tough-mudder-injuriesTough Mudder is an admittedly cool name for an obstacle course, but another name that might be more apt for some is, "Let's go to the ED."

The increasingly popular 10- to 12-mile competitions include such obstacles as the Arctic Enema, Boa Constrictor and Glory Blades, but the Tough Mudder's injury rate, often coming as a result of live electrical wires found in the Electroshock Therapy obstacle, is attracting attention in emergency medicine circles.

The Annals of Emergency Medicine recently published a group of case studies of some Tough Mudder participants who ended up in the ED after suffering from various conditions. The authors also recommend how a community and its hospitals can prepare for the injuries likely to result from the race.

Of the roughly 22,000 participants and spectators at the eastern Pennsylvania competition, 38 ended up in the ED and another 100 or so were given advanced life support on-site. Of the five studied in the journal, one was diagnosed with an inflamed heart caused by electrical shock and another with syncope, closed head injury, electrical injury from direct contact with a source, lacerations to the face and hypertension.

The report resulted from the authors' experience treating Tough Mudder patients at Lehigh Valley Hospital and Health Network, Allentown, Pa., in the spring of 2013. "I had never heard of the Tough Mudder before I went to work that day," says the lead author, Marna Greenberg, D.O.

Greenberg says the electrical shocks create a lot of uncertainty for participants and for clinicians treating shocked patients. For example, it's not clear how much shock their already stressed organs are absorbing.

Amy Collins, 29, a participant in the event studied by Greenberg, finished with her father and brother, but not without complications. "Lack of hydration is what got to me the most," Collins says.

She also got burned by the electrical wires — her husband recorded the injury on video. "You can see it did wrap around my neck, and my head snapped back," Collins says, though she didn't feel the burns until later.

Despite all that and more, [her Air Force-member father fractured his shin], Collins says she'd do it again.

Greenberg suggests that hospitals should find out ahead of time if a Tough Mudder is being held in their community, and be prepared to handle unusual injuries and situations, given the uncommon use of electrical shocks.

And the voluminous muck creates challenges. "If you come in from the mud, it's not hazardous waste but it's dirty," Greenberg says. "Everybody had to shower or hose down before they could come in."

You might want to get a couple more garden hoses, she says.