Marathon Race Medical Administration

"I loved it, absolutely loved it" a qualitative study exploring what student podiatrists learn volunteering as part of an interprofessional medical team at a marathon

BACKGROUND

Final year podiatry students volunteer annually as part of the wider interprofessional medical team at both the Brighton and London Marathon race events, supervised by qualified podiatrists, allied health professionals and physicians. Volunteering has been reported to be a positive experience for all participants and a way of developing a range of professional, transferable, and where appropriate, clinical skills. We sought to explore the lived experience of 25 students who volunteered at one of these events and aimed to: i) examine the experiential learning reported by students while volunteering in a dynamic and demanding clinical field environment; ii) determine whether there were elements of learning that could be translated to the traditional teaching environment in a pre-registration podiatry course.

METHODS

A qualitative design framework informed by the principles of interpretative phenomenological analysis, was adopted to explore this topic. We used IPA principles to enable analysis of four focus groups over a two-year period to generate findings. Focus group conversations were led by an external researcher, recorded, independently transcribed verbatim and anonymised prior to analysis by two different researchers. To enhance credibility, data analysis was followed by independent verification of themes, in addition to respondent validation.

RESULTS

In total, five themes were identified: i) a new inter-professional working environment, ii) identification of unexpected psychosocial challenges, iii) the rigors of a non-clinical environment, iv) clinical skill development, and v) learning in an interprofessional team. Throughout the focus group conversations, a range of positive and negative experiences were reported by the students. This volunteering opportunity fills a gap in learning as perceived by students, particularly around developing clinical skills and interprofessional working. However, the sometimes-frantic nature of a Marathon race event can both facilitate and impede learning. To maximize learning opportunities, particularly in the interprofessional environment, preparing students for new or different clinical settings remains a considerable challenge.

Medical Tent Utilization at 10-km Road Races: Injury, Illness, and Influencing Factors

PURPOSE

To increase awareness of the need for coordinated medical care at 10-km races and to help direct future medical planning for these events.

METHODS

We related medical encounter data from nineteen 10-km road races to runner, race, and environmental characteristics. We quantified the most commonly used resources and described the disposition of runners in these encounters.

RESULTS

Across the 19 races and 90,265 finishers, there were 562 medical events for a cumulative incidence of 6.2 events per 1000 finishers (95% confidence interval, 5.7-6.8). Race size was associated with an increased incidence of medical events. Overall, the most common diagnosis was heat-related illness (1.6 per 1000 finishers), followed by musculoskeletal complaints (1.3 per 1000 finishers) and fluid-electrolyte imbalances (1.2 per 1000 finishers). For all diagnoses, runners with finishing times in the first performance quintile and in the fifth performance quintile had greater representation in the medical tent than mid-pack runners. Most runners were treated with supportive care, basic first aid, and oral rehydration. Ninety-four runners (1.0 per 1000 finishers) required ice water immersion for exertional heat stroke. There were low rates of hospital transport (0.2 per 1000 finishers), and no fatalities.

CONCLUSIONS

In 10-km road races, injury rates are low compared with longer races in similar weather conditions. Common medical issues can be managed with basic resources in the on-site medical tent. Green flag start race conditions may not predict race safety with regard to exertional heat stroke risk. There were no deaths in nearly 100,000 finishers.

Medical Coverage in Mass Events: The Oxfam Trailwalker 1996 to 2007

Medical coverage of mass events is quite different from medical practice within hospitals. The environment can be hostile and chaotic. Participants may behave unpredictably due to the effects of alcohol, drugs, or simple surges of adrenaline during sports events. Emergency physicians have provided medical coverage for many events. Together with emergency nurses, they formed core members of the medical teams in these events. It is natural as staffs of emergency departments are trained to handle acute medical and surgical illnesses. In many cases, emergency physicians are medical directors of events and are responsible for organising and coordinating such medical coverage. Local examples are the Sixth World Trade Organization Ministerial Conference in 2005, the Oxfam Trailwalker, and the Equestrian Event of the 2008 Beijing Olympics and Paralympics. It is expected that many more emergency physicians will be invited to organise medical coverage for mass events in Hong Kong. Doctors from other specialties will provide additional assets. Input from doctors specialised in rehabilitation, for example, can implement the concept of rehabilitation in planning medical coverage. This article serves to illustrate the principles used in the medical coverage of Oxfam Trailwalker. Trailwalker was started as endurance training for the Gurkhas in Hong Kong. Walkers formed teams of four to complete the 100 km MacLehose Trail within a 48-hour time limit. Oxfam Trailwalker has a crowd of over 10,000 participants each year. The number of medical contacts is about 1600 to 1800 each year.

Life-threatening events during endurance sports: is heat stroke more prevalent than arrhythmic death?

BACKGROUND

Two important causes of sudden death during endurance races are arrhythmic death and heat stroke. However, "arrhythmic death" has caught practically all the attention of the medical community whereas the importance of heat stroke is less appreciated.

OBJECTIVES

The study sought to determine what percentage of life-threatening events during endurance races are due to heat stroke or cardiac causes.

METHODS

This retrospective study examined all the long distance popular races that took place in Tel Aviv from March 2007 to November 2013. The number of athletes at risk was known. The number of athletes developing serious sport-related events and requiring hospitalization was known. Life-threatening events were those requiring mechanical ventilation and hospitalization in intensive care units.

RESULTS

Overall, 137,580 runners participated in long distance races during the study period. There were only 2 serious cardiac events (1 myocardial infarction and 1 hypotensive supraventricular tachyarrhythmia), neither of which were fatal or life threatening. In contrast, there were 21 serious cases of heat stroke, including 2 that were fatal and 12 that were life threatening. One of the heat stroke fatalities presented with cardiac arrest without previous warning.

CONCLUSIONS

In our cohort of athletes participating in endurance sports, for every serious cardiac adverse event, there were 10 serious events related to heat stroke. One of the heat stroke-related fatalities presented with unheralded cardiac arrest. Our results put in a different perspective the ongoing debate about the role of pre-participation electrocardiographic screening for the prevention of sudden death in athletes.

Mortality among marathon runners in the United States, 2000-2009

BACKGROUND

As participation in marathon running has increased, there has also been concern regarding its safety.

PURPOSE

To determine if the increase in marathon participation from 2000 to 2009 has affected mortality and overall performance.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

We used publicly available racing and news databases to analyze the number of marathon races, finishing race times, and deaths from 2000 to 2009 in marathons in the United States.

RESULTS

The total number of marathon finishers has increased over this decade from 299,018 in 2000 to 473,354 in 2009. The average overall marathon finishing time has remained unchanged from 2000 to 2009 (4:34:47 vs 4:35:28; P = .85). Of 3,718,336 total marathon participants over the 10-year study period, we identified 28 people (6 women and 22 men) who died during the marathon race and up to 24 hours after finishing. The overall, male, and female death rates for the 10-year period were 0.75 (95% confidence interval [CI], 0.38-1.13), 0.98 (95% CI, 0.48-1.36), and 0.41 (95% CI, 0.21-0.79) deaths per 100,000 finishers, respectively. There was no change in the death rate during this time period for overall, male, or female groups (P = .860, .533, and .238, respectively). The median age among deaths was 41.5 years (interquartile range, 25.5 years). Fifty percent (14/28) of deaths occurred in participants less than 45 years old. Myocardial infarction/atherosclerotic heart disease caused 93% (13/14) of deaths in those 45 years and older. A variety of conditions caused death in younger racers, the most common being cardiac arrest not otherwise specified (21%, n = 3).

CONCLUSION

Participation in marathons has increased without any change in mortality or average overall performance from 2000 to 2009.