REVIEW ARTICLE Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines Martin D. Hoffman • Andy Pasternak • Ian R. Rogers • Morteza Khodaee • John C. Hill • David A. Townes • Bernd Volker Scheer • Brian J. Krabak • Patrick Basset • Grant S. Lipman Published online: 19 April 2014 Ó Springer International Publishing Switzerland (outside the USA) 2014 Abstract An increasing participation in ultra-endurance foot races is cause for greater need to ensure the pre- sence of appropriate medical care at these events. Unique medical challenges result from the extreme physical demands these events place on participants, the often remote settings spanning broad geographical areas, and the potential for extremes in weather conditions and various environmental hazards. Medical issues in these events can adversely affect race performance, and there is the potential for the presentation of life-threatening issues such as exercise-associated hyponatremia, severe altitude illnesses, and major trauma from falls or animal attacks. Organization of a medical support system for ultra-endurance foot races starts with a determination of the level of medical support that is appropriate and feasible for the event. Once that is defined, various legal considerations and organizational issues must be addressed, and medical guidelines and protocols should be developed. While there is no specific or universal standard of medical care for ultra-endurance foot races since a variety of factors determine the level and type of medical services that are appropriate and feasible, the minimum level of services that each event should have in place is a plan for emergency transport of injured or M. D. Hoffman (&) Department of Physical Medicine & Rehabilitation (117), Department of Veterans Affairs, Northern California Health Care System, 10535 Hospital Way, Sacramento, CA 95655-1200, USA e-mail: martin.hoffman@va.gov M. D. Hoffman Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA A. Pasternak Silver Sage Sport Performance and Silver Sage Center for Family Medicine, Reno, NV, USA I. R. Rogers St. John of God Murdoch Hospital, Murdoch, WA, Australia I. R. Rogers University of Notre Dame, Murdoch, WA, Australia M. Khodaee Á J. C. Hill Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA D. A. Townes Department of Medicine, Division of Emergency Medicine and Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA B. V. Scheer Borders General Hospital, Melrose, UK B. V. Scheer Team Axarsport, Alicante, Spain B. J. Krabak Department of Rehabilitation, Orthopaedics and Sports Medicine, University of Washington and Seattle Children’s Sports Medicine, Seattle, WA, USA P. Basset Dokever, Pierre-Be ´nite, France G. S. Lipman Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA 123 Sports Med (2014) 44:1055–1069 DOI 10.1007/s40279-014-0189-3