Medical Treatment in Iceland


It is compulsory to have Insurance that covers any loss of your possessions, injury or illness, or any other incident relating to your trip to the Fire + Ice Ultra or any other activity organised by Extreme Adventure Races ( Adventure Resources ).

Any Medical treatment in Iceland for Non-Icelandic residents must be paid for at the Time of treatment.

To take part in the Fire + Ice it is compulsory to have Insurance.

In addition for those that qualify,  we strongly suggest you apply for the European Health Insurance card.   See below

Our own medical team operate a safety-first approach to the  well being of Competitors and the Fire + Ice crew.

If it is required you will be taken for Medical treatment at the nearest hospital, all costs associated with that are your own responsibility, however the injury or illness has been caused.



The European Health Insurance Card (EHIC) replaced the old E111 in 2006.

Your EHIC lets you get state healthcare at a reduced cost or sometimes for free. It will cover you for treatment that is needed to allow you to continue your stay until your planned return. It also covers you for treatment of pre-existing medical conditions and for routine maternity care, as long as you’re not going abroad to give birth.

The EHIC is valid in all European Economic Area (EEA) countries, including Switzerland. For more information about what is covered in each country see our country-by-country guide.

You can apply for a free EHIC online here

An EHIC renewal or application is entirely free of charge. However, other unofficial websites may charge you if you apply through them.

If you’re having difficulties with the online application form, you want to update your personal details or  replace a lost or stolen card, call the automated EHIC application service on 0300 3301350.

If you have any questions about the European Health Insurance Card then the section below may provide the answers. However, if you still have further questions then you should contact the Overseas Healthcare Team on 0191 218 1999. If calling from abroad ring 00 44 191 218 1999.

How to survive a Multi Stage Ultra Event like the Fire + Ice

Preparing for your first ultra race will be like nothing you’ve ever faced before. You will push yourself beyond your previously established limits of physical endurance and mental resistance. Exactly how you get to grips with your first ultra will be an intensely personal experience, but there are various aspects of the race you will definitely need to consider beforehand. And remember, this is a first step into the unknown, which brings with it all sorts of new problems and challenges that you will need to solve if you are to survive your first race/event.

Make sure you have the right kit

Having the right kit for your ultra marathon sounds so obvious it’s painful, but runners still get so caught up in the moment when they approach race day, it can be easy to forget something really important. While you might get away with forgetting to bring a cap or a sun visor in a half or full marathon, you will pay for that mistake big time in an ultra (try imagining a 50 mile (80km) race in the mountains and desert without one).

Long distance endurance races like this are difficult enough, so don’t sabotage your efforts with a silly mistake. Your motto has to be check and check again when it comes to your kit before you hit the road.

Pace yourself

Although there won’t be the usual stampede to break to the front that you sometimes get in distance races, it is really important to pace yourself. Despite the euphoria and nerves that you will inevitably experience, don’t go off too quickly. Stick to your pacing plan, even if that’s only 4 miles an hour. Always bear in mind that if you’re running a 100 mile race that will require 20 hours or so on your feet, which is an awful lot of running and walking.

Although you might initially feel fantastic for the first 10 hours at a 5 mile an hour pace, you can be sure the second half of the race won’t feel as much fun if you haven’t trained for that sort of speed. Keep in mind at all times that the point of running an ultra is to finish it, not finish up in hospital.

Break it down

Like all long distance events it can be totally overwhelming to try and think of the distance in the round. The best policy has to be breaking it down into manageable goals. For some runners, that can mean splitting a 100-mile event into roughly four marathons. Or it can be looking at it as 10 sections of 10 miles. Choose whatever works best for you and set a succession of mini targets that are achievable. It will help you enormously mentally and ultimately physically to view the race like this, and it will certainly help silence the persistent grumbling of that inner voice which is always looking for an excuse to tell you negative things.

Be prepared for anything

Expecting the unexpected is one of the best pieces of advice you can take with you on your first ultra. Be prepared for the fact you could suffer anything from heat exhaustion, frostbite, blisters, an injury, dehydration to hypothermia, and that those calamities are all part of the experience. But comfort yourself with the knowledge that you can mitigate the potential impact of any of the above by doing your homework beforehand, finding out exactly what and where the extremes of climate and terrain could be.

Given that there are so many potential variables when you are on your feet for so long, you need to be have a flexible race plan. Yes you must have a race strategy, but be ready to change that plan in a heartbeat if for instance the weather closes in, you become ill or your running companion sustains an injury. This also includes the ability to know when to pull out of the race if you’re struggling. Being stubborn and resilient is one thing, but jeopardising your health and safety is another.

You really don’t want to be 70 miles into a race in the middle of nowhere, wishing you had pulled out at mile 50 where there was a medical station where they would have confirmed your suspicion that you had indeed broken your foot. Always remember things happen in ultras, but as long as nothing is a nasty surprise, you will be able to cope with everything that happened within your event.

