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From nutritionists and mechanics to masseuses and media officers, top-tier teams are made up of a whole squadron of satellite staff.
Among the most important of any team’s staffer circus are the medics charged with caring for a flock of wafer-thin athletes toeing the line between elite performance and physical meltdown.
The U.S.-trained physician Dr. Kevin Sprouse spent 13 years with EF Education-EasyPost as head of medicine. He traveled with the team through the calendar, amassed as many race days as even the most illustrious of riders, and saw more Tours de France than most racers would wish for.
Heading into 2023, Sprouse will turn his expertise toward a role in sport science with Jonathan Vaughters’ pink-clad crew.
VeloNews caught up with Sprouse about his life on the road as a medic in the high-stakes WorldTour peloton.
VeloNews: So how does it work, are medics part of a team’s full-time staffing set-up? Are you directly employed by EF Education-EasyPost?
Dr. Kevin Sprouse: On our team, we’ve never had full-time physicians. Instead, we have a team of part-time doctors. But different teams do it differently.
In my time as head doctor with EF I always pushed for part-time roles, because I feel like if we have one or two doctors who spend all of their time with the team, they become very medically and academically myopic.
The five or six doctors that we have on staff, depending on the year, all have backgrounds in sports medicine. But they’ll also have formal training in emergency medicine, rehab, medicine – all sorts of other things that are useful.
VN: How much of the time do you find yourself dealing with “regular” ailments for your riders?
KS: A surprisingly large amount of the things that come up on the road are totally unrelated to sport.
We’ll be at a hotel in rural France, and somebody knocks on my door at 2 am with abdominal pain, and we have to figure out if it’s appendicitis, if it’s something they ate, anything.
At that point, you’re very much into the role of an emergency physician, like doing acute diagnosis and triage. And if you don’t do that frequently, that type of acumen falls away very quickly – that’s why I push for part-time staff that are also working elsewhere.
VN: So, take us through a day at a race. Do you wait for riders to come to you, are you at-hand during the actual race, what’s your schedule like?
KS: Typically in the morning I’ll get up early to try to do something active like go for a run. It’s good to get out as you’re pretty sedentary the rest of the time.
Then I’ll be around for breakfast when the riders come down, just to be present and to just chat informally with some of the guys. A lot of it is just organic conversation around nothing sport-related a lot of time. But just being present opens the door to pertinent conversation regards their condition for the race or may suggest something’s not right in general.
I’ll typically ride the bus to the start so I can be with the riders, and to talk to the directors about anything that comes up. If say, anyone comes to me with a medical concern, we can think about how that concerns race strategy, or we may talk about hydration needs, lots of things.
In the race, I’ll be in the front seat of the first car with a small medical bag to take care of whatever I can take care of on the road.
The bag has a little of everything, electrolytes, medications, bandages, inhalers, you name it. Being in that first car means I can be on-hand in a minute, maybe less. It’s all about assessing as quickly as possible if a rider is fit to carry on racing – and of course, you’ve got to be really mindful of concussion.
Then at the end of the day, I’ll be on the bus with them back to the hotel, catching up with everyone on how the race went, taking care of road rash injuries, but also just getting a feel for how well they feel, how well hydrated they are, or, if there was some performance concern, if it has a medical component.
And from there it’s dinner and I just make rounds of the riders one more time.
VN: It must be pretty stressful out on the road at the really big races?
KS: I think some find it a bit much, but I feel sort of used to it. Even at a huge race like the Tour de France, when you’ve got experience from an emergency room [Sprouse is trained in both sports and emergency medicine – ed], it feels kind of normal.
VN: What are the common complaints that come up when you’re out on a race, other than the more obvious road rash, fractures, dislocations etc?
KS: During COVID, for a couple years, it was very uni-dimensional with respect to illnesses. Our determination was basically, “do they have COVID or not?”
But prior to that, and more so now, in the early part of the season, we find there are a lot of upper-respiratory illnesses.
As we transition into warmer weather, we tend to see fewer of those and instead encounter more gastrointestinal complaints, whether that’s from something a rider picked up in travel, at the hotel, or whatever else. So there’s a bit of seasonality to the illnesses we see.
And, of course, there are overuse injuries from riding. Back pain, knee pain, neck pain – things like that always pop up. At a grand tour, almost every rider gets a little something like that.
VN: Gastrointestinal issues seem to be one of the most common things that take riders out of a race. How come they’re so prevalent?
KS: If someone is peaking for an endurance event, their body is stressed and the immune system is likely suppressed, and that makes them more susceptible to things.
But the reason that we see a lot of gastrointestinal issues I think is probably multifaceted. One being the immune suppression, another being the huge demand on the G.I. system. Having to take in 8,000 calories a day and process that is asking a lot, so it puts the G.I. system, at a higher risk of inflammation, infection, things like that.
When we travel with a chef and food truck, we take away a lot of the variables that can lead to gastrointestinal problems. But if we’re eating in the hotels, oftentimes, the hotels are pretty poor in terms of quality, and the kitchens can definitely follow suit. I’ve been in some hotel kitchens where I’ve looked in and just immediately walked out and said “we’re not eating here, it’s just not healthy.”