To:                 All M&T Bank Vermont City Marathon & Relay Runners

From:            Suzanne Elliott, MD, FACEP, FAAEM and Katie Dolbec, MD, FACEP, CAQSM; Medical Directors

Denise Alosa, ATC and Alison O’Connor Sutherland, ATC, AEMT; Medical Coordinators

Important Race Information and Logistics


The 2022 M&T Bank Vermont City Marathon Medical Team is a group of dedicated volunteer medical personnel available to assist you on race day. Our Team provides rapid assessment and treatment of your medical needs during the marathon.


No matter how fit you feel on race day, this information could help us save your life should something happen to you on the course.


Medical Stations on the Course

Medical tents are located at the start and finish area in Waterfront Park, at Champlain Elementary School (miles 2 and 15), and Leddy Park (miles 10.5 and 23.5). In addition to these tents, medical aid stations are located throughout the course (about every 1.5 - 2 miles). The aid stations are staffed with two medical personnel who can be identified by their red vests with “MEDICAL” written on the front and back, and a photo ID badge. Please do not hesitate to seek help or ask any questions – we are here to help you!



The weather at this time of year can be unpredictable. Be sure to check the local forecast and plan accordingly. The average temperature for May 29 in Burlington is 53 degrees at 7am and 68 degrees at noon. Race officials will monitor the temperature, humidity and radiant heat to determine the risk of weather related danger to participants. Please look for signs posted at each aid station indicating the current alert.


Rules about Fluids

Physiological function and performance is compromised as a result of dehydration. Therefore, it is necessary to ingest fluids during exercise in order to maintain physiologic functions and prevent early fatigue and heat-related illness. Sports drinks are generally the preferred beverage to maintain optimum hydration (many of these include essential electrolytes such as sodium). The following tips will help you decide how much to drink on race day:

·       Drink at least 16 ounces of fluid 1-2 hours before the race.

·       Drink another 16 ounces of fluid in the hour immediately before the race.

·       Check your urine 1/2 hour before the race, if clear to yellow then you are well pre-hydrated, if dark and concentrated then drink more fluids!

·       As a general rule, drink no more than 1 cup (8-10 ounces) of fluid every 15-20 minutes during the race - that does not necessarily mean a cup at EVERY water station, but gauge according to weather. Water/Sports Drink stations are located throughout the course.

·       Drinking more water does not make it less hot; you need to listen to your body and slow down if necessary.                 

Remember to drink enough but DO NOT OVER DRINK! Fluid replacement should approximate sweat and urine losses to maintain hydration at about 2% body weight reduction. These are guidelines only – athletes must take responsibility for their individual needs. Runners who sweat more than average will require more than the recommended amount of fluids.  



What is hyponatremia?  Hyponatremia is a disorder of fluid-electrolyte balance that results in a dangerously low sodium concentration in the blood.

What causes hyponatremia in athletes?  Excessive drinking, sodium loss from sweating, and the kidney’s limited capacity to excrete water will dilute sodium in the body’s fluids.


Who is at risk? Athletes that drink too much before and during prolonged exercise and “salty sweaters” are at risk. Research has shown that females, runners with a slight build, runners taking over 4 hours to complete the course, and those taking nonsteroidal anti-inflammatory drugs (such as Advil, Motrin, Aleve, ibuprofen, naproxen, etc.) may be particularly susceptible to this risk.


What are the symptoms?  Nausea, vomiting, throbbing headache, dizziness, severe fatigue, swollen hands and feet, wheezy breathing, confusion, disorientation, and lack of coordination may all be seen with hyponatremia. In severe cases, it may result in seizure, respiratory arrest, coma and even death.  Symptoms can occur up to 24 hours after an endurance event.


How Do You Prevent Hyponatremia? 

·       Follow the guidelines above.

·       Drink a sports drink that contains sodium. Do not rely solely on water for endurance events longer than 2 hours.

·       Do not restrict salt in your diet. Examples of high sodium foods are potato chips, fritos, pretzels, tomato juice/sauce, chicken noodle soup, chicken broth, and Gatorade

·       Do not take NSAIDS (Advil, Motrin, Aleve, ibuprofen), or any anti-inflammatory medications before, during or after the race. Tylenol may be taken safely.


Heat Related Illnesses

A spectrum of heat related illnesses exists, including heat cramps, heat exhaustion, and heat stroke. One does not go from one to the next in a continuum. Heat exhaustion is characterized by a variety of non-specific symptoms which may include nausea, vomiting, dizziness, mild confusion, etc. This usually resolves with cooling and rest. Heat stroke is a life-threatening illness manifested by mental status change and body temperature at or above 104 degrees. We have seen heat stroke in each of the past 3 years in both relay runners and marathoners. This has been at much cooler temperatures than are expected for this year. Listen to your body, slow down if necessary, and seek medical help for any concerns.  


Pain Relievers

Recent medical research has shown that non-steroidal anti-inflammatory drugs (NSAIDs) like Advil, Motrin, Aleve, ibuprofen, naproxen, etc. may be harmful to a runner’s kidney function if taken within 24 hours of an event. NSAIDs are thought to increase the possibility of hyponatremia during endurance activities by causing decreased blood flow to the kidneys and interfering with a hormone that helps the body retain salt. Therefore, it is recommended that on race day (after midnight on race day) you do not use any analgesic but acetaminophen (Tylenol) if needed. NSAIDs may be taken again 6 hours after you have finished the race providing you are able to drink without nausea or vomiting, have urinated once, and are feeling physically and mentally normal.  NSAIDs would be beneficial at that time in preventing post-event muscle soreness.


After you Cross the Finish Line

Runners should continue to walk for at least 15-20 minutes after finishing the race. Standing still or stopping can cause you to feel nauseous, dizzy, and weak. Endurance athletes may experience syncope or fainting immediately after completing a race if they don’t continue to walk. Walking will help to redirect the blood pooling in your legs back to vital organs, including your brain. Drink fluids slowly as tolerated. If you think you need help, ask one of our medical personnel at the finish.


After your initial walking period, some experts agree that slowly stretching your leg muscles will assist in the reduction of cramps and post-race soreness. Post-event massage continues to be controversial. Most experts agree that a massage within the first 2 hours after the race does not prevent muscle soreness.



The Medical Team is here to help! Please stop by the medical tents if you need help or have questions. We're here for you! At each and every medical station on race day will be medical professionals to help you along the way.