Introduction: Adventure racing (AR) is a wilderness multisport endurance event with the potential for significant injury and illness. Despite its increase in popularity, the medical and health implications of participation in AR have not been extensively studied. Consequently there is relatively little literature or formal guidelines to assist in the development of medical support for AR races. Methodology: This paper explores the results of a prospective cross-sectional study that recorded pre-, in- and post-race injury and illness incidence in 184 adventure race athletes competing in an expedition-length World Championship. The findings are compared with previously reported injury and illness profiles in AR in order to provide information to allied health professionals providing medical coverage for such an event. Results: Fifty-nine cases of injury or illness were recorded during the race; representing an overall rate of 2.5 injuries per 1000 race-hours and 1.0 illnesses per 1000 race-hours. Two competitors required air evacuation for medical attention. Respiratory conditions were the single-most common condition resulting in race withdrawal and the most common illness (52%) recorded during the race. During the race the lower limb was the most frequently injured region; the majority of these injuries were blisters or bullae to the feet, which when combined with sprains and strains to the knee or foot accounted for 57.2% of all in-race injuries. The injury profiles are not too dissimilar to those that have been reported during similar expedition-style races however the illnesses reported differed from the gastointestinal type illnesses that have been reported in races in hotter environments. Conclusion: On site medical support for an expedition-style adventure race must be prepared for not only the minor and moderate illnesses and injuries described in this study, but also the potentially life threatening and severe trauma as seen in this race and previously reported in similar races. The fact that each AR race is different both geographically and climatically makes comparative analyses difficult and the true incidence of injury and illness in this athletic population is difficult to ascertain or predict. The results of this study significantly add to the limited literature on health events during AR and allow future medical teams to be better informed and prepared.