Sports Med 2007; 37 (4-5): 291-293CONFERENCE PAPER 0112-1642/07/0004-0291/$44.95/0

© 2007 Adis Data Information BV. All rights reserved.

Marathon Medical SupportHistorical Perspectives‘From Cradle to Averting the Grave’

Dan S. Tunstall Pedoe

London Marathon Medical Director 1981–2006, London, UK

The history of marathon medical support is largely undocumented and anecdo-Abstracttal. Modern mass-participation marathon events attract thousands of variablytrained and acclimatised participants to an event that is physically very demand-ing, in some cases covers difficult terrain, and may be held under stressful climaticconditions. Medical support for mass-participation events such as the marathon isdirected at minimising the potential risks and avoiding the worst scenario wherelocal medical emergency services and hospitals are flooded with casualties.

The history of marathon medical support is large- • organisation and recruitment of the medical andly undocumented, anecdotal and difficult to sum- related support;marise because of its complexity. My personal expe- • liaison with local medical services and hospitals;rience as medical officer to the British Road Run-

• liaison with the media and the sponsor;ners Club in the 1970s (pre running boom) is• collecting and reporting the number and types ofcontrasted with that from being Medical Director of

medical and first aid contacts and relating thesethe London Marathon.to the weather for improved care and athleteModern mass-participation marathon events at-safety.tract thousands of variably trained and acclimatised

participants to an event that is physically very de- With >30 000 participants in several marathons,manding, in some cases covers difficult terrain, and the human diversity involved makes every event ‘anmay be held under stressful climatic conditions. experiment’ and the types of runner can differ fromMedical support for mass-participation events such marathon to marathon and even from year to year inas the marathon is directed at minimising the poten- the same marathon. The history of medical supporttial risks and avoiding the worst scenario where for marathons is an evolution of responsibility fromlocal medical emergency services and hospitals are a casual involvement on race day, to an all embrac-flooded with casualties. ing involvement in the birth and weaning of novice

Medical support includes: marathon runners (advice on their training, diet and• medical input to pre-event planning (e.g. safety safety precautions) months before the event, to de-

of the course, entry requirements); veloping the medical delivery systems for race day.

• education of participants, organisers, marathon With fields of >30 000 runners, the medical plan-medical support staff and local hospital staff re- ning may involve as many as 1500 medical and firstgarding possible hazards, their avoidance and aid staff for >40 aid stations, a field hospital at thetreatment; finish, a large number of static treatment vehicles,

292 Tunstall Pedoe

mobile cardiac arrest vehicles and paramedics on medical officer for the London to Brighton racemotor bicycles or bicycles. involved driving up and down the Brighton road

informing race marshals where you were going to beDelivery of medical support on race day is awith little medically related activity. The 100 run-major logistic enterprise, which is dictated by theners with low morbidity rate did not justify anythingrelationships between the statutory emergency ser-more at that time.vices, the local first aid organisations, the receiving

hospitals or clinics, the medical liability insurance Following the collapse of Jim Peters in the 1954and the recruited medical support staff for the mara- Vancouver Commonwealth Games marathon, thethon; therefore, the medical operation varies from evolution of medical care has had various threads,race to race. Marathon medical support continues at including: (i) concerns about the weather and expos-the hospitals and may involve intensive care of heat ing marathon runners to the heat of the midday sun;stroke victims or serious cases of hypopnatraemia (ii) debate as to how core temperature can be mea-and emergency angioplasty to resuscitated runners sured; and (iii) whether medical support should bewith coronary disease. purely first aid with rapid transfer to hospital or

whether the marathon should provide on-site carewith intravenous fluids and other treatment to mini-1. Pre Running Boom Marathonsmise the load on local hospitals.

Early marathon and ultra marathon races wererun by small numbers of dedicated club athletes who 2. New York: 1980usually spurned medical advice or intervention, butmight raid the first aid box to dress blisters or care Recruited by Chris Brasher to organise the medi-for minor issues. They were likely to be very wary of cal care for the first London Marathon in Marchthe doctor unless known to be “one of them.” I 1981, I visited the New York Marathon in Novem-remember desperately trying to maintain my pace ber 1980. A British child psychiatrist who had runover the last mile of a half marathon and being several New York Marathons had offered to helppassed by a cheery group of runners, one of whom with the medical side and took me to his designatedcalled out, “Hello Doc! Do you need one of your New York Marathon aid station in Central Park.pills?” Volunteers were assembling, most of whom did not

