Going to extremes: Doctoring desert runners

What would possess someone to run 150 miles across four of the world's most formidable deserts in the span of eight months?

That's the question Brian Krabak, MD, hopes to answer with the help of the approximately 100 racers who participate in the annual 4 Deserts -- a series of seven-day races across deserts that are among the hottest, driest, windiest and coldest places in the world.

Dr. Krabak has been medical director for six races -- the most recent in Antarctica in 2007. He has amassed data about injury rates and illnesses and questioned racers about their techniques for rehabilitation and fueling up for the different legs of the race, some of which top 50 miles a day.

Dr. Krabak is planning to submit his research for publication in a couple of months and wants to use the information to counsel extreme-sport athletes on their risk of injury and how to avoid harm.

"If a racer can make it to day five, he or she likely will finish," said Dr. Krabak, an associate clinical professor of orthopedics and sports medicine at the University of Washington and Children's Hospital in Seattle. "The medical incidents usually come in the first couple of days. A racer can't adjust to the climate and just doesn't make it through."

Ideally, racers need two weeks to give their bodies time to acclimate to the conditions of each race location. But most runners come in just two days before the race starts.

The most common medical issues tend to be dehydration and skin infections. Frequent injuries are muscular strains and -- not surprisingly -- foot blisters. Lots of them.

Dr. Krabak, who is an avid runner, has studied injured racers to figure out what types of injuries are incurred in each leg of the races. Now he is collecting profiles of each racer to assess the mental capacity involved in training for, running and recuperating from a race as difficult as the 4 Deserts and the coping methods different athletes use to get them to the finish line.

"Anecdotally, they are highly successful A-types, business leaders and entrepreneurs with a small subgroup of people who are doing it for charitable reason," said Dr. Krabak, who also has provided medical care to athletes at a summer and winter Olympics and several other races. "All of them seem to love a challenge and appreciate the environment. For others it's the beauty of the scenery."

Avoiding injuries is key concern

In 2006, the races were in the Gobi Desert in China, the Atacama Desert in Chile, Antarctica and the Sahara Desert in Egypt. To provide proper care, Dr. Krabak scouts each race location in advance to assess any medical and emergency concerns germane to the site. That means figuring out the best way to transport injured runners and members of the medical team who need to reach those runners.

In most cases, the medical team gets from checkpoint to checkpoint, and anywhere in between, using sports utility vehicles. Sometimes a helicopter is on standby.

On occasion, slightly more unusual transportation is required.

Dr. Krabak once employed a camel to get a dehydrated racer from the top of a mountain. The runner made it up but was too tired to make it down. A storm was brewing.

When it became apparent the racer wasn't going to make it without help, Dr. Krabak and the camel went to pick him up. The athlete sat on the camel as Dr. Krabak guided them on a two-hour trek down the mountain.

The doctor also scouts each location to determine where to set up medical stations and figure out an evacuation route for racers who need emergency care. He must consider illnesses or injuries that are unique to race locations, such as snake and scorpion bites in the Sahara.

He puts together a medical team of four to eight physicians, including some residents, and a handful of nurses. Most of the physicians have a sports medical background, including extreme sporting events such as the 4 Deserts.

Once the team is assembled, it compiles medical histories of race participants to make sure the team can meet any special needs of runners. Racers range from ages 18 to 72, but the bulk are in their late 30s or early 40s.

Most injured runners are reluctant to leave the race, but the final decision about pulling out rests with Dr. Krabak. In the pre-race briefing, organizers make it clear that safety comes first.

"Medical trumps everything," Dr. Krabak said.