Thoughts on Being Cancelled

[The following narrative depicts the views of the writer and does not represent any official statements nor policies of the Department of Defense or Marine Corps Marathon Organization.]

We dodged a bullet, or so we thought. The Army Ten-Miler announced its cancellation. We had heard rumors earlier in the day and were anticipating the announcement. But we were not concerned about the Marine Corps Marathon suffering the same fate. Although we shared many of the same partners for our events, we had a solid plan in place to keep moving forward with our race. We were in constant contact with our partners and had affirmative responses to the questions posed to us.

Was the threat outlook low for the National Mall and federal lands? YES. Did we meet the intent of the National Park Service rules for COVID-19? YES. Did we meet with our medical partners to discuss staffing, support, and hospital bed space? YES. Did we collaborate with other scheduled races to be sure we had viable plans for best practices, concerns, and solutions? YES. Did we meet with Public Health Leads from our region and share our mitigation strategies and answer their concerns? YES.

On Friday, September 17, we had a late afternoon call with a senior member of one of our partners. He voiced some concerns about our mitigation and wanted to know why we thought we could make this work when other military events cancelled. He had to take our final race approval to a higher level but voiced support for our plan and the detailed process we had gone through to get the “YES.”

 On Monday, September 20, I left for the Inaugural Annual Meeting & Scientific Conference, a sports medicine conference in Indianapolis. I was super excited because I was presenting twice on topics that support my role at the Marine Corps Marathon Organization; this is something for which I am passionate. The first talk, “Sideline Management and Emergency Response of Adaptive Sports,” is based on lessons learned from our 2019 race. The second talk, “Physical Therapists Running the Show: Exploring Leadership Roles of the Sports Physical Therapist at Large Running Events,” would be presented with Dr. David Nolan, the lead physical therapist for the Boston Marathon. Dave and I have collaborated on and shared many of our work experiences. Our presentation highlighted the roles PTs can and do play in the administration and execution of large-scale events.

 Throughout the conference I was checking in with work via text and email because I knew I had a lot to do upon my return to Quantico. We had only five weeks remaining to complete everything for our events. In addition, because of the move to virtual in 2020, several of our team members and volunteers were new and had no real experience with managing care at races. This, of course, added the pressure of getting them prepared. But we were excited for the event. There is something “electric” about race week preparation and, for me, I enjoy the chaos and problem-solving that happens on race day. Also, I always see people rise to the occasion and figure things out; that is very satisfying.

Wednesday night I saw a message on my cell phone. It was my boss. He rarely calls outside of working hours, but I thought it was related to a personnel issue he and I were both managing (I did not review the message as I was trying to enjoy the conference and knew I would speak with him in the morning). Then, on Thursday morning, I received a message that I needed to join a conference call. I called my boss; the news was not good, but there was still a chance. We huddled for over 90 minutes talking about other options should one of our partners not support. We needed to move forward and see if we could gain momentum and support for another plan. In the meantime, we also needed to stop contracts where we could, if possible. There would be another meeting on Thursday afternoon with an advocate who we hoped would keep us at YES. I reached out to my medical partners asking them to keep this information at close hold and we reviewed our plan again with them. They were still giving us a YES.

I presented my first talk on Thursday. I focused, and we had a great response from the audience. But the day did not go so well; before it was over, we were told “NO.” The tears started. I honestly believed we could safely run our events and provide a morale boost to those within and outside of our organization. I was so beyond disappointed, it is hard to describe. I reached out to each of the partners I was coordinating with and some were surprised, others were not. Each commented on our superb planning efforts to provide a safe event.

We sent out a press release which, in part, read:

The 2021 Marine Corps Marathon (MCM) Weekend events scheduled for Friday, October 29 through Sunday, October 31 in Arlington, Virginia and the nation’s capital, have been canceled due to security and safety precautions currently in place. “After exhausting all possibilities, the opportunity to safely operate and execute a live event is just not feasible at this time,” said Rick Nealis, director of Marine Corps Marathon Organization (MCMO). “Though we had high hopes to welcome home our running community this October…”

The most difficult part was reading comments on social media. Some were brutal and the attacks felt personal, many implying that we failed in our planning and execution. Others were sympathetic with many of my friends and volunteers reaching out to me. I had to stop looking.

I told my fellow presenter Dave about the cancellation. Of course, we still had to deliver the second talk at the conference but I did not know if I could keep my emotions in check. After outlining everything we do to prepare for the race, my last slide read “CANCELLED.” There was nothing more. 

