Medical evaluations enroute?
Dark Horse
I was talking with another seattle rider about the incidents on the
Cascade 1200. The rider who touched wheels with another and broke his
collarbone is a friend of his. He was taking the view that the risk
level in a 1200k should require periodic medical evaluations enroute.
Checking for fatigue level, dehydration, cuts 'n bruises and the like.
His point was that these should be mandatory, since he saw people in
the 600 that he considered too tired to ride. And the 1200 was
obviously worse.
What do people think? My immediate reaction was that I would not ride
an event with mandatory medical checks, and I'll bet I'm not the only
one. The "line-in-the-sand" word for me is "mandatory". I'd be
perfectly OK with a medical volunteer, but flatly opposed to required
checks. There is this concept called "Adulthood" that this other rider
was too willing to remove.
So who would ride under those limitations?
And who would not?
Dark Horse
John Jost
Mandatory medical checks. Who is to say where the line should be drawn. Should a medical person who is perhaps a non-cyclist have the right to say... no your leg is cut or your saddle sores are too big, or you're dehydrated and are now disqualified. I don't think so.
On the flip side, would it be NICE to have someone with medical training as a volunteer? Sure would. Someone with experience who could make health recommendations, not demands.
Can you imagine the additional cost of a 600K or 1,200K brevets if you had to hire a medical professional for your events? I know for me... it would be a ride killer. John Jost "Free will carried many a soul to hell, but never a soul to heaven." --- On Thu, 7/17/08, Dark Horse <flyin...@gmail.com> wrote: |
Jeff Loomis
> What do people think? My immediate reaction was that I would not ride
> an event with mandatory medical checks, and I'll bet I'm not the only
> one. The "line-in-the-sand" word for me is "mandatory". I'd be
fatigue level is too high to continue. I did not ride the Cascade
1200 (still working up to my first 1200) but I was one of the final
few finishers in this year's Seattle 600. I may well have been one of
the riders that the commenter judged too tired to ride, but I am
confident that I was not a danger to myself or others. We already
have a definition of "too tired to ride" which is when a rider fails
to make a control in time.
I am strongly opposed to a mandatory medical check, but I'm not sure
if I would be willing to boycott a ride if it had one so I guess I
would have to answer a definitive maybe to the survey.
Jeff Loomis
Steve Rice
in Farmer with her and tried to speak to her - she was completely
checked out. This was an extreme case and they did try to work with her
to keep her in the ride. I did see plenty of people who were having
trouble of all kinds. I started (and finished) the ride with a
collarbone I had fractured 4 weeks before the start - would the
hypothetical medical staff have prevented me from riding? I feel that
as long as I am not checked out mentally, nobody besides me should be
making the call as to if I am capable of riding. I am personally
responsible for my decisions and actions and I accept the possible
outcomes of my decisions. I do not want someone taking responsibility
for my actions - they would be much more conservative than me for fear
of being sued.
Steve Rice
Jennifer Chang
I'm the rider you saw that was "checked out" at Cascade 1200. And I was, looking back.
I do want to put forth, however, that, while RUSA and SIR President, Mark Thomas, did make the decision that I would no longer be able to participate in Cascade 1200, he did give me the opportunity to make my own decision about it, at a very personal level. While I was "checked out," I retained enough of cognitive functioning to insist that I be allowed to make my "own" decision about whether or not I could complete the ride. That was very important to me, even in that state.
Mark allowed me to get on the bike, and when I realized that I "swerved" and could not keep the balance, while trying to get on or off the bike, and there was a "delayed" processing of visual perception, that made me unable to respond quickly to the oncoming traffic, I got off the bike and told him, "You're right, I can't do it." While I wanted to finish the ride that I had started training for, since dark, rainy, freezing December, I'm not a wacko enough that I would attempt to do so at all cost.
It might have been time-consuming, and even frustrating, for the organizers to spend that much time with me, after it was clear to them I no longer possessed the mental capacity to complete the ride. As for me, however, I am ever grateful that they spent that much time with me, while I slowly processed that I could not complete the ride. Because of that allowance, I am disappointed that I could not finish the ride, but not regretful. If that choice had been taken away from me, I would have forever wondered whether or not I could have completed the ride.
I do not simply want a medical doctor to make the decision on whether or not I can continue on in the ride. The best thing about the whole process was that it was the EXPERIENCED RANDONNEURS, who understood my desire to finish the ride, who also had the presence of the objective mind, with the advice of medical experts, who made the decision, on my behalf, that I could not continue on in the ride. Sometimes, such a decision needs to be made on behalf of someone, who does not possess the full functioning mind, as I was then. However, since it is the decision, on MY behalf, I want someone LIKE me, who understand what these rides MEAN to me, to make the decisions on my behalf, as I would have done, had I the full faculty. I'm a cyclist, not a doctor. And if I'm going to choose someone to make a riding decision for me, it would be a cyclist like me, who can also heed to medical advice.
I am truly thankful, too, that even when the decision was made, at organizational level, that Cascade 1200 organizers continued to work with me, at personal level, so that I would not have regrets. I hate living life with regrets.
Jennifer
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Mike Biswell
Jennifer
This is a nice personal post.
However, speaking only for me, you really put a lot on the volunteers, and the idea of forever wondering or never knowing or regretting isn’t so much, especially as now only 2 weeks later you are not wondering at all. You DNF’d a crazy bike ride that 99.9% of the people you ever met have never heard of, and can’t relate to.
It’s hard to ride in the heat – the body gets tired and taxed just sweating so much, can only recover energy/fluids/electrolytes so quickly in any condition, and more.
Reading this, if you weren’t taken to a doctor right after stopping, or even before, and/or something worse happened, like your internal organs ‘checking out,’ or falling over into the road in front of a car, there would be very sad implications for a lot of other people, including your family, and our bicycling family, who would of course be sued, waiver or no, with all of us feeling awful about ‘your choice.’ But maybe there wouldn’t even be that much information, and there would always just be another sad biking mystery/tragedy.
