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Playbook · 04 · Foundation
Medical & safety plan
This is the document that lets you sleep the night before. A race above treeline, hours from a trauma center, with afternoon lightning and thin air, demands a real plan — written, staffed, and rehearsed. Land managers require it; your conscience should too.
The altitude risks, named
- Acute Mountain Sickness (AMS) — headache, nausea, fatigue; common and usually manageable, but the warning sign.
- HAPE / HACE — High-Altitude Pulmonary/Cerebral Edema; rare but life-threatening. The treatment is descent, plus oxygen. Your medical staff must recognize these and your evacuation plan must move a patient down fast.
- Hypothermia & exposure — it can snow in July above 12,000 ft; a wet, bonked rider on a pass gets cold quickly. Mandatory-kit rules (jacket, layers) belong in the rider agreement.
- Dehydration & hyponatremia — dry air drives huge fluid loss; balance water and electrolytes at aid.
- Trauma — high, loose descents; the medical plan must handle fractures and head injuries, not just cramps.
Evacuation — the core of the plan
You are operating in remote high terrain where minutes matter. Build the chain before race day:
- Coordinate in advance with Lake County EMS, the Sheriff, and Search & Rescue, and with the local hospital (St. Vincent Health in Leadville) — plus know the transfer path to a Front Range trauma center and the air-ambulance options and their weather limits.
- Map evacuation points — every aid station and road junction is a labeled extraction point with GPS coordinates and vehicle access.
- Descent-first for altitude illness — a suspected HAPE/HACE rider goes down immediately with oxygen while EMS is mobilized.
- Written medical action plan (MAP) per stage — who calls, what they say, where the patient goes, staged by severity.
On-course medical & SAG
- Contract a medical provider experienced in endurance/wilderness events — a lead physician or paramedic director, EMS at start/finish, and roving medics/EMTs with the SAG fleet.
- The UTV SAG fleet doubles as first-response — every SAG vehicle carries first-aid, a way to warm a rider, and comms; medics ride the high stages.
- Oxygen and AEDs at the finish and key aid stations.
Communications above treeline
Weather & lightning protocol
- Design starts so exposed high sections clear before early-afternoon convection (see Course design).
- A written lightning hold/stop plan: monitoring source, trigger distance, how riders are held or pulled, and how the race is neutralized or a stage shortened/cancelled.
- Daily go/no-go weather briefing with the race director, medical lead, and course chief.
Incident command
- A clear chain of command: Race Director → Course Chief + Medical Director + Safety Officer, with radio authority to stop the race.
- A single Emergency Operations point that owns the radio net and the call to EMS.
- Rider screening — medical/emergency contact at registration, acclimatization guidance (see Athlete guide), and mandatory-kit enforcement at sign-in.
Mandatory kit
Publish this at registration and enforce it at sign-in. At this elevation it is a safety requirement, not a suggestion.
- Packable waterproof/wind shell and a warm layer — it can snow in July above 12,000 feet.
- Full-finger gloves or spares, and a buff/neck cover for cold descents.
- Self-repair kit — tube, plugs, pump or CO2, multitool, chain link.
- Two bottles or a hydration pack, plus emergency calories.
- Phone and any required tracker, and the printed emergency number/card (cell coverage fails on the passes).
- ID and any critical medical info on the rider.
Incident-severity ladder
Every marshal, medic and SAG driver works from the same simple ladder so the radio call is fast and clear:
| Level | Example | Response |
|---|---|---|
| Green | Cramp, minor mechanical, mild AMS | Aid station or SAG handles it; log it. |
| Yellow | Rider can't continue, cold/exhausted, minor injury | SAG extracts to the nearest evacuation point; medic assesses. |
| Red | Suspected HAPE/HACE, chest pain, head injury, fracture, unresponsive | Descend immediately with oxygen; net control activates EMS/air ambulance; race director notified. |
| Black | Lightning in the area, multi-rider incident, lost rider | Stage hold/neutralize per the weather plan; incident command runs it. |
The daily go/no-go
Before each stage, the race director, medical director and course chief hold a short weather-and-readiness briefing and make one call: go, delay, shorten, or cancel the stage. Document who decided and why. A stage race that can shorten or cancel a day cleanly is a stage race that stays safe when the mountain says no.
Sources
- Wilderness Medical Society altitude-illness guidance; CDC high-altitude travel guidance
- Lake County EMS / Search & Rescue; St. Vincent Health, Leadville — coordinate directly
- Event medical providers experienced in ultra/endurance and wilderness settings
This is planning guidance, not medical direction. The plan must be written and signed off by a qualified event medical director and local EMS before the race runs.