At least they knew who I was! They felt that no know each other. Several different medical speciali-one, especially staff at local hospitals, knew any- ties were represented, plus a ham radio operator,thing about runners’ problems and that they would some State Troopers and their military ambulances.recover more safely if left to their own devices. No one seemed to be acting as ‘team captain’. TheLuckily, most runners healed successfully without radio operator could not get reception at the desig-medical intervention. I learned a lot from them, but nated site and moved 200 yards along the road, butbeing unsuccessful in persuading a runner with a the others refused to join him. The weather had beenhaematemesis to go to hospital still rankles, as does warm the previous year but it was very cold with ahearing third-hand after the London to Brighton strong 30–40 mph wind giving a wind chill tempera-event that one runner had to stop near the finish with ture near freezing. The stations had been issued skinwhat sounded like rapid atrial fibrillation. He rested, contact thermometers (Tempidot™) for axillaryrecovered, and finished the race avoiding me and my temperatures, none of which registered as the run-ECG machine for fear of being advised to stop ners were all severely chilled at the skin level. Therunning. Medical cover for a marathon or even the aluminium foil blankets issued to the runners at theLondon to Brighton double marathon consisted of finish were shredding in the wind and Central Parkone or two first aid posts and a doctor in a car, was transformed by aluminium foil blowing aroundcarrying dressings, drip sets, ECG machine and in the wind and wrapping around trees and roadsideportable defibrillator, which were never used. Being furniture, blowing across roads and floating up into

© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (4-5)

History of Marathon Medical Care 293

the sky. Treatment for the severely chilled runners Lawrence MD. It facilitated doctors and medicalprofessionals participating in marathons, both asconsisted of warming them up in the back of therunners and volunteer medical support staff, andmilitary ambulances, which had extremely powerfulwas especially involved with the medical support forheaters.the Boston Marathon, which in return waived itsNow, New York aid station captains recruit theirstrict qualifying time for physician entrants who

own teams.pledged to help runners along the course. The Inter-national Marathon Medical Directors Associationwas founded in 1981 to provide a forum for race3. London: 1996. Impact of Sponsors:medical directors to share information. The Ameri-Health Event or Major Medical Disaster?can Road Race Medical Society was founded in2003 to bring all interested in road race medical care

In 1996, the London Marathon had a sponsor and research together via internet and group meet-promoting the race as a ‘health event’. The water ings such as the 2006 World Congress on the Sci-supplier (also a sponsor) had an advertisement ence and Medicine of the Marathon in Chicago. Theshowing an ecstatic runner pouring the contents of American College of Sports Medicine (ACSM) En-two water bottles over his head. On the day of the durance Interest Group also meets at the ACSMmarathon, the air temperature suddenly increased Annual Meeting to discuss and improve medical10°C, peaking at 22°C with a strong sun. The run- care.ners were not acclimatised to this heat and the early

Further reading on marathon medical support isrunners stopped at water stations and poured succes-available.[1-3]

sive bottles of water over themselves depleting whatwould have been more than adequate supplies ofdrinking water. Later runners suffered in the heat. AcknowledgementsSome picked up discarded bottles and begged atdoorways for water or filled them from petrol station

The author has indicated that he has no affiliation orforecourts. Ninety runners were taken to local hospi-financial interest in any organisation (other than the London

tals (most were discharged a few hours later) and 50 Marathon) that may have a direct interest in the subject matterof these were taken to St Thomas’s Hospital near the of this article.finish. Fifty casualties from an event arriving at onehospital is technically a ‘major medical disaster’,though in practice it only caused some temporary Referencescongestion in the accident department. We now

1. Milvy P, editor. The marathon: physiological, medical, epidemi-supply more water and have spray stations, which ological, and psychological studies. Ann N Y Acad Sci 1977;

301: 1-1090are redundant most years.2. Recommendations of a Consensus Conference. Popular mara-

thons, half marathons and other long distance runs: recommen-dations for medical support. BMJ 1984; 288: 1355-94. Road Race Medical Organisations

3. Tunstall Pedoe D. Marathon medicine. London: Royal Societyof Medicine Press, 2000

No history of the medical support for marathonswould be complete without mention of the Ameri- Correspondence: Dr Dan S. Tunstall Pedoe, 29 Meynell Cres-can Medical Joggers Association (now the Ameri- cent, London, E9 7AS, UK.can Medical Athletic Association), founded by Ron E-mail: DanTPMARDR@aol.com

© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (4-5)