You took it too far, which at times can be part of the personal exploration that is randonneering, showing personal toughness, but also applying that toughness as ‘stubbornness’ toward the organizers, who, again, only my opinion, should only relied on to stamp the cards and maybe give out bananas, and some cots to sleep on, cheer a little, and not too much more. Not every volunteer is going to be someone like MT, perhaps they won’t even be a bicyclist.
Though a common experience in rando, you were still very lucky to have the kind SIR volunteers there for ya, but these people are not coaches or a safety net. You now have this one experience of your own to remember, build on, and know / manage yourself better. Please don’t take it so far next time, or we will indeed have to start keeping some doctors around. J
Mike
Ps. Last words of Tom Simpson (David Millar’s debate coach): ‘Put me back on my bloody bike.’
Cc:
ran...@googlegroups.com
Subject: [Randon] Re: Medical
evaluations enroute?
John McClellan
> an event with mandatory medical checks, and I'll bet I'm not the only
> one. The "line-in-the-sand" word for me is "mandatory". I'd be
> perfectly OK with a medical volunteer, but flatly opposed to required
> checks. There is this concept called "Adulthood" that this other rider
> was too willing to remove.
>
> So who would ride under those limitations?
I've faced them in triathlons and ultra-marathon runs. When I ran
Vermont 100 mile trail race, there were 3 mandatory medical checks,
with a weigh-in and general assessment of condition at each one. But
before the event, the race director was very clear about what they
would judge to be a medical issue and what was "your problem." "Your
problem" constituted virtually everything but a compound fracture,
loss of coherence, and (usually concomitant with loss of coherence)
loss of more than 7% of your body weight. They would pull you from
the race due to any of these conditions. Anything else, e.g., cuts
and bruises, sprains, most upper body injuries, etc., would be my
problem. And I did get cuts, bruises, lost toe nails and an nice
ankle sprain to boot. The race director's instructions for all of
these problems? "You deal with it!" So I dealt with it and did not
feel in the least that my adulthood was being violated. I knew what
the ground rules were going in, I knew that I faced a hard challenge
and that while disaster was unlikely, there was a safety net to guard
against it, but I was free to experience a very bad day on my own
(thankfully, despite the injuries, it was actually a very good day!)
Under those circumstances, we all know what would be needed to prevent
the medical staff from pulling us from the event. Keep hydrated, keep
nourished, keep the electrolyte levels up, don't attempt to exceed a
sustainable pace.
I don't know what happened at Cascade beyond what I've read on this
board, but it sounds like a very tough ride. As Mike describes very
well, conditions can be so extreme as to impair our good judgment, and
if a preventable tragedy were to occur, there would be significant
risks and liabilities faced by the organizers, waiver or no waiver.
On a trail run, the price of momentary loss of "reason" is almost
always quite low. You are probably moving at a walking pace and fall,
you get cut, you might sprain or break something. The likelihood of a
serious injury is minimal. I don't need to describe how different it
can be on a bike.
I'm not advocating mandatory medical checks, but I certainly wouldn't
object. And I would certainly respect the judgment of any event
director who told me I wasn't fit to continue. He or she has
something at stake in this as well.
John
Jennifer Chang
Point and advice well taken. About not being "stubborn" in future about the completion of a ride, if I'm "checked out." Hopefully, if I'm not, I won't be as stubborn. (=
However, my point still stands. If it ever came down to deciding who can or cannot participate in a randonneuring event, I would prefer an experienced randonneur/organizer to make that ULTIMATE decision, based on the medical advice, rather than the medical personnel himself. An exception might be when that medical personnel is an experienced cyclist, who has been endowed with this power by the organization, in the first place.
Jennifer
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Charles Coldwell
> I don't know what happened at Cascade beyond what I've read on this
> board, but it sounds like a very tough ride.
There was some hot weather, but I don't think it was worse than the
Shenandoah 1200. I didn't do both (only the Cascade), but if there is
somebody on the forum who did, chime in. There was about a 30% DNF
rate on the Cascade 1240K event, compared to a 46% DNF rate on the
Shenandoah. For comparison, the abandonment rate on the wet 2007
Paris-Brest-Paris was about 30% also (with much better statistics; two
more DNFs would have pushed Shenandoah to 50%). The DNF rate is
probably the best metric we have for the difficulty of a ride.
> And I would certainly respect the judgment of any event director who
> told me I wasn't fit to continue.
IIUC, an official can pull a rider's card if the official believes
continuing will present a significant risk to the rider or others.
Officials are reluctant to exercise this authority.
Chip
--
Charles M. Coldwell, W1CMC
"Turn on, log in, tune out"
Somerville, Massachusetts, New England (FN42kj)
GPG ID: 852E052F
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NickBull
personnel checking us out on the route, that it would always be their
call whether a rider continues, and never would be the call of the
organizers.
Imagine: Doctor says the rider can't continue. Organizer says "Hey,
what does the doctor know. Get back out on the course if you want and
keep riding." Rider has accident. Who gets sued? Who testifies
against them in court? Who loses?
On Jul 18, 11:35 am, "Jennifer Chang" <insipidper...@juno.com> wrote:
> Point and advice well taken. About not being "stubborn" in future about the completion of a ride, if I'm "checked out." Hopefully, if I'm not, I won't be as stubborn. (=
> However, my point still stands. If it ever came down to deciding who can or cannot participate in a randonneuring event, I would prefer an experienced randonneur/organizer to make that ULTIMATE decision, based on the medical advice, rather than the medical personnel himself. An exception might be when that medical personnel is an experienced cyclist, who has been endowed with this power by the organization, in the first place.
> Jennifer
>
>
> Jennifer<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
> This is a nice personal post.
>
> However, speaking only for me, you really put a lot on the volunteers, and the idea of forever wondering or never knowing or regretting isn’t so much, especially as now only 2 weeks later you are not wondering at all. You DNF’d a crazy bike ride that 99.9% of the people you ever met have never heard of, and can’t relate to.
>
> It’s hard to ride in the heat – the body gets tired and taxed just sweating so much, can only recover energy/fluids/electrolytes so quickly in any condition, and more.
