The B.A.A. and the Boston Marathon Medical Team urge all runners to consult their personal physicians prior to training and running the marathon. Traditionally, distance running is a safe and healthy form of exercise, but there are inherent risks associated with running extreme distances, especially if you have certain pre-existing medical conditions. Only a physician, who is familiar with your personal medical history, current health status, medications, and your preexisting risk factors, can advise you as to whether you are fit to run the Boston Marathon. Taking these simple steps, and taking the advice of your personal physician, will give you the ability to make the right decisions and enjoy a health race.

MEDICAL SERVICES: THE START AT HOPKINTON:

The Athletes' Village will have two medical tents that can offer assistance with most last-minute medical needs. Band-Aids, Vaseline, a pre-race stretch, or just a word of encouragement can be offered by our medical team.

Please complete two very important tasks before leaving the Athletes Village.

1. Write down your current or pre-event weight on the back of your bib. This figure may help us determine if you have been over-drinking during the event. Scales will be available at both medical tents.

2. It is also very important that you complete the emergency contact information on the back of your bib. Information such as allergies, medical conditions and emergency telephone numbers should be included. If possible, at least one of the emergency contact numbers should be that of someone waiting for you near the finish.

Medical Services: The course

The American Red Cross provides 26 medical aid stations strategically located along the course. Each tent is staffed with a variety of medical professionals, offering basic first aid to those in need. Course medical coverage is supported with ambulances and EMS bike teams provided by Fallon Ambulance, AMR and Cataldo Ambulance Company.

Sweep Medical Bus Program

Medical sweep buses are positioned along the course aid stations. These buses are available to those runners that cannot finish the race and/or may have a minor medical problem. Each bus is staffed by medical volunteers who are available to provide first aid. A runner may choose to rest on the bus while it is parked at a first aid station. However, once the bus begins to move, the runner’s chip will be removed, once this occurs the runner may not re-enter the course to complete the marathon. Medical Sweep buses are required to travel from aid station to aid station and do not travel directly to the finish area in Boston. Once you arrive in Boston, you have the option of seeking care in our medical tent or entering the chute system to pick up your clothes.

Medical Services: Finish Line/Finish Area

Medical teams are located at the finish line, and the main medical tent, which is located on Dartmouth Street. A second tent/facility is located further down on St. James Street, adjacent to the Fire & Ice Restaurant. Additional members of the medical team are staffed along recovery zones leading to the Family Meeting Area. Medical personnel can be identified by their red volunteer jackets: If you are injured or feeling ill, please seek out a member of the medical team for assistance.

Massage Therapy Services

Massage therapy is offered to the athletes on a limited, first-come first-served basis. Treatments may last from five to 15 minutes. Pre-event massage is offered inside the Hopkinton Middle School gymnasium at the Athletes’ Village on Monday (race) morning. Post-event massage in Boston is offered at the Dorothy Quincy Suite inside the Back Bay Events Center at the corner of Berkeley and Stuart Streets near the Family Meeting Area. Expected wait time for a massage varies with the number of volunteer massage therapists available at the time.

Post Race Suggestions - After You Cross the Finish Line

During any prolonged physical activity, the body’s blood supply is usually redirected to the extremities and away from internal organs. Runners should continue to walk after finishing the race. Standing still or stopping can cause nausea, dizzy and weakness – normally resulting with a runner passing out. Walking will help redirect your blood to vital organs, so it is advisable to keep moving. In any event, if you think you need help, ask one of our medical personnel for assistance.

Medical Expenses - Any medical expenses incurred on race day are the sole responsibility of the runner.

KEY MEDICAL ISSUES:

