Despite her last-place finish, the crowd inside Franklin Field was roaring, possibly with the loudest cheers of the three-day event. Embraced at the finish line and celebrating with push-ups, Keeling had just broken the world record for her age group.

Just beyond the track, medical volunteers stood ready with wheelchairs, as the mixed Masters race for athletes aged 80 and older is a high-risk event for competitors’ health.

Jason Pan, then a trainee and now an attending physician at Penn Medicine’s Department of Physical Medicine and Rehabilitation, was volunteering at that year’s Penn Relays. This race was a moment he would not forget.

“This is what I went into sports medicine for,” he said. “If you can make it to that age and still be running, that was truly inspiring to me.”

First volunteering at the Penn Relays in 2013 during his residency in sports medicine, Pan has since become the Penn Relays’ medical director, a role he’s held since 2019.

As medical director, Pan leads approximately 120 medical volunteers, alongside additional emergency medical services workers, to ensure the safety of all Penn Relays attendees, including both athletes and fans.

Bringing more than a decade of experience volunteering at the event, Pan emphasized the key to leading the competition’s medical teams: “preparation, preparation, preparation.”

Sticking to the plan

By the time the first starting gun fires each April, preparations have been underway for months.

Beginning in the December of the previous year, Penn Med and Penn Athletics collaborate to plan medical coverage for the three-day event. Supporting Pan at the helm of this coordination is Moe Louidor, Penn track and field’s athletic trainer and Penn Relays’ medical support liaison, joined by two other physicians.

Penn Med’s Lauren Salesi, team sports medicine physician for the Philadelphia Union and Penn Relays’ assistant medical director, has volunteered at the Penn Relays since 2023, bringing expertise in family medicine and orthopedic surgery.

Alexis Tingan — Penn Relays’ medical director emeritus, former Penn track and field team physician, and Jefferson Health’s current division director of sports medicine — displays over 25 years of experience at the Penn Relays as a medical consultant, providing mentorship to the next generation.

These collaborators work to ensure that protocols are in place for the meet. Due to the longstanding nature of the Penn Relays, these plans are generally unchanging, passed down from Pan’s predecessors, Tingan and Rahul Kapur, who served as previous medical directors. 

Yet, Penn Relays’ medical leadership uses lessons from critical situations that have occurred at the event as a way of revising protocols.

For instance, in Louidor’s first year working at the Penn Relays — during the first session of the first day — one spectator went into cardiac arrest in the stands.

“That really put in perspective why we have all these protocols, and that day changed a lot of our protocols,” Louidor said. “We can’t just think about this as a track meet; normal people are here. What do you do if that happens again? … You go from orthopedic injuries to first responder real fast.”

When this emergency occurred, Pan recalled that one of the volunteers, a sports medicine fellow at the time, addressed the situation effectively before he even arrived at the scene.

“They were actually the first one out onto the field and was the one who was basically running the code out there,” Pan said. “They were already doing a very good job. … We can trust our fellows.”

Pan added that this trust comes from his teams’ thorough preparation: “When you’re prepared, even for ‘catastrophic things’ that happen, like a cardiac arrest, like a fracture, if you have all the equipment in place, it doesn’t feel like a scramble.”

Part of this preparation comes from athletic trainers, including Louidor as well as Penn Athletics Head Athletic Trainer Anthony Erz, whom Pan called the “backbone” of the operations. The trainers coordinate materials used to triage athletes at Weightman Hall, where the Penn Sports Medicine Center is located, alongside smaller medical areas around Penn Park.

“We will set up multiple treatment tables to perform evaluations, along with two dedicated first aid stations for managing lacerations, abrasions, ice, and other minor needs,” Erz wrote. “In addition, we will have smaller medical areas positioned in the paddock and at the throwing complex, each equipped with first aid supplies and essential emergency supplies such as AEDs, splints, and other necessary equipment.”

Given that track and field events take place across Franklin Field and the Mondschein Throwing Complex, the medical teams also consider the event’s place in University City.  

“We have to figure out how many ambulances do we want to have on site,” Pan said. “We have to think about geography. We have to think about traffic patterns. We have to think about, ‘Does it make sense to send someone to HUP, which is the closest facility, versus [Penn] Presbyterian [Medical Center], which is the trauma center?’”