>
> Reading this, if you weren’t taken to a doctor right after stopping, or even before, and/or something worse happened, like your internal organs ‘checking out,’ or falling over into the road in front of a car, there would be very sad implications for a lot of other people, including your family, and our bicycling family, who would of course be sued, waiver or no, with all of us feeling awful about ‘your choice.’ But maybe there wouldn’t even be that much information, and there would always just be another sad biking mystery/tragedy.
>
> You took it too far, which at times can be part of the personal exploration that is randonneering, showing personal toughness, but also applying that toughness as ‘stubbornness’ toward the organizers, who, again, only my opinion, should only relied on to stamp the cards and maybe give out bananas, and some cots to sleep on, cheer a little, and not too much more. Not every volunteer is going to be someone like MT, perhaps they won’t even be a bicyclist.
>
> Though a common experience in rando, you were still very lucky to have the kind SIR volunteers there for ya, but these people are not coaches or a safety net. You now have this one experience of your own to remember, build on, and know / manage yourself better. Please don’t take it so far next time, or we will indeed have to start keeping some doctors around. J
>
> Mike
>
> Ps. Last words of Tom Simpson (David Millar’s debate coach): ‘Put me back on my bloody bike.’
>
> Cc: ran...@googlegroups.com
> Subject: [Randon] Re: Medical evaluations enroute?
>
> I'm the rider you saw that was "checked out" at Cascade 1200. And I was, looking back.
> I do want to put forth, however, that, while RUSA and SIR President, Mark Thomas, did make the decision that I would no longer be able to participate in Cascade 1200, he did give me the opportunity to make my own decision about it, at a very personal level. While I was "checked out," I retained enough of cognitive functioning to insist that I be allowed to make my "own" decision about whether or not I could complete the ride. That was very important to me, even in that state.
> Mark allowed me to get on the bike, and when I realized that I "swerved" and could not keep the balance, while trying to get on or off the bike, and there was a "delayed" processing of visual perception, that made me unable to respond quickly to the oncoming traffic, I got off the bike and told him, "You're right, I can't do it." While I wanted to finish the ride that I had started training for, since dark, rainy, freezing December, I'm not a wacko enough that I would attempt to do so at all cost.
> It might have been time-consuming, and even frustrating, for the organizers to spend that much time with me, after it was clear to them I no longer possessed the mental capacity to complete the ride. As for me, however, I am ever grateful that they spent that much time with me, while I slowly processed that I could not complete the ride. Because of that allowance, I am disappointed that I could not finish the ride, but not regretful. If that choice had been taken away from me, I would have forever wondered whether or not I could have completed the ride.
> I do not simply want a medical doctor to make the decision on whether or not I can continue on in the ride. The best thing about the whole process was that it was the EXPERIENCED RANDONNEURS, who understood my desire to finish the ride, who also had the presence of the objective mind, with the advice of medical experts, who made the decision, on my behalf, that I could not continue on in the ride. Sometimes, such a decision needs to be made on behalf of someone, who does not possess the full functioning mind, as I was then. However, since it is the decision, on MY behalf, I want someone LIKE me, who understand what these rides MEAN to me, to make the decisions on my behalf, as I would have done, had I the full faculty. I'm a cyclist, not a doctor. And if I'm going to choose someone to make a riding decision for me, it would be a cyclist like me, who can also heed to medical advice.
> I am truly thankful, too, that even when the decision was made, at organizational level, that Cascade 1200 organizers continued to work with me, at personal level, so that I would not have regrets. I hate living life with regrets.
> Jennifer
>
> ____________________________________________________________
DrCodfish
To Toss in the towel or be tossed, that is the question.
Great topic, better suited to the hot stove league (off season
prattle) perhaps, but then again, we are right in the ’heat’ of the
season (get it) so memories are pretty fresh.
What Do We Know?
I’ve thought a lot about this over the last year or so. We had a
rider die on a brevet last year which raised lots of questions and
brought the discussion in to focus. The dramatic possibilities are
not theoretical. Not to be too dramatic but randonneuring can be a
life threatening activity.
Viewed through this lens it might seem obvious that we should be
erring on the side of caution: We should require medical certification
to participate, and subject participants to medical review during our
events, have course marshals, require the wearing of reflective gear
24/7, and what else? Only ride closed courses?, institute age
limitations?, what other safety measures are prudent?
But you can look at this through the other end of the telescope and
draw another conclusion:
Every time you swing a leg over the top tube you are putting your life
at risk. The act of riding a bicycle is dangerous. Far more
dangerous than walking, or staying home, or playing golf, or most
other sporting activities for that matter. Young people are hurt on
bikes, just like old people, shoot, forget the bike, any day of the
week you can read about someone who was killed riding in a car, more
in fact than those of us on a velo. Given this set of facts,
obviously, medical supervision and standards is not necessary. So,
where is the middle ground?
What Do We Think?
I don’t consider myself a long experienced rando, I have been at this
for less than 10 years, so I am still learning … a lot. I have
developed a taste for long brevets though, I find them much more
rewarding, and of course much more challenging.
Five 1200’s and four 1000’s have provided me with lots of personal
experience and opportunities to observe many people riding in various
states of distress. I have seen people soldier on whom I thought
shouldn’t have: A rider on one 1200 crashed into the back of a parked
car (that right there is a red flag) he was really messed up, but
insisted on continuing (this was in the last couple hundred K). A
compromise was struck: Organizers insisted he be seen by medical
professionals at a hospital, and he agreed to abide by their
recommendations. As it turned out he returned to the ride and
finished, At the end of that ride he and another fellow who also
crashed were commiserating happily at the end of the ride. I really
wish I had had my camera at the time, they looked like survivors of
“extreme cage fighting, the amateur edition”. By the way, that too
was an extremely hot 1200K.
On another 1200 I watched another rider continue on even though he was
so exhausted and sleep deprived that he would occasionally wobble. I
counted him out a full 24 hours before the finish. He didn’t quit,
and together we finished as co-lantern rouge ‘winners’. And who has
not sen the legions of shirmers neck sufferers crawling to the finish
at PBP? The one legged, peddlers, those who have to stand for most of
the last 200K?
