen, nurofen, voltaren, aspirin, etc) during endurance events has been proven to be dangerous. It is requested that runners do not take NSAIDs during GOW100s. The dangers far out-way any perceived benefits. In fact research has shown that taking pain-killers during ultras does not improve finish rates.

Rhabdomyolisis

kidney failure & cola-coloured urine.

Muscle breakdown is expected during an ultramarathon, and potentially leads to clinically significant exertional rhabdomyolysis. Rhabdomyolysis can cause kidney failure or the heart to stop in the worst cases. Signs of clinically significant rhabdomyolysis during or after a race include generalised muscle pain or weakness out of proportion to the effort, cola-coloured urine, or the inability to urinate 12 to 24 hours post-race. Clinically significant rhabdomyolysis can occur alongside low blood-sodium levels due to overhydration, adding complexity to the health emergency. Specific training and proper hydration are among the best ways of avoiding this illness.

How can you prevent exertional Rhabdomyolysis plus or minus kidney damage in ultrarunning?
Train for the terrain you plan to run on. Repetitive, unfamiliar stress to any muscle group can set you up for rhabdomyolysis.

Drink when you are thirsty (avoid dehydration and overhydration) and do not drink if you are not thirsty, to avoid developing a low sodium level.

If you have developed exertional rhabdomyolysis plus or minus kidney failure before, you are at greater risk.

Avoid use of NSAIDs while racing (eg nurofen, ibuprofen). NSAIDs decrease the kidney’s ability to clear waste products from the blood stream and increase the risk of kidney injury.

If you are on any prescription medications, determine with your doctor if they are associated with an increased risk of rhabdomyolysis.
If you have a fever or systemic infection with or without fever, you are in a pro-inflammatory state, putting yourself at higher risk of exertional rhabdomyolysis and probably should not be racing while your body is attempting to recover.

Postural hypotension

feeling faint at the finish line

It is not uncommon to feel nauseated and faint once you cross the finish line and stop running. The simple explanation is that you have been pumping lots of blood around your body to run fast and when you suddenly stop all that blood just pools in your legs and deprives your brain of blood. To normalise things your body wants to get horizontal so it makes you pass out or at least feel faint to encourage lying down.

The best way to guard against this common malaise is to keep moving around for a while after finishing and if you do feel faint lie down and raise your legs on something. But be sure to tell someone you are not feeling well.

Ipods & Music

While earbuds are allowed in this race, it is imperative that they are not used on road sections of the course. This is a significant safety issue. There is very little road where cars will be encountered but runners need to be able to hear cars coming, so headphones out of ears on the roads. Also, courtesy dictates that they should be off in checkpoints so that you can hear volunteers and organisers give directions.

Snakes

Consider any snake venomous and avoid at all costs. All runners are carrying compression bandages just in case. Latest recommendations from the Royal Flying Doctor service are worth a quick read:Flying Doctor issues new snakebite advicePublished 05 Oct 2017

Our South Eastern Section has updated its advice and procedures following the publication of a new snakebite study. The Australian Snakebite Project is the most comprehensive ever carried out, involved over 1500 patients and collated snakebite data from the past 10 years (2005-15).

“The publication of this study is very timely as the warm, dry winter and sudden rise in temperatures has brought snakes out early this year,” said Tracey King, Senior Flight Nurse at the RFDS South Eastern Section, who has attended snakebites during her career.

“As venomous snakes are found in every state and territory we urge everyone, not just those in the warmer Outback locations, to be vigilant.”

“There are around 3,000 reported snakebites each year in Australia, resulting in 500 hospital admissions and an average of two fatalities.”

The Australian Snakebite Project threw up some surprising statistics, which challenges many long-held perceptions about where snake attacks occur and how to treat them.

In those attacks in which the snake was positively identified, the brown snake was the most common biter (41%), followed by the tiger snake (17%) and red-bellied black snake (16%).

There-quarters of the people bitten are males aged in their 30’s. Most snake attacks occur near houses, not in the bush. Half of all bites occurred while people were out walking, with gardening and trying to catch a snake the most common other scenarios.

While only 20- 25 out of 835 cases they studied resulted in death, the effects of a snakebite can be debilitating and far-reaching. Three-quarters of those bitten experienced venom-induced consumption coagulopathy, which causes blood clotting and life-threatening haemorrhages. Acute kidney injuries, brain and muscle damage and cardiac arrest are other possible side effects.

“That’s why it’s important that people act quickly after a possible bite,” said Tracey.

“Surprisingly, they’re often painless and may go unnoticed as tissue damage is mostly light – lacerations, scratches or light bruising along with some bleeding or swelling. As over 90% of snakebites we found to occur on the upper and lower limbs, these are the places to check first.”

“Common symptoms include an unexplained collapse, vomiting and abdominal pain, bleeding or paralysis.”

Many dangerous myths surround the treatment of snakebites. The most important dos and don’ts include.

Do NOT wash the area of the bite or try to suck out the venom. It is extremely important to retain traces of venom for use with venom identification kits.
Do NOT incise or cut the bite, or apply a high tourniquet. Cutting or incising the bite won't help. High tourniquets are ineffective and can be fatal if released.
Do bandage firmly, splint and immobilise to stop the spread of venom. All the major medical associations recommend slowing the spread of venom by placing a folded pad over the bite area and then applying a firm bandage. It should not stop blood flow to the limb or congest the veins. Only remove the bandage in a medical facility, as the release of pressure will cause a rapid flow of venom through the bloodstream.
Do NOT allow the victim to walk or move their limbs. Use a splint or sling to minimise all limb movement. Put the patient on a stretcher or bring transportation to the patient.
Do seek medical help immediately as the venom can cause severe damage to health or even death within a few hours.

The new study has prompted the RFDS SE to reverse previous long-standing advice about the importance of identifying the colour and type of snake.

“Staying in the area after an attack can be dangerous and recent advances in medication mean we can now treat any snakebite with a generic polyvalent anti-venom, so identification is no longer necessary.”

The Basics on Hyponatremia

Rhabdomyolosis