By Joan Tupponce

Managing medical preparations for the 2023 Allianz Partners Richmond Marathon is a massive undertaking for Rachel Middlebrook, R.N., C.E.N., and the multidisciplinary event medicine team from VCU Health, which provides emergency assistance for runners and spectators on event day.

Middlebrook, who works in the emergency department at VCU Health Emergency Center at New Kent, has signed up to provide emergency medical support since its beginning and took a leadership role in 2019. Each year, she recruits anywhere from 15 to 20 nurses for marathon support.

“I ask people to carve out about 10 hours for the event. Sometimes things run a little bit long,” she said. “We are usually there from 4:30 a.m. to 5 p.m.

”The recruiting process takes time, months ahead of the marathon. Middlebrook looks for VCU Health team members with a special emphasis on those in critical care and emergency medicine.

“But, I am always happy to have some extra hands with different nursing backgrounds and specialties,” she said.

Middlebrook says she and nurses that participate enjoy being involved in the community.

“There is something to be said for being out in the community and providing service to the community outside of the hospital,” she said. “I think that’s important. You get to create a relationship with folks you might not have met in the hospital.”

For Mary Caldwell, D.O., making sure the runners are safe is also personal.

“Running is my number one passion,” she said.

Caldwell, a physician specializing in sports medicine in the Department of Physical Medicine and Rehabilitation at VCU Health, was once a Division I NCAA collegiate middle-distance runner for Lafayette College. That love for the sport carries on in her adulthood, as she has participated in marathons across the country.

Since 2018, she has worked with Jeff Ferguson, M.D., an emergency medicine physician at VCU Medical Center, as co-medical directors of the marathon as part of the VCU Health event medicine team.

“We look at how we can make sure they are safe building up to and on marathon day. We know we will have emergencies — from the runners and spectators — so we prepare for the worst-case scenario. But first, we try to prevent them,” Caldwell said.

Medical assistance every step of the way

VCU Health signs can be seen along the race route. The health system has been cheering on runners for more than five years as the races’ official medical sponsor.

Team members provide medical care in one of six tents — complete with medical emergency equipment — set up along the course and at the finish line. A few tents handle first-aid and provide skin lube to prevent chaffing. The tent at mile marker 13 handles advanced first aid. Mile marker 22 has a dunk tank for runners suffering from heat stroke.

“Most of these tents are limited and more geared toward getting first-aid needs met and getting runners back on the course,” said Ferguson, associate professor of emergency medicine in the VCU School of Medicine.

Most of the emergencies happen at the end of the race.

“Running can get pretty scary sometimes,” Caldwell said. “Even elite runners can have issues as well as novices.”

Many of the issues seen during the race include muscular injuries, orthopedic issues, cramping, dehydration and gastrointestinal symptoms.

“We see a lot of niche patients that you don’t see in your everyday practice,” Caldwell said, noting higher-than-normal outdoor temperatures could cause runners to have high body temperatures, heat stroke and low sodium. “We are seeing the numbers of patients creep up as it gets hotter and hotter.”

Caldwell and Ferguson spend months planning for race day, normally starting the process immediately after the previous year’s race.“There’s a lot that goes into it,” Caldwell said. “There’s a lot of planning to make sure you have the right supplies. We also do a lot of educational seminars with the runners on subjects such as safe running and how to prevent injuries.”

Ferguson supports Sports Backers with emergency response coordination with the city of Richmond Fire and Emergency Services, Richmond Ambulance Authority, Richmond Police Department and VCU Health Emergency Management Department. He also recruits physicians and students from the VCU School of Medicine who serve as spotters.

“We put the spotters in certain areas and right after the finish line. They encourage people to move and keep walking. That’s crucial to prevent a medical emergency,” Ferguson said. “It’s very satisfying to see everything come together and provide medical care more than EMS. We extend care to where the patients are. They get the care they need, and we don’t have an overcrowded ER.”

Caldwell, who sees the race from both the perspective of runner and doctor, gets a feeling of joy after the race for the runners.

“Also, it makes me feel good that I am there and can make a difference for people who are really sick,” she added. “It’s fun when you see how successful people can be doing the sport you love most and that you are the one keeping them safe.”

The event medicine team also provides services at other major events in the Richmond region, including NASCAR races at the Richmond Raceway and PGA Tour golf tournaments, to name a few.