On the other hand I have seen lots of people pull out long before I
thought they needed to. Many more than those who went past what I
thought was a safe point. But in their minds, it was time to quit.
Do we argue with them? Should we have course marshals there to
determine if they are sufficiently injured or diminished to allow them
to quit?
What’s At Stake?
Mike says Jen took it too far and that if she had continued on and had
a dire consequence there likely would have been much sadness … and a
lawsuit. BUT, what if Jen had been seen by medical professionals who
had prescribed a treatment and upon completion she had gone out on her
bike and gotten splattered anyway? Who’s liable then? Would that
scenario be sufficient to prevent a lawsuit? We all know the answer.
There is no immunity from a lawsuit; the risk of being sued is there
regardless. And these days I see a lawsuit as just a legal trip to
Vegas. It seems to me to be more a crap shoot than anything.
Beyond liability there is the question of personal responsibility or
“adulthood” as someone mentioned.
In the 1940’s or 50’s would we be having this conversation? It was a
different era and there was not the culture of litigation that exists
today. But things have certainly changed so we have to at least
consider liability as we put up courses and events. But I don’t
assume that the risks are any greater now than they were then. Just
the liability has changed.
There is an assumption to some degree that if you enter such an event
you accept a heightened risk of personal harm. Randonneuring 101
tells us all that we are to be self reliant and self sufficient.
Accepting that credo implies an acceptance of responsibility for our
decision to participate. The waiver, the ride report, the stories
from past participants, are all the official and unofficial “There be
dragons here” sign. We should know that we proceed at our own risk.
In this sport it just is not reasonable to accept the opportunity to
participate while deferring the liability for this decision to
others.
When you got your physical for PBP what was the first thing your Doc
said when the question of soundness came up? Of course (s)he said you
were nuts, and many of us (and our family members ) believe that we
have to be a little nuts to do this anyway. There is no question that
a rider can find his/her self in a state of diminished mental
capacity, at some point on a long brevet. The dirty little person
secret here is that at this point things get interesting for me. Of
course I like the notion of me breezing through a challenging 1200K
brevet, feeling little or no physical challenge and having 100%
control of my entire mind all the time. But I know for me that will
likely never be the case. It’s the muddling through. The proof once
more that my head is harder than this wall, the affirmation that I
have not yet come to the point where I need to consider moving from
the field to the bleachers that I relish. And of course the harder
the challenge, the more rewarding the triumph. And oddly, I assume
that a DNF on such a hard ride would be all the more disappointing
(for me).
John suggests that it would nice to have someone with medical training
as a volunteer. I think so too. But personally, I’d rather have a
massage therapist.
Are We There Yet?
How ‘extreme’ is randonneuring? Is this on the order of adventure
racing or reality TV shows, or is it just a rung above STP or other
‘challenging’ club rides or events? This is probably more important
to he question of med supervision than we think. And, do we have the
right (rigorous enough) qualification requirements to be confident
that we will experience few if any of those decisions about continuing
or ‘being pulled’?
Jennifer references balance issues. This is a red flag, and has been a
personal concern for me. People who ride with me know at the back end
of long brevets I have ‘balance issues’ especially mounting and
dismounting. Once those 700c gyroscopes start spinning the balance
issue seems to recede. I am aware of this and so my attention in
these situations goes way up when I am long into an event. In fact,
as I go farther into a 1200 one of my own personal survival strategies
is to give myself more room than I normally require. I don’t want to
do harm to others but also, I know that they may be operating with
impaired mental and physical abilities. We ALL need to become more
alert to dangers.
But the central question here is the case of a rider who may not be
able to form rational decisions. Just like in life, determining when
to relieve someone of their right to decide for themselves is a huge
issue. I do not know if we can generate a simple checklist or ‘field
sobriety test’ for exhausted riders. I fear that if we tried, we’d
end up investing as huge amount of resources and probably still not
have a fool proof system. All you need to do is let one rider
continue after being deemed ‘OK’ and have him/her have a serious
accident and then what do you have?
What To Do?
But this is an important question and I think perhaps RUSA should
consider collecting some data on future events that might help develop
an informed policy. Perhaps as part of the brevet organizers report
for any brevet 600K or longer there should be the requirement to
report on this issue. A series of questions could be developed that
can help bracket or target conditions or circumstances that may be
used as indictors of potential problems or effective solutions for
future events.
It’s interesting that we have seen rides cancelled, or postponed for
bad (wet, cold, icy) weather but I‘m not aware of rides being
rescheduled for brutally hot weather. (perhaps I recall something in
Texas, how ‘bout that Dan?) And whether you believe that global
warming is real or just Al Gores invention (like the internet?) the
fact that we are seeing some ‘extreme’ weather recently cannot be
disputed. We had to reroute C1200 because of last winters extreme
weather, we’re just now working on rerouting our 3 Volcanoes 300K for
the same reason, the Shen 1200 sounds to me like it was similar to a
ride on Mars (day time) so perhaps we need to consider too hot/humid
as a reason to reschedule.
It is easy to see it both ways. “Put me back on my bike” may be
unreasonable, “let me get back on my bike” … maybe not so much.
Yr Pal Dr (I'm no doctor, haven't even stayed in a fancy motel
laterly) Codfish
albert meerscheidt
The Cascade Bike Club just finished running Seattle to Portland (STP) this year. There were wheel touching crashes in the first 30 miles. It was hot, several people ended up in the hospital with IV's - they were only doing two 100 mile days. Should that ride have had mandatory medical checks? Let me skew your answer by telling you that we had over 160 medical personnel riding the route with us, along with Gold Wings, and SAG support.