These plans of action in medical crises are often predetermined. Tingan and Pan explained the steps taken when handling the occasional femur fracture, which requires off-site care.

“Every few years, we have someone fracture their femur while running, and so they come in on the stretcher. They have to go X-ray,” Tingan said. “[We] examine them and try to coordinate getting them to the hospital.”

“We ended up transporting them directly to Presbyterian,” Pan said, explaining how his team handled one year’s fracture. “Even though it was a farther away facility, that’s where the trauma services were [located].”

Nevertheless, not every situation requires emergency protocols. Salesi noted that the intensity of track and field can make some conditions look more critical than they are.

“Sometimes, when you have all of that adrenaline, and you’re coming out of a sprinting event, something can look very serious,” Salesi said. “You realize you need to give them a second to decompress, calm down, get their heart rate down because they were sprinting with full effort.”

The treatments administered by physicians and trainers can differ due to the diversity of events in track and field.

“It’s different across how people present from distance events, how people present from sprinting events,” Salesi said. “They’ll come off the field at different levels of heightened emotion, and you have to have that ability to know, ‘OK, this person just ran a 400[-meter dash], but this person just sprinted 100 meters.’”

More than the differences between events, the uniqueness of the Penn Relays comes from the range of competitors’ ages, spanning from third-grade runners to senior citizens. Caring for both amateur and professional athletes adds another dimension.

Most athletes competing at the Penn Relays are adults, so the standard protocols of medical care apply. However, age adds new considerations for the Masters athletes, such as a particular attention to their cardiac health, according to Pan.

For athletes under the age of 18, there is an added challenge of obtaining consent, a “quirk” of medicine at the Penn Relays.

“Sometimes, we actually have to go into the stands and find their responsible adult first to consent on something because they can’t technically consent for themselves,” Pan said. “Most of the times when you’re in a pediatric hospital, the patients come with their parents or guardians. We have this additional layer.”

Tingan similarly captured the breadth of the task to provide care to athletes in different stages.

“It’s unlike any other medical coverage that you will do because there’s so many different types of athletes and different age groups,” Tingan said. “Being able to know what to do when a high school student comes into the training room who’s injured, versus a collegiate athlete, versus professional athlete — how to manage that situation and communicate with the athlete, coach, parents, with the trainers. Those are things that aren’t taught in medical school.”

Regardless, the medical teams are ready to go once the Penn Relays starts.

“Whatever happens at the event, we have a plan. Everyone knows the plan. We’ve all practiced the plan, from the medical staff to facilities to operations to the officials,” Louidor said. “We’ve done all the prep, so once the event starts and we get into a flow, it runs itself.”

A “family feeling”

Penn Med recruits approximately 120 medical volunteers through its network, with up to 250 responders including EMS, deployed across the three days of competition. 

“The team is comprised of medical students, of residents, of fellows, and of course, attending physicians — not just sports medicine physicians, but across all disciplines — athletic training students, physical therapists, physician training students.” Tingan described. “It’s kind of a big medical party, where so many different specialties and experts come together.”

These volunteers often come from Philadelphia institutions but also travel from across the United States. 

“One of the amazing aspects of the [Penn] Relays’ medical coverage is that it’s very much a family feeling,” Tingan said. “It doesn’t matter if you’re from Drexel, from Jefferson, Penn, Temple, independent — everyone is a part of the medicine family.”

During his tenure as medical director, Tingan emphasized a culture of inclusion in recruiting volunteers for his medical teams. Pan has continued that legacy since inheriting the medical director role.

“We have a very diverse group of volunteers, from Physical Medicine and Rehabilitation, Family Medicine, Emergency Medicine,” Pan said. “We’re not territorial about, ‘Who is in charge of this?’ We’re all a team. Everyone works together, and it’s nice to get those different perspectives.”

This openness to volunteers allowed Salesi to contribute when she first arrived at Penn Med’s Department of Family Medicine and Community Health in January 2023. Soon after, Pan asked her to join the Penn Relays’ medical leadership team.

“There was a call to volunteer for [Penn] Relays. I thought, ‘Oh my gosh, how cool? This is the national event. … What a cool opportunity that we as Penn get to host this and serve as the medical team,’” she recalled. “So I immediately signed up.”

