Medical Training for Ultrarunners

The Missing Link in Trail Running by Team RunRun Coach Connor Phillips

Hot spots and blisters. Strains and sprains. Maceration and trench foot. Dislocations, fractures, and impalements. Dehydration, hyponatremia, and rhabdomyolysis. Hypothermia and heat illness. Should runners take Advil (ibuprofen) or Tylenol (acetaminophen)? How well equipped or trained might you be to manage these problems in a race? How prepared are you to help yourself, your training partner, or an unknown party in distress on a mountain summit or in a remote desert canyon? 

As runners, we subject our bodies to abuse, during training and races alike, which increases the risk of injury or illness. We also normalize ultralight backcountry travel with minimal to no first aid supplies. Personally, the first aid kit I carry on runs includes vet wrap to protect my dog’s torn pad and toilet paper for, you know… Rarely do I carry bear spray in grizzly country but I bring my Garmin Inreach Mini, if I remember to grab it. 

As a trail runner, running coach, firefighter/ EMT, backcountry guide, volunteer race medic, and wilderness medicine instructor, I ask you to do as I say and not as I do. And I ask you to take a wilderness medicine course. 

Ultra runner receiving medical attention during a race
Providing all of the medically necessary care at Moab 240, 2022.

Wilderness medicine is a specialty branch of pre-hospital care and emergency medicine. These courses focus on identifying and stabilizing life threats as well as preventing, assessing, and treating injuries and illnesses common to backcountry travel. The main difference between basic first aid and wilderness medicine is learning to take care of yourself or others when: communication with the EMS system is unreliable; a backcountry rescue may be hours to days away; and resources like first aid supplies or other gear are limited. Wilderness medicine training prepares you to respond more confidently to a backcountry emergency through classroom sessions paired with repetitive, hands-on scenarios and drills. 

There are a number of different wilderness medicine courses offered to improve medical preparedness for ultrarunners in the field. The two most common are 1) Wilderness First Aid (WFA) is a 16-24 hour course best suited for backcountry day trippers and 2) the Wilderness First Responder (WFR) is an 80-hour class for people who spend days in the backcountry, those who appreciate learning more about pathophysiology, and students keen to understand the “how” and “why” behind medicine and care. These classes are the industry standard of training for guides and weekend warriors alike. Many races recognize these certifications as acceptable qualifications to volunteer as a race medic. The time and financial commitment for these courses can seem daunting but what you learn in a course can save yours or someone else’s life. 

Two extreme examples come to mind. During the fight for his life, professional ultrarunner Gabe Joyes relied on his long expired WFA training to preserve body heat and minimize blood loss after stabbing his femoral artery with his running pole. In her book Out and Back, skyrunning legend Hillary Allen notes that one of the first people to provide care after her 150 foot fall was a fellow racer with medical training. Though extreme, the remote nature of our sport dictates the importance of learning this craft.

Many skills taught during these courses can be applied in urban settings as well. One example is using a bleed kit or AED, now commonly found in airports, bus stations, malls, and schools around the country, to stop a bleed or correct a heart arrhythmia during cardiac arrest, respectively. Similarly, you will learn to assist someone afflicted by a sudden anaphylactic reaction by administering their life-saving medication, whether they are eating at a restaurant or an aid station.

At Moab 240, I have seen runners wait in line for over an hour to have me look at their feet, something they or their crew could do in 10 minutes if they had the proper training and confidence. After these courses, you will be prepared to treat many illnesses and injuries and better recognize the seriousness of issues you cannot manage or diagnose. You will feel more confident in your ability to manage your feet throughout a race and be better prepared to support your friends to the finish. This training will give you foundational medical knowledge and skills that can be applied anywhere, which will help your running preparedness and potentially save lives.

No previous medical training is required to take a WFA or WFR; anyone can participate. You may find yourself in a class alongside professional guides and recreationalists with various outdoor experiences (e.g., mountaineering, climbing, kayaking, backpacking, etc.) These open enrollment courses often need more time to delve deeply into details specific to trail running.

For that reason, I am excited to announce a WFA for Trail Runners course in Leadville, CO from June 21-23, 2024. In addition to the standard WFA curriculum, which is a fantastic introduction to wilderness medical training, we will devote an additional day to covering niche runner-specific issues. Think: how to best treat a blister on every part of the foot, tape injured ankles and knees to increase finishing chances, recognize rhabdomyolysis, and manage over the counter medication administration during a race so as to not create acute liver or kidney issues. This course is conveniently timed to coincide with the Leadville Trail Marathon and Heavy Half; come a week before your race to acclimatize and learn an essential skill or stick around to volunteer as a race medic after the course.

If the WFA for Trail Runners does not fit your schedule, a general WFA or WFR is still a worthwhile, and, in my opinion, essential pursuit. When choosing to invest in a wilderness medicine course, I urge you to consider the following:

  1. Seek a course with a Wilderness Medicine Education Collaborative member school or one that adheres to WFA and WFR certification standards. 
  2. Avoid online-only courses, as they are inadequate at providing essential hands-on training. Instead, choose a WFA that offers a minimum of 16 hours of in person learning or a WFR course with a minimum of 45 hours in person when considering hybrid formats. The hybrid model is great because you can learn approximately 30 hours of online material at your own pace before committing to the in-person learning, thereby reducing your travel time away from daily life.
  3. The effectiveness of your training weans over time so it is imperative that you seek out opportunities to practice your skills regularly outside your scheduled recertification window (between recertification courses). Volunteering as a race medic is a great place to start. Some schools also offer in house continuing education to help keep skills sharp.
  4. Ensure the school integrates CPR and AED training and certification within your chosen course at no extra cost.
  5. Compare the topics and skills taught on the school’s course outline with those listed in the standards documents for WFA and WFR available on the WMEC website. Not all schools follow the WMEC standards and thus may not offer the entire gamut of topics, including mental health and psychological first aid.
  6. Inquire about staff qualifications. Anyone can start a wilderness medicine school and claim to be an expert. Look for a school recommended to you because it has an excellent reputation, has stood the test of time, and requires its instructors to maintain high-level medical certifications in addition to completing annual in-house continuing education requirements. 

The company I teach for, Desert Mountain Medicine (DMM), meets or exceeds all the above recommendations. I am proud to say that I teach for the best wilderness medicine school in the country. DMM celebrated its 25th anniversary in 2023, is a founding member of the WMEC, and offers courses nationwide. 

Blister care is essential medical training for ultrarunners
Prevention is ideal, but blisters may be inevitable. In the WFA for Trail Runners, we will learn how to manage blisters, amongst a broad range of other medical topics relevant to daily life, backcountry travel, and trail running.

If you are excited to sign up for the WFA for Trail Runners, you can do so directly on the DMM website. For run coaching inquiries, connect with Connor on TeamRunRun. If you have questions about the intersection of running, racing, crewing, coaching, and medicine, feel free to reach out to the author at  [email protected] or @phillycondor on Instagram. 

Connor Phillips is a lifelong runner and medical professional. He has accumulated thousands of hours guiding in remote wilderness settings in addition to his work as a running coach, firefighter/EMT, and wilderness medicine instructor. When not traveling to run, crew, or pace fellow trail runners, Connor splits his time between the mountains of Jackson Hole, WY and his hometown in California’s Central Valley.