Monkey Man
second day at the beginning of the climb up Chinook Pass. I hit the
"extra" gravel from the fresh chip seal & went over the bars landing
on my left side. I had a black eye, cut above my left eye, cuts on my
left hand, sprained left thumb, road rash on my left side, large
bruise on my left leg & very sore ribs. After visiting the doctor
when I got home I found out I had slight fractures to two ribs. I
also discovered I had broken my helmet. Should I have been allowed to
continue? My appearance certainly wouldn't have given anyone
confidence that I was fit to continue. My wife & riding partner after
circling back announced "we're done". After a self examination I
determined even though I looked like hell I was good to continue. I
would have been very upset if someone had determined I was unfit to
attempt to finish. I certainly wasn't at my best and I did fall once
again later that evening due to my hand injuries & strong wind gusts.
The remainder of the ride was painful & sleeping was difficult but I
made the decision myself to continue and eventually complete the most
difficult ride of my life. I'm very thankful that the decision to
continue was my own. Medical volunteers would be great but how would
you position them to service such a wide field? Even though we were
able to piece together suitable medical supplies I would suggest more
complete first aid kits at the controls. I believe the correct
decision was made concerning Jennifer. Had I been unsteady Robin
certainly would had intervened and stopped me from riding. The SIR
volunteers showed compassion for a fellow randonneur by persuading
Jennifer to make her own choice. We randonneurs are "not quite right"
in our quest to complete events. There is a fine line between
stubborness and determination. Thank God for free will!
Val Phelps
Lone Star Randonneurs
Jennifer Chang
I'd really hope that the organizer would have agreed with the doctor at that point, (=, but if he/she hadn't...there still exists another scenario, in which an organizer says, "go for it," and the rider does complete the ride.
If I were a legal advisor or the medical personnel on duty, I'd always err on the side of safety, so I completely understand your perspective, Nick. What I'm expressing here is a rider's perspective, about whom I'd personally prefer to designate to make decisions on my behalf, if I was incapable of making such a decision. The way I might designate the executor of my will.
I'd prefer someone who thinks like me, who would struggle with this decision, weighing all sides, as much as I would. Of course, I'm assuming that the experienced randonneur/organizer would be someone, who would consider, not only the potential lawsuit questions, but the personal elements involved in training for and attempting a ride like this. Not to mention, the inputs from the medical experts. I'm still betting that those combinations would be best found in an experienced randonneur/organizer than in a mere medical personnel, who might be a non-cyclist, hired for that occasion.
Jennifer
Mike Biswell
>If I were a legal advisor or the medical personnel on duty, I'd always err on the side of safety, so I completely understand your perspective, Nick. What I'm >expressing here is a rider's perspective, about whom I'd personally prefer to designate to make decisions on my behalf, if I was incapable of making such a >decision. The way I might designate the executor of my will.
Hi Jennifer
The person that needs to make the decision ‘on your behalf’ is you. But, because of overexertion/whatever, you couldn’t do this, and you were bailed out by SIR who took care of you. Lucky!
From reading this – I don’t really know, it seems MT humored you for a while, even while you were being pulled from the ride. No one can stop you from continuing on a public road, really except you, and if you wanted to protest in the rando way, you could have just kept going, paid for your own hotel room, signed your own card, finished within the limit (or 2 days later?), being sure to give everyone the finger crossing the line and so forth. However, you were in no shape to do this, apparently, and stopping was the only good call.
This is bike riding, not riding until blindness or passing out. It is too much to have the expectation that SIR volunteers will always take care of you, or monitor your well-being. Talking about designating the first convenient SIR person, or anyone as in charge of your ride/health, rather than you, is taking away from your own experience and ride, regardless of eventual DNF or success, and is also simply not a real option.
Just my opinion and I respect your riding and courage.
Related: The rides are very cheap, $10 for the 200km in NorCal in August – It’s not interesting to me to pay $50-$80 per ride just to have a doctor squad / whatever, and have to ask if it’s okay for me to ride.
Mike
Nicholas Bull
Off to a brevet ...
Best of luck on the RM.
Nick
GeorgeSwain
24-hour race. At the pre-ride meeting, the organizer told the group
of assembled riders that he reserved the right to pull riders off the
route in the event that their perceived ability to ride and handle the
bike was so compromised as to be dangerous to themselves or others.
This would not need to be a permanent disqualification, and might only
necessitate a temporary nap. Ultramarathon cycling and randonneuring
is SERIOUSLY dangerous. The LAST person in a perfectly lucid state of
mind to make the ultimate decision in these cases of extreme
exhaustion and fatigue is the rider. Many of us are stubborn as hell
and the activity we engage in has the potential for serious cognitive
impairment.
I'm not sure that an organizer would want to delegate the decision-
making to a doctor, though. In fact, I don't see the need. While many
randonneurs are doctors, the costs would be prohibitive and it's not
the qualifications that come from years in medical school that are
most needed. A cool head, experience with this type of event, and a
decisive personality are what is needed. Perhaps we should encourage
the participation of volunteers with EMS or first-aid training. Above
all, though, the decision should rest with the RBA, not some hired
doctor.
I'm surprised this is not already perceived as the role of the
organizer on a long event. I imagine that RUSA's insurance agent would
have a few things to say about it! Think of the liability (not to
mention feelings of responsibiity) that an organizer would encounter
if he or she felt that they were negligent for not pulling someone off
an event if that person was a hazard. We're not playing chess here.
There is a lot of danger involved and we should be sure that the RBAs
are trained and have the authority and support to make decisions in
these cases.
Be safe,
George Swain
West Park, NY
On Jul 19, 4:59 am, "Nicholas Bull" <nick.bike.b...@gmail.com> wrote:
> Maybe others would take a different view, but if I were the organizer, I'd
> take all of what you say into account, but if the doctor said "no" then
> there's no way on earth that I would contradict them. I have two children
> who are depending on me to put them through ballet school (and maybe
> eventually college) and a wife who is hoping not to eat dogfood with me in
> our retirement years. That trumps any consideration of "doc says no but,
> gee, I think this randonneur is tough enough to do it." If the doc has said
> no, and I say yes, and you ride and get killed, then your family sues me,
> the doctor testifies against me, and I lose everything. Big downside risk.
