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Lucas & Martha getting supplies for a few patients, long after the 7 A.M. cut-off point   Mile 85 medical team - L-R Thomas Lass, Michael Powell, Lucas Marciniak, Martha Strain, Eva Willett, & Jenny Holm

Marathon Medical: SMU Nursing Student Goes the Distance to Help Fellow Runners

On the last weekend in June, more than 350 elite athletes gathered high in the Sierras to race one of the most renowned ultra marathons: the Western States 100. This 100-mile course takes runners from Squaw Valley to Auburn, California on a grueling trail of steep switchbacks, swift-water river crossings, and mountain passes; through both thick snow and temps that can exceed 100° F. To help each runner make it to the finish line safely, you might find Lucas Marciniak leading the medical team at mile 85. Marciniak is a nursing student in the Accelerated Bachelor of Science in Nursing program at Samuel Merritt University San Francisco Learning Center.

As medical captain, Marciniak’s role is to oversee care of the runners and to make the determination on whether it is safe for them to proceed. The hours are long, starting at 4p.m. and going throughout the night until the following morning. As the night goes on, the medical tent can get a bit crazy. While a big responsibility, Marciniak states that it is really a team effort.

"Everyone on the team has worked professionally in emergency settings and knows how to keep their cool under pressure and with limited sleep," explains Marciniak, a former EMT for Yosemite National Park.  "As each runner reaches mile 85 of the race, we assess them, paying close attention to their mental status and weight compared to their starting weight (as an indication of fluid status), along with addressing a host of other ailments."

While this year’s moderate temperatures in the mountains decreased the number of runners needing medical attention, Marciniak and his team still saw a host of problems. Among the medical conditions  fielded by the team were hyponatremia, hypoglycemia, dehydration, muscle/skeletal injuries, potential  renal failure, medication toxicity, exhaustion and extensive blister care. Twice during the night, they also had to send a medical team down the trail to assess runners that were reported injured.

The race has an extensive set of medical protocols that combine both front-country and back-country medicine. Most of the aid stations are remote and a long way from the nearest hospital. There are no lab tests, teams of specialists, or high-tech equipment, so it is crucial to have competent medical teams with great assessment skills.

"Our goal is to get runners to the finish line, but our priority is their safety. As fit and finely conditioned as these runners are, the nature of this endurance marathon pushes the participants," says Marciniak , "and as the athletes drive themselves to such extremes, the body responds in ways not commonly seen."

Lucas doing some foot care, only 15 miles to go!

This was Marciniak’s third year providing medical aid at the race, and he was excited to be able to fit it in during the intensive 12-month accelerated nursing program.  As part of Samuel Merritt University mission to provide care in diverse communities, the University also values volunteer work.  The faculty and staff at the San Francisco Leaning Center campus were generous in helping to arrange for a weekday clinical so he could attend.

"Volunteering is extremely important to me. I love participating and giving back to the community; in this case helping hundreds of elite athletes push the bar of human endurance, safely."  Yet to squeeze this in, even on the drive Marciniak was busy studying his notes for the midterm the following week. "I recently finished the medical/surgical series (MCA I, II, & III) and the classroom lectures, along with clinical experience from San Francisco General Hospital, were a huge benefit. I was constantly applying what I learned," he says.

Marciniak add that his nursing studies have been key in helping him understand and effectively assess such uncommon pathophysiology. "Having knowledge of the endocrine biochemistry has been key to understanding the role of ADH (Anti-Diuretic Hormone) and it how it is inappropriately produced in extreme activity causing retention of water, which in turn, can lead to hyponatremia."(Currently, new research is being done at the WS-100 to look into how the body responds in such events.)

Along with a rigorous class schedule, Marciniak continues to volunteer for Bay Area Mountain Rescue, focusing on wilderness medicine and rescue in remote settings. He loves the challenge, pressure, and teamwork of responding to emergencies, and chose nursing because he was inspired by nurses’ ability to touch more lives than any others in the medical profession.

"SMU has been an amazing place for me to learn. I have met some incredible RNs and students, and I come out of each clinical day with a big grin, excited about the profession I am going into," he shares. Marciniak will be starting his preceptorship soon and graduating in November, 2011.

 
Martha Strain, SMU alum,  keeping the IV fluids warm early in the morning Lucas taking vitals
 
  www.samuelmerritt.edu