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Carol Zlatich, nursing student at Chamberlain College of Nursing and volunteer at Medical Aid Station 7, right, passes out Tylenol, while Lt. Cmdr. Stephanie Smith, a family medical physician at the Washington Navy Yard Branch Health Clinic, which falls under Naval Health Clinic Quantico, marks the number tags of runners who receive pain relievers.

Photo by Mike DiCicco

When marathoners push past limits, Quantico-led medical team is there

28 Oct 2013 | Mike DiCicco Marine Corps Base Quantico

At 6 a.m., almost two hours before the 38th annual Marine Corps Marathon got underway, the staff of Medical Aid Station Alpha was preparing for the end of the race. As the aid station just across the finish line, Alpha is the largest and busiest of the 10 medical tents around the race course, all of which are managed by active duty Naval Health Clinic Quantico employees.

Navy Capt. Bruce Adams, a senior physician at the clinic and the senior medical officer for this year’s race, instructed the station’s “shoot team” on helping runners who collapse while waiting for their medals. It’s a common enough occurrence that helping these runners who have already finished the race is the entire job of this 17-person team. When runners stop moving after pushing themselves for more than 26 miles, their blood pressure drops, Adams explained.

“The blood starts to go down with gravity, and the brain doesn’t like that and starts to turn the lights out,” he said.

In the end, a marathon is an endurance test, and the medical aid stations are the safety net that rescues those who push themselves to their absolute physical limits and, sometimes, beyond.

Adams advised the shoot team members that, when they approach a runner who is leaning over and gasping, they should do it from the side if they care about their shoes. “It’s very common, when they come across the finish line, to hurl one or two times,” he warned.

All 260 or so of the Quantico clinic’s active duty personnel were on the job running aid stations, along with about 150 volunteer ham radio operators who were the backbone of the medical team’s communication system and 210 other medical volunteers, most of whom were from area medical schools. They worked in coordination with about 300 emergency medical services personnel from Arlington and Washington, D.C.

The medical team is distributed according to the projected geographical injury dispersal, that is, much more heavily toward the end of the run, where runners are exhausted.

“The needs of each aid station are determined by prior history,” said Navy Lt. Adam Preston, head of the clinic’s optometry department and officer in charge of the Naval Health Clinic Quantico personnel for the marathon. Accordingly, the first aid station along the route has a staff of about 10, while Alpha has 70 personnel in the tent and another 30 or so working as shooters and “roamers,” finding the runners who may have forced their way across the finish line in a condition that warrants medical attention.

“The marathon functions like a planned mass casualty,” Adams said, explaining that if all the patients the race generates were sent to area hospitals, they would be enough to shut down the emergency rooms.

While the Alpha staff treats many runners who fall out after running the course, those who collapse while still running are the real concern, he said. Nearly all of those cases are caused by potentially life-threatening conditions, such as heat stroke or heart attack.

Three cooling tubs sat outside the tent, ready to be filled with ice water in the event of heat casualties.

Other common medical issues that can come with marathon-running include dehydration, cramping, blisters and muscular-skeletal injuries like sprains and tears, said Master Chief Petty Officer Cornell Boyd, the Quantico clinic’s command master chief.

Also not uncommon, Adams said, are multiple muscles cramping simultaneously. “They’ll think they’re dying,” he said of the unfortunate runners who experience this condition. “Everybody in the tent will know. It’s excruciatingly painful.”

But the action in Aid Station Alpha wouldn’t begin in earnest until around noon.

Other medical tents around the course expected less excitement. At Aid Station 4/6, Lt. jg Brendan Good, patient administration medical boards program manager at the clinic and officer in charge of the aid station, said his crew of 17 anticipated some blisters and sprained ankles and other muscular-skeletal injuries.

He said the main goal at his station, located just south of the Lincoln Memorial, which runners pass around mile 11 and again around mile 16, was to treat non-serious injuries as quickly as possible on the five cots in front of the tent and keep those patients moving. If their energy levels drop, they’ll become sore, tired and cold, and they may not finish the race.

“Luckily, it’s pretty cool out, so I’m not expecting a lot of heat-related injuries,” Good said.

By about 10:30 a.m., runners were pouring past Aid Station 7 on the National Mall, just past mile 17.

There, Cmdr. Tuanh Halquist, a dentist at the clinic and the officer in charge of the station, said she and her crew of 20 had only treated a sprained ankle. “So far, it’s been really quiet, knock on wood,” she said.

They were busying themselves offering Tylenol and water, as well as Vaseline intended to protect against chafing, to the passing runners, and they had no shortage of takers.

Back in Arlington at about a quarter after noon, the 41-person crew at Aid Station 9/10 was expecting the clientele to pick up any minute. Thus far, they had only had about 10 patients, said Lt. Cmdr Yasir Bahrani, who runs the dental department for the Quantico clinic and was the officer in charge of the station. They had all been minor cases, mostly dehydration, he said, and no one was being treated at the moment.

However, as the first aid station after the 14th Street Bridge, which runners must reach by 1:05 p.m., Station 9/10 would soon see a lot of runners who had pushed themselves hard to make that deadline, he said, adding that he expected the caseload to start mounting even earlier than that. “The folks who kind of lag behind are often the ones who need our assistance.”

Unlike the stations back in D.C., each of which had a handful of cots out front and a few more inside, Bahrani’s tent had more than 20 cots. Sure enough, within less than half an hour, three runners were in the tent being treated for cramping and dehydration.

At about 2 p.m., a majority of the runners who would finish had done so, but back at Medical Aid Station Alpha, the workload was still high. Cmdr. Christopher Niles, who is the clinic’s department head for Staff Education and Training, as well as the nurse manager for the Behavioral Health Clinic, when he’s not the officer in charge of the Alpha station, said 63 patients had been admitted so far, and about as many had been quickly treated on the cots out front. Before the tent finally cleared at 4 or 5 p.m., he estimated, those numbers would nearly double.

About 10 patients were scattered among the 40 or so cots in the tent. A heat stroke case had just been brought in from an ice bath. One girl shivered violently under blankets while two volunteers manipulated her legs. A couple of men were hooked to saline intravenous drips, a common treatment for cramping. Some were getting cramps massaged out of their legs or were simply resting and recuperating from whatever ailment had brought them in. One runner had just been sent to the hospital with chest pains.

It was Niles’ third year managing the tent, and he noted that many of the volunteers there had worked this most crisis-ridden station for longer than that. “We like to come back because we like this type of setting,” he said. “It’s like an [emergency room] setting.” Many of the volunteers and personnel have ER experience, and Niles trains in trauma treatment.

“You don’t want to sit around like this all day,” he said, twiddling his thumbs.

Three volunteers led in a runner with an icepack tied to her ankle. She was grinning.

Identifying herself as Margaret Baumgartner of Arlington, she explained that she’d actually sprained the ankle two weeks earlier, and a volunteer was now treating the blister caused by the way she had wrapped her own injured ankle in order to run in her fifth Marine Corps Marathon.

 “I’m proud of this,” she beamed. “I am proud and surprised that I actually finished.”

So another single-minded runner achieved her goal, with the help of a little protection from herself.

— Writer:

Marine Corps Base Quantico