> If the doc has said no and I say yes and you finish, I get a warm feeling
> (and the doc refuses to ever work with us again). Pretty small upside
> reward. Maybe others who are less risk-averse than me would be willing to
> contradict trained medical personnel. But you're asking an awful lot of
> people who stand to gain very little and could lose everything they've
> worked for.
>
> Off to a brevet ...
>
> Best of luck on the RM.
>
> Nick
>
>
>
>
> > I'd really hope that the organizer would have agreed with the doctor at
> > that point, (=, but if he/she hadn't...there still exists another scenario,
> > in which an organizer says, "go for it," and the rider does complete the
> > ride.
>
> > If I were a legal advisor or the medical personnel on duty, I'd always err
> > on the side of safety, so I completely understand your perspective, Nick.
> > What I'm expressing here is a rider's perspective, about whom I'd personally
> > prefer to designate to make decisions on my behalf, if I was incapable of
> > making such a decision. The way I might designate the executor of my will.
>
> > I'd prefer someone who thinks like me, who would struggle with this
> > decision, weighing all sides, as much as I would. Of course, I'm assuming
> > that the experienced randonneur/organizer would be someone, who would
> > consider, not only the potential lawsuit questions, but the personal
> > elements involved in training for and attempting a ride like this. Not to
> > mention, the inputs from the medical experts. I'm still betting that those
> > combinations would be best found in an experienced randonneur/organizer than
> > in a mere medical personnel, who might be a non-cyclist, hired for that
> > occasion.
>
> > Jennifer
>
Mike Biswell
>From: GeorgeSwain
>Sent: Saturday, July 19, 2008 4:59 AM
>To: randon
>Subject: [Randon] Re: Medical evaluations enroute?
>I guess that I just don't get it
Last year I did a 400km with no secret control, no support, RBA doing the
ride, and no one there to make any call except the individual rider.
Longer permananent - who's there to help/advise?
Regards!
Mike
Roger Peskett
care.
In extreme circumstances, people’s judgment can get clouded because of
the mental strains and effects created by their physical condition. In
those circumstances, they can be lucky if someone happens to be around
who advises them or even forces them to stop, for their own benefit.
This is just a bit of good luck because, by allowing ourselves to get
beyond the point of being able to make our own sound judgments, we
have already made an error. Anyone who then tells us to stop is only
performing the good and entirely optional and voluntary act of saving
us from ourselves.
As a rider at PBP, I saw many wobbling and swerving riders by the last
day. Maybe I could or should have tried to stop them for their own
good. I didn’t. But ultimately, each is responsible for her or
himself.
Medical checks? I don’t think I’ll be bringing along my own medical
team to brevets. As a randonneur, I prefer to ride without support. If
my brevet organizer does more than stamp cards (and she always does do
more), that’s just a nice bonus. I’ll check myself from time to time,
thank you very much. If I chance to hear someone getting concerned
about what they observe of my mental or physical condition, I’ll aim
to listen to them with care, because I should not have let myself get
to the point of needing others to look after me.
Tom
assisted with the initial care of the 2 Cascade 1200 riders who
crashed outside of Quincy. I was called before JC was stopped and
encouraged the organizers to STOP HER. I have tremendous admiration
for JC's toughness and never say quit attitude. That is what gets many
of us through these rides where we routinely push ourselves well
beyond the usual limits. The conditions of the Cascade 1200 were
horrendous that weekend. I suspect that many endurance event
organizers would have cancelled their event under those weather
conditions and those are the experts that would testify against the
RBA and other organizers if and when a heat related tradgedy occurs on
a bevet. JC experienced heat stroke that day and we are all blessed in
many ways that she recovered so well. It is a testimony to her
physical and mental strength. However, we and the rider may not be so
lucky next time. Maybe we need to move the Cascade 1200 out of central
WA to avoid being set up once again by mother nature.
The Seattle Mountaineers has a practice of designating a "Medical
Officer" on their more challenging group climbs. That person is a
climber who is chosen by the climb leader and may be an MD, RN,
paramedic, EMT, etc. Their climbing experience is also a factor. All
climbers are expected to communicate any significant health problems
that they have to the climb leader who shares that information with
the Medical Officer. Maybe RUSA should consider asking RBAs to
designate a Medical Officer for rides >= 600K. Because the riders are
so spread out and a participant may also be impaired by exhaustion and
weather conditions, it would have to be a rider who is volunteering to
support the ride. That person would be available by cell phone to all
ride support staff and riders themselves. That person could patrol the
2nd half of the riders where occult heart disease and other medical
conditions are most likely to lurk.
I also think that the RBA and his/her delegates should have the right
to end the participation of any rider who they judge to be a danger to
themselves or others (riding without lights or reflector). I would be
glad to work with a RUSA committee to develope objective guidelines to
help organizers determine who should be stopped temporarily (1 hr rest
off the clock) and who should be disqualified. Vomiting and unable to
hold down fluids is an example of an objective criteria to make a
rider stop for 1 hr off the clock. If they can hold down 8 oz after
the rest then they are back on the clock. If they are not or they
start vomiting again, they are done for that ride. Poor balance,
disorientation to time or place are other fairly objective parameters
that could be used to evaluate someone who seems to be in trouble.
These changes wouldn't cost a penny but would increase the safety of
the rides. Yes, it may mean a little less independence but perhaps a
lot less risk for RUSA and the RBA and other race organizers. Some of
the risks are unexpected and very difficult to avoid such as the crash
of the 2 riders near Quincy. Others risks such as heat injury are much
more predictable and we all should have seen that one coming.
Let's not let JC's brush with near tradgedy be in vain.
Tom Martin
Peter Noris
I was pulled from PBP after a crash resulting in a concussion. It was not my decision; riders told me I was slurring my speech, and even unable to ride a straight line, when I thought I was. Left to my own, given that this ride would have been my second SR5000, I really did not want to stop. If riders are telling you you are riding in an unsafe fashion and you don't realize it yourself, it's time to face the fact that you ARE impaired, and need to stop, which is what finally happened to me. If it's only a question of needing sleep, then sleep and try again. If it's medically induced, and you are so impaired you can't realize it, listen to the other riders or officials.