Mental toughness

Having talked a little about stubbornness and dealing with that, the flip side is your ability to tough it out when it hurts. Running an ultra will hurt. That is a fact. How much it hurts and where depends on your training, physical resistance and physiology.

As you prepare for the race, keep reminding yourself that it will be tough and you will have bad patches when you want to stop racing. But wanting to stop and needing to stop are two different things. Bad patches are a runner’s worst enemy but most constant companion. You will certainly have moments of doubt during the race, but learning to distinguish between an anxiety and a real problem is part of the challenge that an ultra will force you to meet.


The anecdotal accounts of runners who have run your particular event should be recommended reading as part of your preparation. Knowing how the weather can close in at a certain stage of a race, or how a trail can be icy even in summer, is exactly the kind of forensic knowledge you will need. Reading anything written by ultra runners can be invaluable generally and talking to people who have attempted the same kind of thing will crystallize things even more clearly in your mind.

Have a pacer

Depending on the race distance, a lot of ultras allow runners to meet up with a pacer in the latter stages of the event. This can be a huge bonus because they join during those stages of the event when you may be struggling. So many ultra runners will testify that the arrival of a friend, mentor, loved one or family member can work wonders for morale and give you the injection of enthusiasm, speed, re-assurance and good old running love you need. If you find you’re flagging at mile 60 of a 100-mile race, there is nothing more uplifting than the sight of a running companion to help you rattle off that final 40 miles.

Ultra Running Nutrition guide for MDS, Fire and Ice and Similar events

Ultra running nutrition for the Marathon des Sables, Fire and Ice and other multi day events — Without the technical jargon

Many events require you to carry a minimum of 2000 Kcal per day, although it is common for many people to take more, sometimes 3000 Kcals or more. With the right choices that is easy to do, with very little dry weight and a much smaller space taken up in your backpack. What is also important is not just the amount of Kcals, but the makeup and quality of those Kcals. A typical breakdown of your ultra running nutrition intake for the event would be in the region of 20% protein, 30% fat and around 50% carbohydrate.

Some brands of Freeze dried meals are much bigger than others. A good meal is important, Extreme Adventure Food has a large choice of 800 Kcal breakfasts, and main meals, and 500 Kcal deserts, for even bigger portions consider the Extreme Expedition  Food 1000 Kcal meals, they are high energy, low weight and critically compared to other brands they take up less space in your pack.

For some years now Extreme Adventure Food has been the brand of choice by Mohammad Ahansal, 5 times winner of the Marathon des Sables, winner of the Fire and Ice ultra and many other ultras around the world, remember to take a selection to give you a good variety during your event, typically they are prepared by adding hot water for a short time ( it varies depending upon recipe, but most are 4 to 8 minutes )  stirring to ensure it is all mixed before consuming, if you need to they can be prepared with cold water, but with cold water the rehydration time is usually double.

One exception to that is Ultra Fuel Liquid Food, 100g gives you 450 Kcal, which includes 58g of Carbohydrate and 20g of protein, it takes around 30 seconds to prepare ** but one of the most important features is that unlike conventional food it does not need to be broken down by your stomach, and it is absorbed into your system in around 6 minutes, much quicker than other forms of food that typically take 25 minutes or more.  The five versions that require cold water are a perfect way to take food in the middle of the day without actually stopping. The advantage of delivering energy into your body at such a quick rate compared to other options is obvious.

Just like your water during each stage, a little and often is a good way to approach your energy intake when on the move, it is unlikely you will stop around midday to prepare a meal, and there are a large number of choices on snacks, chews and energy bars, read the ingredients carefully, as quality varies, sometimes a product name makes implications that the ingredients do not support.

Energy drinks, a little like the bars and other energy snacks, energy drinks are not all the same, the way energy is delivered can vary, but a drink that supplies carbohydrate and electrolytes is an advantage when compared to one that supplies just one or the other, although electrolyte only tablets, are an easy and convenient way to flavour water, they are not all the same, compare what is in each tablet, there is a big difference in ingredients, the cheapest is not always the best value.

One energy drink designed specifically for endurance activities, and especially long distance and ultra-running, is the Extreme Ultra Fuel 4:1 that comes in 4 refreshing flavours, a perfect drink for during and after your run, as it has carbohydrate, electrolytes and protein, most energy drinks do not have all three, and the way it is combined in this product, ensures you get the carbohydrate delivered to your body as efficiently as possible.

