An Overview of Chicago (Illinois USA) Marathon Prehospital Care Demographics, Patient Care Operations, and Injury Patterns

Abstract

Introduction:Large-scale mass-sporting events are increasingly requiring greater prehospital event planning and preparation to address inherent event-associated medical conditions in addition to incidents that may be unexpected. The Bank of America Chicago Marathon (Chicago, Illinois USA) is one of the largest marathons in the world, and with the improvement of technology, the use of historical patient and event data, in conjunction with environmental conditions, can provide organizers and public safety officials a way to plan based on injury patterns and patient demands for care by predicting the placement and timing of needed medical support and resources.Problem:During large-scale events, disaster planning and preparedness between event organizers, Emergency Medical Services (EMS), and local, state, and federal agencies is critical to ensure participant and public safety.Methods:This study looked at the Bank of America Chicago Marathon, a significant endurance event, and took a unique approach of reviewing digital runner data retrospectively over a five-year period to establish patterns of medical demand geographically, temporally, and by the presenting diagnoses. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, coordination, and communication to ensure a safe and secure event.Conclusions:The Chicago Marathon is one of the largest marathons in the world, and this study identified an equal number of participants requiring care on-course and at the finish line. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. As technology has evolved, the use, analysis, and implementation of historical digital data with various environmental conditions can provide organizers and public safety officials a map to plan injury patterns and patient demands by predicting the placement and timing of needed medical support, personnel, and resources.

Review of Injury Patterns of the 2018 Bank of America Chicago Marathon to Optimize Medical Planning

“…Runners passing this tent have the finish within eyeshot. Typically, this tent has a very low volume of patients; however, the patients who do stop often need advanced care, such as transfer to a hospital for sudden cardiac arrest or inhalers for a severe asthma exacerbation (12,21) The data did support our hypothesis as, although the number of runners stopping to receive medical care had a bimodal distribution with peaks at the halfway point of the race and finish line, the percentage of medical complaints was highest at the finish line tents. In the 2018 race, there were only three runners who stopped at the Indiana tent; however, all of them had syncopal episodes from exercise associated collapse and required advanced care, such as evaluation with laboratories, treatment with fluids, and transfer to the main medical tent for monitoring.…”

“…By better understanding what medical resources and personnel are needed at various distances of a marathon, health care professionals can be better equipped to handle injuries. Event planners can utilize this information to reduce waste and improve efficiency in distribution of supplies as well as personnel (12,25). Ultimately, additional longitudinal studies that enhance the strength of prediction models for injury patterns in marathon racing can serve to improve the care of runners and potentially save lives.…”

“…This retrospective chart review of medical records from the 2018 BOACM looks at the type and volume of injury reported at various distances along the route of a large-scale marathon to determine the resources necessary at each aid station. By optimizing race day resource distribution, better medical care can be provided for competing athletes (12).…”

“…A cross-sectional study of the 2018 Bank of America Chicago Marathon (BOACM) in 2011 focusing on hydration practices of marathon runners showed that the majority of runners seeking medical care were inexperienced and had no preexisting concern for having a medical event during the race (11). Prior studies suggest that the most common race day injuries are minor and musculoskeletal (MSK) in nature, but that all tents should be equipped to handle the rare medically catastrophic event (5,6,(11)(12)(13). Running-related hyperthermia, hyponatremia, and cardiac arrest can prove fatal if there is no plan in place to manage these athletes (14).…”

Social mass gathering events influence emergency medical services call volume

“…Another reason might be physical barriers, such as roadblocks, which lead to detours and diversions (2). From an operational perspective, the event may pose a risk for its participants, individuals not involved but in the same catchment area, and the responsible EMS system (5)(6)(7). Although most individuals present with minor complaints, nearby emergency departments may be confronted with unusually high numbers of patients within short periods of time (8)(9)(10).…”