DNFs are temporary; the guilty feelings of a rider who couldn't get you to stop or the driver that hits you when you wander across the center line and you die is permanent.
--
Peter
"Seeing the U.S.A. one brevet at a time"
13 regions and Canada - more to come!
321-794-0500 cell - 352-275-5888 home - Skype me at Peter.F.Noris
RUSA2691
"If that choice had been taken away from me, I would have forever
wondered whether or not I could have completed the ride."
riding against their will, I don't think the rider should go through
life whistfully wondering, "Would I have completed the ride if
only...". Rather, that person should be thinking back, "Thank god that
person cared enough to stop me. Who knows what might have happened if
only...".
If a somewhat incoherent, wobbling cyclist came up to me as I watered
my garden and asked for a drink, I would like to think that I would
somehow stall that person while my wife dials the police. I would do
the same for an inebriated, swerving motorist stopping to ask
directions. At some point it comes down to doing the right thing,
whether volunteer or RBA or medic or fellow rider or even a stranger
watering their garden. I think it's that simple---and JC's case seems
like an illustration of this type of situation.
Paul
Greg
idea, but it can become a slippery slope. In the 600K brevet in AZ,
riders are cautioned against riding past the sleep stop because there
are no services or traffic (for help) for 70 miles. Should an
organizer stop someone who decides to push through without a tire pump
and has only a couple gu packs? Should an organizer stop a rider who
has no thermal and/or rain wear as that rider decides to push on as
the temperature and rain start to drop? Or a rider who's crashed and
has a road rash and blood running down their leg?
I suspect that an RBA wouldn't hold back a rider in any of those
cases. So heat stroke isn't really a special case, but rather one of
many cases that one can imagine.
In almost every waiver I've signed, it says that RUSA considers me to
be on a personal ride. So either it is a personal ride and riders
decide things for themselves, or it's not a personal ride and others
share in the decision making process of whether to proceed or not.
I agree with Jan that the proper course of action is to educate riders
about various health hazards - heat stroke, hypothermia, hyponatremia,
sleep deprivation, etc - and then let the riders' personal rides
unfold.
Many people ride for different reasons, and will have different
thresholds for pain, discomfort, heat, cold, sleep, etc. And so one
rider may pay a greater price in the form of a debilitating crash or
even organ failure, than another rider who rides at the same speed and
eats and drinks the same quantities. I abandoned a 300K because I felt
unable to continue riding safely, and I've pushed through on a ride
when it was 100 in the shade and I had 10 miles of climbing ahead of
me. Other people may have made different decisions, which they're
entitled to do. Because it's a personal ride.
Greg
Jerry Zornes
JZ
Mike Biswell
From: Jerry Zornes
Sent: Sunday, July 20, 2008 2:06
PM
To: randon
Subject: [Randon] Re: Medical
evaluations enroute?
Mountain biking comes with risks that are in my mind larger than on my road bike. Yet the medical staff does little to interfere with riders or the race. They will examine a rider who asks for aid or who's crashed out and can't ride. other than that, I've seen people keep riding through amazing injuries and weather conditions. It seems wrongheaded to have a third party pull a contestant off the course
Jerry,
Thanks post and I wish I could claim some 24hr rides palmares like you too, but not yet.
But, really – nobody ever dies in 24hr MTB racing, or do they? Much different than road biking alongside cars. Speaking from ignorance – so, apologies if I’ve got it totally wrong.
My worst crashes have all been MTB crashes, almost riding off cliffs and stuff, so can really understand where you are coming from, and I always ride overcautiously when I MTB alone, which frequent, even if I am a patently wimpy MTB’er in the first place…
Trying to work discussion back to the 2nd and (mainly) 1st party…
Regards!
Mike
Harry Spatz
answer. Not many doctors understand the ultra endurance athlete or their
needs. My doctor, for example, told me not to ride so hard when it's hot,
after I complained of a specific symptom set. I looked up my specific
symptoms on the Internet and learned about hyponatremia. Now, I no longer
have problems in the heat, no thanks to my doctor. I fear there would be
lots of false positives because the repercussions to the doctor are minimal
for stopping someone that could go on, but a mistake the other way could
trash their career. There appears no simple way to implement "doctors"
anyway because you would need several doctors, one at each checkpoint, and
perhaps roving ones along the route and this makes no practical sense.
Their best use is for emergency treatment, from a cost/benefit viewpoint.
Prevention is something that deserves more thought. I believe that each of
us has five major functional needs-fluids, calories, electrolytes,
rest/sleep, and proper pace that need to be monitored and adjusted for
successful brevet riding. If we examined the strategies for balancing these
in successful Randonneurs versus unsuccessful ones, we could come up with
some strategies that might diminish DNFs and also increase the safety of
Randonneuring, particularly for people untested at the distance and/or
conditions they are attempting. Perhaps the personnel manning the controls,
should become familiar with the symptom sets attributable to improper levels
of the aforementioned needs, to help riders who are suffering even before
they need to consider quitting. I would like to see a "post mortem" on how
people who quit for medical reasons addressed the five functional needs
mentioned above during the course of the ride, and a conclusion as to why
they DNF'd, and what they might have done differently. This would be
helpful for others, as would the strategies adapted by the always-successful
riders. I believe that for legal and practical reasons, the rider must be
his own decision maker, but that does not mean that the decision be made in
a vacuum.
Here is an experience I had on the Berkshire series 2nd 200K this year. I
saw another recumbent rider at the start and we arranged to ride together.
He identified himself as an experienced century rider, but never had ridden
a 200K. At around 40 miles he was decidedly weaker on the hills than
earlier and I asked him some questions, but he said he was fine. At around
65 miles I heard a loud yelp behind me, so I turn around to see what's up.
This guy had a terrible cramp. I interrogated him to find that his eating,
drinking, and urination were sufficient, but he had no electrolyte strategy.
