Mobile ER Brings Big-Time Care to Small-Town Triathlon

ST. JOSEPH, Mich. -- Competitors who visited St. Joseph, Mich., for the Whirlpool Steelhead 70.3 Triathlon Aug. 4 might have expected to find a beautiful rural racecourse and small-town charm in southwestern Michigan. What they might not have expected to find was a fully staffed mobile emergency room equipped to handle the wide range of injuries and conditions that long-distance athletes face.

Large races, like the LaSalle Bank Chicago Marathon with 45,000 participants, commonly have emergency treatment tents. Smaller races, however, don't usually have a medical tent operated by an ER physician and staff. Steelhead drew around 2,700 to compete in the half Ironman race in the town of approximately 9,000.

Steelhead's mobile ER, more than just a first aid tent, was for the first time operated by ER staff from Lakeland HealthCare, a not-for-profit healthcare organization offering a full continuum of care in southwest Michigan. Michael Westfall, D.O., Lakeland assistant medical director for emergency medicine, worked alongside Lakeland staff, including three to four each of nurses, athletic trainers and physical therapists. Ambulances and paramedics from Medic 1 Ambulance, Benton Harbor, Mich., were on-site to treat and transport athletes with more serious injuries, such as possible broken bones that required X-rays.

Having an ER physician and nurses means the best care for athletes because ER staff are used to triaging patients and determining what treatment is needed, as well as have experience with a wide range of conditions and injuries, said Kathy Effa, Lakeland manager of emergency services, St. Joseph.

"This prevents a lot of unnecessary trips to the ER and it's more convenient for the athletes," Effa said. "Many racers are visitors to an unfamiliar area without someone who can drive them to the ER."

Since Lakeland was a race sponsor and donated staff, equipment and supplies, the mobile ER also saved competitors money because the care was provided free.

Effa said the mobile ER was equipped to treat all types of minor injuries, from cuts and abrasions to heat exhaustion and more. But unlike a typical first aid tent, having an on-site physician meant the mobile ER could deliver things like intravenous fluids and prescription medication.

Matt Mabry, Lakeland certified athletic trainer and certified strength and conditioning specialist, said he and other physical therapy staff at the mobile ER treated 97 Steelhead athletes. However, the number receiving aid was likely twice that because many athletes got basic care at the triage area such as ice packs and bandages. The mobile ER saw about the same percentage of participants as last year, he said, because the weather was helpful.

"We were prepared for the worst, like having an ice bath for heat stroke," Mabry said. "But it didn't turn out to be as hot as it was supposed to be. Every year we've gotten lucky with the weather."

Most athletes received care for fatigue-related issues such as muscle cramps, dehydration and extreme fatigue, which are the most common injuries, Mabry said. Lakeland had massage therapists on duty to help soothe sore muscles and regain flexibility through stretching. Eleven were serious enough to receive intravenous fluids.

The injuries Mabry and the mobile ER staff treated were typical of the risks triathlon competitors face during grueling events. Injuries are more common with amateurs, who aren't as conditioned as pros, he said. But even pros can wipe out while bicycling or roll an ankle in a pothole.

Other common triathlon injuries include chronic blisters, which can be caused not just by lengthy activity, but also by sand in athlete's shoes from running across the beach after exiting the water.

"Something that simple can cause an injury that can ruin your day," he said.

Other skin abrasions can result from crashing while bicycling at 20-plus miles per hour. Cleaning and covering blisters or road rash helps prevent infection, especially since most athletes are from out of town and linger afterwards rather than going home.

Another risk athletes face is heat exhaustion, although an unexpected change in lake current can bring cooler water and cause hypothermia.

Although rare, a more serious risk is the potential for sudden cardiac arrest if an athlete has underlying heart disease. If a competitor had suffered cardiac arrest during the race, an ambulance would have taken him or her directly to the hospital. But it can happen afterwards, Mabry said, caused by extreme dehydration and/or heat illness. Lakeland had automated external defibrillators (AEDs) at the mobile ER tent.

Sunburn is often overlooked as a risk, so Lakeland also had sunscreen on hand.

"They're outside for 4-plus hours, but the last thing on their mind is, 'Am I getting a sunburn?,'" Mabry said. Sunscreen also helps prevent heat illnesses and dehydration.

Most injuries typically happen during the run portion of the triathlon because it's near the end of the race, where fatigue reduces athletes' coordination, and because of the great distance covered during the run.

In addition to the tent, Lakeland mobile ER staff also worked in transition areas, where the sheer number of competitors can make things hectic. "That way we can help them continue instead of feeling like they have to quit," Mabry said.

The end of a race can bring on its own risks, he said, when athletes stop after hours of continuous activity.

"You're not going to feel very good when you're done," he said. "Don't go lay down. Blood can pool in your legs and feet, causing dizziness. We've even had people pass out." Athletes should continue to walk and drink plenty of fluids. Lakeland had staff at the finish line to separate the people who needed help.

Mabry's involvement in triathlons goes beyond helping. He ran the 5/3 Bank Firecracker Triathlon (a sprint) July 1 in Benton Harbor, which was his first. "I'll do more. I think I'm hooked," he said.

The Steelhead Triathlon consists of a 1.2-mile swim in Lake Michigan, followed by a 56-mile bike through scenic northern Berrien and eastern Van Buren counties, followed by a 13.1-mile run with its finish at Jean Klock Park. Steelhead is part of a worldwide series of qualifying races for the Ford 70.3 Ironman World Championship held in November in Clearwater, Fla., Nov. 10.

For more information, visit www.steelheadtriathlon.com/, www.lakelandhealth.org/, the Lakeland fact sheet or the Steelhead fact sheet. For images, visit the Mobile ER Photos page.