Recovery after each day or stage :  Long distance runners talk about the Golden hour, some even call it the Golden half hour, but what is clear the quicker you start to refuel your body after completing each day, the better you will feel the next day, leave it too late and you will suffer for doing so.  The Extreme Ultra fuel 4:1 is a perfect drink to make straight away, with its careful blend of carbohydrate, electrolyte and protein, it will aid the recovery process better than an ordinary energy drink, Ultra Fuel liquid food is another excellent option, as are many different types of Bars. Once relaxed and your bodies recovery process is under way you can then prepare your evening meal at a more leisurely pace. Once again Extreme Adventure Food has the largest range of High energy, low weight, easy to prepare meals that take up less space in your backpack.

All your ultra running nutrition should be tried before your event, not just at home, but during and after exercise, the middle of nowhere is not the place to discover that something does not agree with you. And don’t be tempted to just take your favourites, variety is important, and you will get fed up of the same flavoured meal, drink or bar every time

Preventing and Treating Blisters for Multi-Stage Races

My approach to blisters is to try to prevent them at all costs! So many people end up with blisters after their first day of a six day race, which I find unbelievable. Anyone who has put in the training miles in the kit they intend to use should have an appropriate blister prevention method. The terrain, frequently damp weather and volcanic ash do seem to conspire to create perfect blister forming conditions. That being said I managed to run the full Fire and Ice with only one significant blister and two Half Fire and Ice’s (now the Viking Ultra) with no blisters. I’ve also provided medical support for five ultramarathons which meant dealing with lots of other people’s blisters, so you might consider me something of a blister expert. In this article I’ll give you my personal blister prevention methods used during the Fire and Ice Ultra 2019 and talk a little about other methods I’ve seen used.

“The terrain, frequently damp weather and volcanic ash do seem to conspire to create perfect blister forming conditions”


There are three key pieces of equipment to consider for blister prevention: socks, shoes and gaiters.

I like to use quite thick Bridgedale hiking socks because I feel they provide a good level of padding and are less permeable to sand than thinner socks. This is one area where I would experiment for yourselves. I’ve heard very good things about Injinji toe socks and think I may try these in my next training block. Other people swear by two pairs of thinner socks to reduce friction, but I find that one pair always slips down or bunches up. Also note that some socks seem to rub more than others when wet, and your feet will almost certainly get wet during the race, so try out any socks you intend to use in wet conditions before the race.

In terms of shoes I like Inov-8 because of their wide toe box allowing my toes room to move around a little. Shoes are a very personal thing. A lot of people say buy a shoe that is half a size up from your usual so that when your feet swell there is some extra space, I haven’t tried this. I personally start the race with the inner soles in and then remove them when my feet start to swell (usually around day three). Inov-8 shoes seem to be designed to work without insoles but check that your shoes do if you intend to try this. Whatever you do make sure you test it in training, you may find that a larger shoe size allows more movement and leads to more rubbing, or taking the inner soles out exposes a seam in the shoe which rubs your foot.

Gaiters seem to be used by about half of runners on the Fire and Ice. I use quite minimalist Inov8 ones which attach to specific points on my shoes. They keep the worst of the debris out, but do let in a small amount of the finest volcanic ash. They are not waterproof but nor would I want them to be, during the water crossings the water will get in one way or another. Some people use desert gaiters which cover the full shoe, these are usually people who have done desert races before. I’ve not used them before but they seem like a very good option to keep out as much sand as possible.

Blister kit – mine includes a few small sterile needles, these are available in bulk from medical suppliers or can often be found individually from specialist running shops. Kinesiology tape is my tape of choice because it sticks very well and conforms to the contours of a foot very well. I carry a small amount of Fleecy Web Roll to use as padding under the Kinesiology tape. Alcohol wipes round out the kit to make sure things are nice and clean so I don’t introduce infection into the blister.

Having the right equipment is essential to preventing blisters


Keeping your feet healthy begins months before the start of the race. For me this means regularly moisturising my feet, which I achieve by applying Trail Toes before each run. You get used to the slippery feeling in no time. One of my ‘luxuries’ during a race is to bring a pot of trail toes foot lubricant to apply before each stage. I’ve tried things like Vaseline, Lanancane and Aqueous Cream before but Trail Toes seems to be the most tenacious and long lasting of all of these. It forms a slippery barrier on your foot which prevents any chafing. It can also be used in other areas where you get friction like the groin or where your backpack chafes. If you bring a few disposable medical gloves with you then you can apply the lubricant to your feet without getting your hands covered, you might get a few odd looks from your tent mates though!

Another common way of preventing blisters is taping your feet before you start running. I personally don’t use this method but I know many people who swear by it. You have to make sure the tape you choose is strong enough and sticky enough to last at least the length of the long day without needing to be replaced. Kinesiology tape tends to work very well for this as it conforms to the foot and sticks very well once applied. The problem with this method is that as the feet get sweating or wet from river crossings the tape can often peel off and bunch up under your foot causing more chafing that it relieves. If you are going to use this method make sure you have enough tape to last the whole race. Some people use both lubrication and taping at once, taping the areas that they know will rub and then lubricating the rest of their feet as a preventative measure.