I asked him if he knew about hyponatremia. Since he was an ob/gyn, he told
me that he did know. What he knew was that hyponatremia comes from excess
fluid consumption and that he was not taking in excess fluids. I agreed,
but told him that he must increase electrolytes-that it comes from
insufficient electrolytes also, but he refused to believe me. That is not
what he was taught in medical school. I offered him four Endurolytes, but
he took only one just to humor me. Twice more he suffered cramps, but only
would take a single Endurolyte each time. Lucky for him the hills were
concentrated in the middle of the ride and the last 30 miles were all down
hill. We did finish the ride in 12:30, but he was "beat." He begged out of
our plans to have dinner together and went back to his motel. I am sure he
left with the notion that he was not well enough conditioned for a 200K
brevet and I doubt that he will ride another. The real culprit was sodium,
but he needed someone with more authority and credentials than I to tell him
so, or perhaps some document to refer to. Unfortunately, the cards in this
brevet were signed by restaurant employees, so there was nobody in authority
there to reinforce my assessment. Had there been some tangible information
available on balancing all the functional needs, his day, and mine, might
have been quite different, as would his future as a randonneur.
Harry Spatz
Embarq Customer
W-W-W
----- Original Message -----
From: "Harry Spatz" <hsp...@baystatescale.com>
To: "randon" <ran...@googlegroups.com>
Sent: Sunday, July 20, 2008 8:32:15 PM (GMT-0500) America/New_York
Subject: [Randon] Re: Medical evaluations enroute?
My opinion is that having doctors on route doing assessments is not the
answer. Not many doctors understand the ultra endurance athlete or their
needs. My doctor, for example, told me not to ride so hard when it's hot,
after I complained of a specific symptom set. I looked up my specific
symptoms on the Internet and learned about hyponatremia. Now, I no longer
have problems in the heat, no thanks to my doctor. I fear there would be
lots of false positives because the repercussions to the doctor are minimal
for stopping someone that could go on, but a mistake the other way could
trash their career. ...
Aaron
the street twice a week at lunchtime for the past year. He
recommended I try swimming instead.
--
Aaron
On Jul 20, 10:03 pm, Embarq Customer <wee-willie-
WMdeR
Mandatory medical checks? The ride organizer already reserves has the
authority to pull folks if they present a danger to themselves or to
others, don't they?
Here in Colorado, our typical 200K-600K brevet support consists of
organizational assistance before and after the ride, a rousing pep
talk by our RBA, John Lee Ellis (who usually rides with us), the
tender ministrations of convenience store staff, and the camaraderie
and on-road support of our fellow randonneurs.
I own a remote and challenging permanent, and I try to check in on my
riders, either at the start, the finish, or at a secret controle, but
they are on a personal ride. I expect the riders to exercise good
judgment and to act in their own best interest while on the route.
Randonneuring is a self-sufficient sport. We are adults, or are
riding with adult supervision, and have a responsibility to ourselves
and our riding companions to ride within our abilities.
I'm not a highly experienced randonneur, as I've only participated in
brevets for the last five years. I've DNS'd multiple long rides
because I was not certain the ride was within my abilities at the
time, and I've DNF'd two long brevets. One 600K for emotional reasons
(I shouldn't have started in that mental state), and one 1000K because
I began having serious trouble in 104degF heat. On the latter, I
DNF'd while the first rider on the course. I rode home, waved to Tom
K. on the route (who eventually set a course record--hard man, that
Tom), took a long shower, had a cool bath and a big isotonic drink,
took a nap, and felt able to ride again after a week of low activity.
I'd found my limit, and I'd learned a valuable lesson in how to plan a
ride in the heat.
Next time, I slowed down in the heat of the day, and wound it up in
the evenings, and things went much, much better.
One of the primary attractions of Randonneuring is the opportunity to
discover and extend our personal limits, subject to good judgment.
I'd be sad to see that part of the challenge taken from our sport.
Best Regards,
Will
William M. deRosset
RUSA 2401
> I was talking with another seattle rider about the incidents on the
> Cascade 1200. The rider who touched wheels with another and broke his
> collarbone is a friend of his. He was taking the view that the risk
> level in a 1200k should require periodic medical evaluations enroute.
> Checking for fatigue level, dehydration, cuts 'n bruises and the like.
> His point was that these should be mandatory, since he saw people in
> the 600 that he considered too tired to ride. And the 1200 was
> obviously worse.
> What do people think? My immediate reaction was that I would not ride
> an event with mandatory medical checks, and I'll bet I'm not the only
> one. The "line-in-the-sand" word for me is "mandatory". I'd be
> perfectly OK with a medical volunteer, but flatly opposed to required
> checks. There is this concept called "Adulthood" that this other rider
> was too willing to remove.
>
> So who would ride under those limitations?
>
> Dark Horse
Harry Spatz
us slow pokes on the final leg. They leapfrog us back to the end, asking us
every so often if we are doing ok. This is much appreciated because there
are often no riders behind to help or report a mishap should problems
develop. I've not needed any assistance this year, but knowing that
somebody is watching my backside does make the event safer. Eric Ferioli
even will cheer as we go by, lifting my spirits in the most difficult parts
3 or 4 hours from the end. These are the kind of things that the organizer
can do to make it safer and more fun for the slower riders.
Harry Spatz
Jerry Zornes
Please don't think I'm trying to minimize the danger of heat stroke. Living the Arizona I've heat stroke/ exhaustion is an ever present consideration. In considering this I actually asked how I would respond if it became very cold during a ride. Would I be able to recognize hypothermia? I'm not sure I would if just thrown into it without any context. But I am able to recognize bad conditions of any sort and as they occur my self awareness of my own personal condition and my surroundings increases. So there's a good chance I would catch hypothermia and take some action even if I didn't know exactly what it was.
Additionally I find it interesting that there is so much concern about getting a form of medical intervention for a sport that to the best of my knowledge didn't have failure of the current system in the last 5 years. Which begs the question why is everyone in such a hurry to fix it?
JZ
Jerry Zornes
http://www.nytimes.com/2008/07/21/sports/othersports/21triathlon.html?_r=1&partner=rssnyt&emc=rss&oref=login
--
JZ