Page 137 - JSOM Summer 2022

Thus, the overall medical encounter incidence is approximate. Types of Medical Encounters |
The proportion of participants seeking medical care ranged and Anatomical Locations of injuries
from 0.4% to 3.2%. 6,19–24 Of those who sought medical care, Table 3 shows a summary of the types of medical encounters
0.7–4.2% were evacuated by ambulance 6,19–24 and 2.3–12.7% and the anatomical locations of injuries for the studies that
were evacuated by privately owned vehicles. 20–22,24 Medical reported these. There are several problems with the medical
personnel on site at the events recommended participants fol- encounters listed in these studies. First, there was the lack
low-up with their personal medical care providers in 3.2% to of standardization of diagnoses. Medical encounter descrip-
9.0% of medical cases. 6,20,23 tions were generally by a variety of medical care providers
(physicians, physical therapists, nurses, medics, lifeguards,
Table 2 show the meta-analyses on medical incidence, evac- emergency medical technician) who have different levels of ex-
uations to hospitals, and referrals to personal medical care. pertise and often enter data quickly during what amounts to
The weighted average of participants seeking medical care was near mass casualty situations. Some studies 6,22,24 report “mus-
1.4% of all participants. The weighted average of those seek- culoskeletal injuries” without defining specific types of injuries
ing medical care and evacuated by ambulance, by personal ve- under this rubric. Second, the types of medical encounters can
hicle, and referred to their personal medical care were 1.7%, differ depending on environmental conditions, which are of-
4.6%, and 5.6%, respectively. However, there was consider- ten not reported in the publication. For example, in the study
able variability in all these weighted estimates as indicated by by Agar et al. hypothermia was the medical condition with
19
the significant Q-statistic and I . the highest incidence, but over 94% of these cases occurred in
2

TABLE 1 Studies Examining Medical Encounters During Civilian Obstacle Course Events
Participants Ambulance Referral to
Medical Evacuation Private Vehicle Personal Medical
Medical Encounter Incidence Evacuation Care for Follow-
Problems Incidence (% of Incidence (% of Up (% of
Study Event (Year) Data Collection Total (n) a (n) (%) medical cases) medical cases) medical cases)
Agar et al., Tough Guy Medical records
2009 19 (2006–2007), from on-site ~20,000 251 1.26 3.59 NR NR
4 iterations medical team
Greenberg Tough Mudder Hospital ER
et al. 2014 25 (2013), records at one ~22,000 38 NR b b NR
2 iterations hospital
Luke & Tough Mudder Presumably
Dutch (2012), 2 medical records
2014 20 iterations from on-site ~22,000 441 2.00 0.68 2.27 3.17
medical team
Lund et al. Warrior Dash Database
2015 21 (2011–2013) & of medical
Tough Mudder encounters
(2012 & 2013), in OCEs, 45,325 1,458 3.22 0.69 2.40 NR
6 iterations presumably
collected on-site
Coleby & Spartan Race Medical records
Thibeault- (2014), from on-site 40,123 165 0.41 4.24 12.73 NR
Rivard 12 iterations medical team
2016 22
Pearkes et Wolf Run, Medical records
al. 2016 6 7 iterations (year from on-site ~43,000 411 0.96 2.68 NR 9.00
not specified) medical team
Hawley et Mud Hero Medical records
al. 2017 23 (2015), from on-site 45,285 557 1.23 1.97 NR 8.62
13 iterations medical team
Rabb & Spartan Race Medical records
Coleby (2015–2017), from on-site 73,366 1,782 2.43 0.95 5.11 NR
2018 24 33 iterations medical team
Abbreviations: ER = emergency room; MSK = musculoskeletal, NR = not reported, OREs = obstacle course events
a Numbers with a “~” are approximate, as provided in the article
b Not clear how patients transported to this single hospital

TABLE 2 Meta-Analyses on Proportion of Medical Incidence, Evacuations, and Referrals to Personal Medical Care
Effect Size % Q-Statistic I 2
Variable Denominator Studies (n) (95% CI) p-value (%)
Medical Incidence All Participants 7 1.4 (0.9-2.1) <0.01 100
Ambulance Evacuations Medical Cases 7 1.7 (1.0-2.9) <0.01 80
Personal Vehicle Evacuations Medical Cases 4 4.6 (3.9-5.3) <0.01 93
Referrals to Personal Medical Care Medical Cases 4 5.6 (4.7-6.6) <0.01 94

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