Foot hygiene during a race is also paramount, after all your feet are the tools that will help you get to the finish line. I carry a small wash kit which consists of a freezer bag, some compressed towels and soap flakes. Keeping feet clean and free of dirt helps prevent blisters forming in the first place. Add a bit of water to the freezer bag (I divide my food up into a freezer bag for each day so at the end of each day I have a fresh freezer bag), drop in a couple of soap flakes and the compressed towel and you can give your feet a quick wipe down at the end of each day. I know some people may think this is a bit of a faff but apart from the long day most people have hours to kill after getting into camp each night and it feels nice to be clean.

There are a few other steps you can take in the build up to the race to maximise the condition of your feet. Getting rid of callouses before the race is a good idea and using a pumice stone or something similar will help you get nice soft feet. Callouses actually promote blisters forming rather than helping prevent them. Footwear and socks you use for work should be comfortable and breathable to help your feet recover between training runs. Keep toenails short so they don’t hit the front of your shoe. Trim your toenails a week before the race, do it too close to the race and you risk cutting your toes and having a wound on your foot which doesn’t have time to heal.

Applying trail toes before a stage in the 2019 Fire and Ice Ultra


Before I tell you how to treat a blister I have one piece of advice, NEVER USE COMPEED!!! Compeed are really useful if you have a blister and are going to be resting for the next few days and have access to clean socks and dry shoes every day. Compeed are designed to absorb the fluid from the blister, the problem is this means they also absorb the water from your socks and shoes. Add this to the stickiness of Compeed mixing with all that volcanic ash you end up with a soggy, sticky, sandpaper like mess in your shoe. When you try and peel a Compeed off it will often take the roof of the blister off and leave you with an open wound on your foot. Don’t even consider putting a Compeed in your race kit.

At the end of the day sometimes, despite your best efforts, you end up with a blister. The one blister I got during the race was on a long downhill stretch with wet socks, my toenail started rubbing and I could feel the blister developing. I decided to stop at the next checkpoint and because my blister kit was easy to find I deal with it in 5 minutes and was on my way again. I start by cleaning the blister and surrounding area, then I pop my blisters with a needle in two places (sometimes if you just pop it in one place the fluid re-accumulates), drain the fluid, put a layer of padding (Fleecy Web Roll) on and then hold it in place with some Kinesiology tape. The blister will still be painful, but hopefully it will reduce to a dull ache rather than an intense sharp pain. The Kinesiology tape will often last for multiple days and if it is still sticking well there is no need to peel it off and reapply at the end of each day, just wait for the end of the race when you can soak it off in the shower.

At the end of the day you are running 250km, some pain and discomfort is to be expected and sometimes you just have to put up with it.

I hope this helps you towards a blister free race, if you’ve got any other suggestions on how to deal with blisters then feel free to send in your suggestions.

Protein for Ultra Runners

Helpful guide: Protein for Ultra Runners

Its not just bodybuilders who need to ensure they are getting enough protein. Our bodies are always renewing damaged cells and tissue, especially after your long hard run. To do this athletes need to make sure they have a regular intake of protein.

Protein :

  • Supports muscle strength and production of power
  • Aid a healthy immunity system
  • It is essential fuel to rebuild damaged cells, tissue and muscle after excercise

Typically an average athlete requires 55gms per day, but as you would expect, intensive excercise increases the amount of protein you need.

As a guidline athletes should be looking at 1.8g per Kg of bodyweight, although in some cases up to 2g per Kg of body weight can be beneficial.

If you dont consume enough protein over a period of time, your performance and recovery times will be severley effected.  You will notice the following effects :

  • Reduced muscle tissue
  • Increased muscle sorness after excercise
  • Reduced immunity and more frequent body infections

Not all proteins ofer the same level of nourishment.,

High quality proteins can be found in : Eggs, Meat, Poutry, Fish, Dairy and Whey

Lower quality proteins can be found in Nuts, Beans and Vegetables

High quality Whey Protein Shakes are a simple and tasty way to boost your protein intake. Especially the High Quality brands such as goprotein, Products like goprotein offer people who take part in extended excercise ( such as Runners, Triathletes,  Mountaineers, Trekkers and so on   ) some unique performance benefits.

However not all Whey products have the same quaility of ingredients, so care should be taken to ensure that you are using a high quality specification, GoProtein is the high quality brand that we stock.

When do I take my Protein Shake :

After training, Whey protein has a very quick digestion speed, it isproven to support muscle repair after excercise.

Before Bed / between meals, protein shakes can be a convenient and nutritous drink to take before sleep or between meals, for continued recovery after training.

The gorotein brand comes in both stanadrd and diet versions, with a large choice of flavours.