Medical and Disaster Preparedness of US Marathons

Despite the events that occurred at the 2013 Boston Marathon (Boston, Massachusetts USA), there are currently no evidence-based guidelines or published data regarding medical and disaster preparedness of marathon races in the United States. Purpose To determine the current state of medical disaster preparedness of marathons in the US and to identify potential areas for improvement.

A cross-sectional, questionnaire-based study was conducted from January through May of 2014. The questionnaire was distributed to race directors of US road and trail marathons, as identified by a comprehensive internet database.

One hundred twenty-three questionnaires were available for analysis (19% usable response rate). Marathon races from all major regions of the US were represented. Runner medical information was not listed on race bibs in 53% of races. Only 45% of races held group training and planning sessions prior to race day. Automated external defibrillators (AEDs) were immediately available on 50% of courses, and medications such as albuterol (30%), oxygen (33%), and IV fluids (34%) were available less frequently. Regarding medical emergencies, 55% of races did not have protocols for the assessment of dehydration, asthma, chest pain, syncope, or exercise-induced cramping. With regard to disaster preparedness, 50% of races did not have protocols for the management of disasters, and 21% did not provide security personnel at start/finish lines, aid stations, road crossings, and drop bag locations.

Areas for improvement in the preparedness of US marathons were identified, such as including printed medical information on race bibs, increasing pre-race training and planning sessions for volunteers, ensuring the immediate availability of certain emergency equipment and medications, and developing written protocols for specific emergencies and disasters.