HYDRATION, DEHYDRATION AND HYPONATREMIA

The Boston Athletic Association and the Boston Marathon Medical Team have provided each registered runner with a brochure, which accompanies this Welcome Booklet. The brochure, entitled “The Right Way to Hydrate for a Marathon,” has been developed by the American Medical Athletic Association and offers important information relevant to athletes of all abilities. It is important for runners to be aware that there are many risks involved in running a marathon. It must also be understood that a runner’s susceptibility to a particular risk will depend on a number of different factors, including factors unique to the individual runner. Medical knowledge and medical therapies relating to long distance running are continuing to evolve and develop. For instance, one of the risks which is receiving attention is hyponatremia, and there are studies which indicate that females, runners with a slight build, runners that take over four hours to complete the course, and those taking nonsteroidal anti-inflammatory drugs (such as Advil, Motrin, Aleve, ibuprofen, naproxen, etc.) may be particularly susceptible to this risk. This is usually associated with weight gain. One suggestion for the runner is to measure their weight before and after a training run. One should finish a long run at about the same weight or up to 2% below the pre run weight. Changes above or below these levels may predisposed to hyponatremia or hyperthermia respectively. It is your responsibility to understand your specific fluid needs and not overdrink before, during or after the event. Unfortunately, no one study is definitive or comprehensive. Therefore, the B.A.A. and the Boston Marathon medical team urge all participants to read publicly available materials and to educate themselves fully about the medical risks associated with running a marathon.

It is very important for the runner to determine hydration needs prior to the race. However as a rough guide, if you are a fast runner on a pace of less than 3 and ½ hours, drinking about 16 oz per hour is usually adequate. If you are on a pace to finish more than 4 hours, about 8 oz per hour is usually adequate. There are frequent water/Gatorade stations along the course for your convenience. However, it is not necessary to stop at every station. This could result in overhydration. It is also very important to not overhydrate at the end of the race. Hyponatremia can occur if rapid rehydration after the race is done. Rehydration should be gradual over the next 24 hours. However, during training, it is important to hydrate after a long run particularly with carbohydrate fluids. This will help refuel your muscles with the needed glycogen. Two ways to continually monitor your fluid status in training are to measure your weight, stripped down, before and after a run. You should gain no weight and typically lose up to 2% of body weight. After determining your fluid needs, stick to this plan during the race.The second is to make sure your urine stays yellow, not clear (overhydration) and not dark like apple juice (dehydrated).

WEATHER CONDITIONS:

Preparing for cold weather: Marathon Monday in New England can be cold and rainy, so runners must dress properly. Approximately 60% of body heat is lost from the head. Please wear appropriate clothing. At the 17-mile mark (entering Newton) when crossing Route 128 and when descending Heartbreak Hill at 21.5 miles (leaving Newton), you may experience strong, cold, crosswinds. If you are certain that you will not need your cold weather clothes, place them on the baggage buses provided in Hopkinton. After you finish the race, change out of wet gear as soon as possible. Heatsheet blankets will be available at the Finish. These blankets help the body retain a limited amount of the body heat, but they are not designed to keep you warm for a significant length of time. The best advice we can give you is to seek out family and friends to assist you. Traditionally, the Family Meeting Area can be cold and windy; a plan to find post-race support groups should be an important part of every runner’s post-race checklist.

Preparing for warm weather: Of all the adversities that runners and marathoners face, heat is the number one offender. This is because it can bring on two conditions that can negatively affect your performance… Overheating and Dehydration.

Overheating is the result of inadequate cooling; when the body cannot keep up with the demands of evaporation of water from your skin. When the body heats up internally, it starts to sweat and sends more blood to the skin where it is cooled by coming into contact with the relatively cooler skin. However, while running, your body's demand for oxygen to the muscles means less blood will flow to the skin and this is when overheating occurs. And thus begins the tug-of-war within your body, especially if you want to keep up a certain pace. Either the blood (and oxygen) goes to your muscles to keep up with the pace demands and you start to overheat because less blood is going to the skin for cooling - OR - the blood goes to the skin for cooling, but less blood goes to your working muscles meaning you'll be forced slow down.

At times, the unpredictable nature of Boston’s weather, especially in April, can offer warmer than normal temperatures, placing runners at risk for the potential of exercise induced heat illness. For those that have experienced the run from Hopkinton to Boston, it is not uncommon to have warmer than normal temperatures throughout much of the course, then, as you enter the City of Boston you can experience much cooler sea breezes.

The degree of risk is determined by two key factors, heat and humidity. Simply stated, when both factors are present runners are encouraged to slow down from their normal pace. If you are experiencing an illness (fever) or cold your risk factors will increase. Deciding not to run when temperature extremes are present or stopping if heat illness becomes an issue is vital to your safety. Failure to do so can result in a rapid rise in temperature to dangerous levels, which may damage the heat regulatory mechanism in the brain. This is heat stroke, which will result in damage to organs such as the liver, brain and kidneys. The symptoms of impending heat illness include weakness, heat sensation on the upper body, a feeling of being light headed, confusion, blurred vision, shortness of breath, nausea, vomiting, a generalized sensation of tingling in the neck and shoulders which can progress to disorientation, profound weakness, and collapse.

