Extended duration events, including both athletic and cultural events, present specific medical and logistical challenges for the medical provider. These events are heterogenous, ranging from remote ultramarathons to multisport adventures and stationary music festivals. Providers must therefore assess the specific risks and needs. However, in general they should expect to encounter a high volume of encounters, the majority for non-life threatening complaints such as wound care, musculoskeletal injuries or gastrointestinal distress. Endurance athletes in particular are at risk for numerous concurrent metabolic derangements that may lead to life-threatening pathology. The implementation of medical care may be significantly challenged by extended duration, remote or rugged locations, international borders and staffing limitations. Providers should engage closely with event staff and participants to minimize and mitigate catastrophic risks, while enjoying the unique events and their more common complaints.