The Penn Relays also offers an experience hard to find in day-to-day sports medicine practice.

“It’s a really nice event from a camaraderie perspective, for all the doctors. A lot of times we’re kind of siloed in our own offices and clinics, and we never actually get to see each other in practice,” Salesi said. “It’s a nice way to work together for a change.”

Medical coverage at the Penn Relays is a labor shared with familiar faces, Louidor added. 

All 14 athletic trainers at Penn Athletics contribute to the Penn Relays. He also noted that the roster of medical volunteers consistently fills up with people who were once strangers but continue to return each year.

“If we had half as many volunteers or half as many athletic trainers, I don’t think this thing goes,” Louidor said. “The day starts at 6:30 a.m. and ends at 11:30 p.m., and these people come out. They’re not being paid. They’re volunteers. … But they just love helping.”

More than a meet

Even for the physicians and trainers, the Penn Relays carries significance beyond the competition.

Tingan, a Princeton track and field alumnus, ran the college men’s 4x800-meter relay at the Penn Relays during his time with the Tigers. Greater than himself, though, the meet is a part of his family history.

“My wife also ran at Princeton, so she competed in the [Penn] Relays, both in college and high school. My father-in-law competed in the Penn Relays. My brother competed,” Tingan shared. “My youngest son actually asked me, ‘When am I going to compete?’”

Despite focusing on his medical career after graduating from Princeton, Tingan will take to the track in this year’s corporate distance medley, this time trading his Orange and Black to represent Jefferson Health’s relay team.

“It’s kind of come full circle,” Tingan said. “So, I will still continue to compete, even to this day, within the [Penn] Relays.”

Outside of competing, Tingan’s connection to the meet carries on. His former coach at Princeton, Steve Dolan, is the current director of the Penn Relays.

“I was joking with him that he followed me to Penn because I was already at Penn,” Tingan said, recalling his time at Penn Med and experience as Penn track and field’s physician. “It just shows the track and field world, right? A lot of people know people as a family, but the Penn Relays is very demonstrable of that.” 

But Tingan also keeps coming back as a medical volunteer for reasons outside of personal ties. The range of athletes he witnesses each year brings him a new perspective on treating injuries.

“From the older athletes or the younger athletes, just seeing in their eyes, this is the biggest stage that many of them will ever compete … and they just really, really want to do well,” Tingan said. “Just understanding that … the disappointment of maybe their performance or with their team, and being able to navigate that emotion while also trying to figure out what’s going on medically … that’s not always in everyday, office-based medicine.”

Tingan emphasized that the “juxtaposition” of having a “high school race followed by a race with a world-record holder right back to back” is what makes the three days of the Penn Relays “special.” 

Salesi, who works with professional soccer and basketball players in her regular practice, is a former track and field athlete who ran the 400m. For her, the competitors in the Penn Relays represent the purpose of sports medicine.

“We’re always counseling our patients about staying active across the lifespan, so it’s great to see people who are truly the model of that, who are still competing in track athletic events in their 80s,” Salesi said. “You’re truly seeing the spectrum of activity across the lifespan.”

Louidor, who cares for the Penn track and field team year-round as the athletic trainer, finds his motivation close to home field.

“I have athletes that it’s like, ‘This is our fourth Penn Relays together.’ I can see the progression of how they’ve done, and I’ve helped them. They’ve helped me,” Louidor said. “At the end of the day, I like to help people get to their goals, and I want to get them to the end of their career, being able to choose what it is for them at the end, not being forced by something to stop.”

Tingan, too, reflected on how time has impacted personal significance.

“It’s just been an honor to be able to be involved with the [Penn] Relays as long as I’ve been involved with it and [to] develop so many great relationships with athletes, coaches, medical staff,” Tingan said. “To see the legacy that started before me from a medical coverage standpoint, one that I carried on, and one that I passed onto Dr. Pan … it’s just amazing. I’m very fortunate to be able to sit back and see what we’ve built over these years.”

And for Pan — who also spends his weekends covering races like the Saucony Love Run and Independence Blue Cross Broad Street Run for Philadelphia’s “weekend warriors” — he volunteers because he enjoys caring for the athletes.

“It doesn’t really feel like work,” Pan said. “If I wasn’t working at the event, I would be buying a ticket and watching the [Penn] Relays anyways.”

---