Why Most Race Medical Plans Fail (And How to Build One That Actually Works)

Endurance races don’t just test runners — they test your entire medical operations plan. In this episode of the AT Pit Crew Podcast, Dr. Ray Castle talks with Russell Sadberry, an athletic trainer with 32 years of experience at Katy Independent High School in Texas, about how to build scalable, reality-tested medical coverage for endurance and ultra-endurance events. Russell brings a rare 360° view from working major events like the Houston Marathon and smaller ultra races, plus insights as the spouse of an accomplished marathoner who has completed four World Major Marathons. They break down how to design and run medical operations that protect participants from the first mile to the finish line: Command structure & roles How to establish a clear incident command structure Defining role clarity for medical volunteers at races of all sizes Medical footprint by event size Building a right-sized medical footprint for 700-runner ultras vs. large-city marathons with thousands of participants Staffing mix strategies Integrating athletic trainers, nurses, EMS, and community volunteers Matching skills to positions so every station is staffed to its mission Communication & redundancy Radio and phone communication protocols Backup plans when primary systems fail mid-event Transport & hospital coordination Designing transport routes and handoff plans Coordinating with local hospitals for different event scales Supplies, equipment & environmental care Essential gear for cooling, warming, and emergency care Building treatment areas that can flex with patient surges Course design & medical coverage How course layout, terrain, and access points drive resource placement Real-time monitoring & thresholds Using weather data, participant flow, and medical encounter trends to anticipate surges Budgets, partnerships & sustainability Budget considerations for smaller or resource-limited events Creative partnership strategies with sponsors and local agencies Contingency planning & reunification Procedures for emergencies, course stoppages, and family reunification What organizers often overlook until something goes wrong By the end of this conversation, you’ll have a practical framework for medical operations planning that scales from local ultras to world-class marathons — and keeps runners, staff, and spectators safer when the race day pressure is highest. Call to Action: Subscribe to the AT Pit Crew Podcast so you never miss a lap. For more resources and continuing education on event medical operations, visit Acti... Chapters (00:00:02) - Emergency Medical Care(00:00:32) - Pit Crew: Endurance Events & Ultra Endurance Events(00:02:43) - General Command and Authority at Races(00:05:36) - What is the medical footprint of a race?(00:08:05) - Emergency Preparedness at an Ultra Endurance Race(00:10:17) - Race volunteers' critical skills(00:11:59) - Primary Communication Modes During an Event(00:14:29) - What Kind of Medical Coverage Does Trail Running Have?(00:19:57) - Medical Supplies and Equipment for Ultra Endurance Events(00:24:30) - Temperature and Cold at the Marathon(00:26:40) - Heat Stroke(00:31:58) - How to Manage the Marathon(00:35:19) - Endurance Events: Contingencies & After Action Reports(00:36:12) - Boston Marathon and Communication Plans in Action(00:40:18) - Five Quick Questions For Russell