Few prearranged events provide better opportunities for emergency health system coordination and planned disaster management than does medical coverage of a major city marathon. No guidelines exist as to the appropriate level of care that should be provided for such an event.
The medical coverage for 2,900 marathon runners and an estimated 500,000 spectators along a 26.2-mile course over city streets for the 1986 Pittsburgh Marathon was examined prospectively. Support groups included physicians, nurses, and medical students from area hospitals and emergency departments and podiatrists, physical therapists, athletic trainers, and massage therapists from the Pittsburgh area. Emergency medical services were provided by city and county advanced life support (ALS) and basic life support (BLS) units, the American Red Cross, and the Salvation Army. A total of 641 medical volunteers participated in the coverage. Data were collected by volunteers as to acute medical and sports medical complaints of all patients, their vital signs, and the treatment provided. Medical care was provided at 20 field aid-stations along the race route (including a station every mile afier the 12-mile mark, and at four stations at the finish line).
Race day weather conditions were unusually warm with a high temperature of 86°F (30°C), relative humidity of 64%, partly sunny with little ambient wind, and a high wet bulb-globe temperature of 78°F (25.6°C). Records were obtained on 658/2,900 (25%) runner-patients of which 52 (8%) required transportation to area hospitals after evaluation at aid-stations: three were admitted to intensive care units. Analysis showed that 379/658 (58%) of the patients were treated at the finish line medical areas, and of the remaining 279 patients treated on the course, 218/279 (78%) were seen at seven, mile-aid-stations between 16.2 and 22.8 miles. The conditions of heat and humidity constitute a near “worst-case” scenario and the numbers of medical personnel that should be available to deliver acute care of hyperthermia/hypothermia and fluid/electrolyte disorders are recommended. Also it is recommended that approximately 50% of medical personnel and equipment should be deployed in the finish line area and that 80% of the remaining resources on the race course be deployed in aid-stations located every mile between miles 16 and 23.