Epidemiology of illnesses encountered during a marathon race – An EMS perspective

Abstract

Background and objectives: There is a dearth of good data from the Emergency Medical Services (EMS) regarding emergencies during a Marathon race. This study aims to document the various emergencies that can occur during the course of a marathon in India. We hope that this study will enable planners to create a database and to improve emergency preparedness for future such events. Methods: Study population A total of 10,000 runners in the age group of 18-80 years, participated in the full (42.2 km) marathon, half (21.1 km) marathon and the 5 K run. Both trained and untrained runners took part in the race. Location Southern Indian city of Hyderabad, on the 24th of August from 5:00 AM to 1: 00 PM. Race conditions Urban and semi-urban parts of the city with both paved and un-paved roads, maximum recorded temperature during the race was 35° Celsius. A prospective descriptive epidemiological analysis of race data of runners presenting with emergencies was done using a standardized patient data collection form given to medical aid providers. Triaging was done according to Canadian triage and acuity scale. Results: Of 10,000 runners, 252 runners required medical assistance during the course of the race. Of all the patients presenting to EMS 248 were Triage priority 3 or 4 requiring urgent or less urgent care • Exercise related musculoskeletal injuries accounted for 200 (79%) of the total cases • Dehydration related cramps accounted for 33 (13%) of the cases requiring oral or IV fluid rehydration • Terrain related blisters and foot injuries – 9 (3.5%) patients • Vomitings - 4 (1.5%) A total of 4 patients were triage priority 2 requiring Emergent care – Transported by EMS to the nearest tertiary care hospital. A 24 year old with symptomatic hypoglycaemia, requiring Dextrose infusion A 45 year old male with Altered mental status secondary to Heat exhaustion and hypotension requiring IV fluid resuscitation A 70 year old male with Hypotension and dizziness requiring IV fluid resuscitation A 23 year old girl who collapsed with hypotension and heat exhaustion requiring IV fluid resuscitation. Conclusion Long-distance running can be a safe and benign sport; however there were serious heat related illnesses requiring hospitalization of runners in this study. A well prepared EMS system is paramount to hosting a marathon in India due to extreme temperatures and mass participation.