This 135 mile race is probably the most physically taxing competitive event in the world. It also has considerable medical risks. All runners and crews must appreciate these two facts both before and during the race.

Heat illness and heat stroke are serious risks. These can cause death, renal shutdown, and brain damage. It is important that runners and crews be aware of the symptoms of impending heat illness. These include: nausea, vomiting, headache, dizziness, faintness, irritability, lassitude, weakness, and rapid heart rate. Impending heat stroke may be signaled by a decrease in sweating and goose bumps, especially over the chest. Heat stroke may progress from minimal symptoms to complete collapse in a very short period of time. Deaths and renal shutdown (kidney failure) have been reported in other ultra-marathons. Adequate conditioning is mandatory.

Adequate fluid and electrolyte intake is the most important preventative for heat illness. Runners may well require dozens of gallons of fluid during this race. Proper pace is crucial.

The high altitude plus exertion can also produce various degrees of altitude sickness. This can lead to severe lung and brain swelling, and even death. The main treatment is rest, and especially to get to a lower altitude.

Blisters are also a problem on this course, with pavement temperatures perhaps reaching 200 degrees. Proper foot care & preparation are essential for having a successful race.

Remember, you are responsible for your well-being while participating in this race. There are no aid stations. Know where your limits are and know your body. Your acceptance of invitation to this race declares that you are aware of the risks & potential health problems.