FITNESS:

Fitness on race day is the full responsibility of the runner. All medical issues must be addressed with your primary care provider and specialist in the area of any specific problems prior to the race. The BAA has no way of determining your ability to safely complete the race. Some typical things that should be addressed prior to the race include but are not limited to:

Heart disease
Asthma or any pulmonary disease
Diabetes
Epilepsy

You should also see your own doctor if you have had any signs or symptoms of heart disease, such are chest pain or chest tightness on exertion, shortness of breath, or palpitations that is out of context of the physical exertion. You should discuss any relevant family history such heart disease or sudden collapse. It is best to list all medical problems and medications on your bib so that the medical team can address these before the race. It is appropriate for you to let the B.A.A. know of any significant problems so that appropriate care be determined.

Race day Fitness

If you are not feeling well on race day, please do not compete even if you are raising money for charity. If you have had diarrhea, a significant respiratory infection, a fever, any chest pain or shortness of breath it is unfair to you, your family, other participants and the race medical team if you compete. There are always many other races to run once your illness has resolved.

Boston Marathon Medical Team- How we can help

1. Public address announcements stating the risk of heat illness or hypothermia will be made in Hopkinton at both the Athletes’ Village and at the starting line. Be aware that extreme weather changes may occur after the start of the race.

2. Fluids are available before, during and after the race. The medical team suggests you drink a pint of fluid two hours before the start and then take fluids along the course at regular intervals and as needed based on personal experience.

Note: medical problems can arise from excessive (hyponatremia), as well as insufficient, intake of fluids. Both water and Gatorade Endurance Formula will be available at each aid station along the route. Gatorade Endurance Formula is a specialized sports drink that contains approximately twice the amount of sodium (200 mg per 8 ounces) of Gatorade Thirst Quencher, along with chloride, potassium, magnesium and calcium to help sustain hydration by better replacing what is lost in sweat.

For more information on hydration, go to www.gatorade.com/endurance or www.gssiweb.com. Gatorade Endurance Formula will help replace some of these minerals lost during exercise, will not prevent hyponatremia. If you feel ill along the course, we strongly recommend that you seek medical attention at one of the Red Cross First Aid Stations.

3. Twenty six (26) American Red Cross First Aid Stations are located along the route and mobile emergency vehicles are positioned for transport to major medical centers. Teams of medical personnel are located at the finish line to assist participants in need of attention, and these teams are supported by a larger medical station located just past the finish line at the corner of Boylston and Dartmouth Streets.

4. If you are feeling ill and experiencing medical problems, you are strongly urged to withdraw from the race. Red Cross, local EMS, and buses staffed with medical personnel will pick you up at any of our Red Cross First Aid Stations or along the route. Participants will be transported to the Finish Area at the rear of the primary medical tent. In some cases you may be transported to a local hospital for follow-up care. We ask that you have hospital staff contact us once you arrive.

The responsibilities of every participant:

1. Consult your physician before starting any exercise program. If you have a known history of a heart problem regardless of how insignificant you feel this is (such as mitral valve pro-lapse), you should obtain a medical consultation from a physician trained in the area of exercise and related heart conditions. If you suffer from exercise-induced chest pain, shortness of breath, dizziness or passing out, you should also consult such a physician before training or running in the marathon. The extremes of this competition place much stronger stresses on the heart than normal daily activities or recreational running.

2. Fill out the Emergency Information, Medical History form, and your pre-race weight on the reverse of your bib number.

3. Listen and understand the meaning of local weather forecasts. Know the risks of participating in extreme temperatures of either range and plan accordingly. Both heat-related injuries and hyponatremia are life-threatening conditions. Adjust your race and hydration plans. DO NOT OVER DRINK!

4. Develop and implement your individual plan for hydration. Be prepared to adjust your plan given the weather conditions and how you are feeling during the race. Learn to judge your fluid intake by your weight changes with running and in different conditions.

5. If you experience or feel you are about to experience a medical problem, ask for help immediately. It is foolish and dangerous to abuse your body.

6. Help your fellow participants. If you notice a runner in distress, ask if help is needed. When appropriate, obtain assistance from our course medical groups, or local fire, police and EMS personnel. Please stay with an injured runner until assistance arrives.