Friends continued to reach out. Several staff members from other races sent messages and I am happy to see that many races are still being held. I continue to process the loss of our event. In the scheme of life, it is a blip, but when you are passionate and ready to return to some normalcy it hurts.

Looking Ahead: Post-COVID

I have not felt capable of writing my IIRM blog for months. Today I sat down and began to reflect on the past year and where we are today.

If our collective prayers and wishes make a difference, then 2021 will be better; we will get back to normal. By spring we will be back to doing all the things we did before. Once we have the vaccine, we will be fine. Races will start again; people will come back. Beer tents and race stories will return. But, then again, maybe it won't be until the summer.

Will the Olympics happen? The NBA bubble was great but look at the NBA now. College sports are shutting down and starting up again. High school sports are going on as normal or being played in empty gymnasiums with or without video feeds. Or they are not happening at all. Athletes at all levels have tested positive for COVID-19, some with devastating effects to their hearts and ending their careers or worse. This summer my 25-year-old son got COVID-19. He also had pneumonia in two lobes and cardiomyopathy. Today he is doing better.

Many of us have watched while others have had their events cancelled, and we’ve experienced our own cancellation after cancellation. We hear conflicting information about runners and events. Among the many comments floating around are: Virtual events are great. Virtual events will not last. We will include virtual events as an option with all our future events. Runners are not ready to come back. Runners are wanting to compete in-person. Waves and spacing work. Can we really manage spacing in larger events? Running with a mask may impede respiratory function. Running with a mask does not affect oxygenation levels.

We can socially distance (from the beginning I felt it should be physically distance and we should keep the social part). We can have drive-thru packet pick-ups and virtual expos. Permits are not being issued for many events yet. Boston April 2021 is not happening; maybe it will be Boston in October. Or, perhaps, November. What about the World Marathon Majors? Will we have runners and Marines in the streets of DC in October? Maybe it will all need to wait until 2022.

We held two small live events this year out of the 19 scheduled. Each had less than 325 entrants, spaced in waves and on wide courses. Everything after the finish was self-serve. There were no sponsors. I measured circles six feet apart at start lines and spray-painted dots on the ground at finish lines to keep runners apart. I reviewed medical protocols with my providers. I answered questions from runners and staff and volunteers. Medical staff wore full PPE in open air tents. In two events we saw only two runners with injuries. Most of our staff time was spent packing up shirts, medals, and premiums to mail out to our virtual runners. I decided to walk our 10K and marathon since I did not have anywhere to be on what would have been race day. I am fortunate, I still have a job.

I attended online training with other event staff persons to learn best practices and share "survival" ideas. I met with my medical counterparts to talk about COVID-19 testing, mitigation strategies, and how to talk to our race directors about our concerns. I wore and continue to wear a mask every day. On January 22nd I received my first dose of the Pfizer vaccine. I feel lucky. Hopefully in three weeks there will be enough for me to get my second shot.

Many of you could write a similar story. Some of our colleagues have lost their jobs. Others, like me, are not planning race operations; instead, we are doing other things in hopes that we will soon be back to planning race operations. One year ago I was in Washington state visiting friends and having tea and talking about the year ahead. I had no idea what 2020 had in store for us. None of us did.

Nowadays many of us are hoping that we will see an abundance of vaccine, that everyone will take it, and that the variants will not take hold. We are also hoping we can get permits and attend expos. Personally, I am hoping that on this November 1st, I can reflect on the prior day and grumble about my fatigue of being awake for 19 hours—and smile knowing we have come out on the other side. 

A Medical Coordinator's Thoughts Amidst a Pandemic

Today I still have a job, my family is well, and my boss has accepted telework...at least for now. I am spending my days discussing, arguing, and fact-finding, explaining and teaching about COVID-19. I attend virtual webinars from industry leaders about COVID-19 and the impacts on events. I read about Joe Desena’s Spartan events this past weekend and the efforts to make it safe. I reach out to those smarter than me to inquire about epidemiology, false positives, and rates of infection and ask, “What would you do?” I hear many calling for no large-scale events until we have a vaccine.

I am tired and torn. I am confused about the different state “phases.” I am now reading about the skyrocketing increases in infection rates some states are experiencing as a result restaurants, bars, and other activities re-opening. Then I hear that running a race is no different from going to the grocery store right now.

I worry about our athletes in adaptive sports being pushed to the wayside because they are deemed higher risk. I hear some say it might be more convenient to cancel or postpone the race for adaptive athletes but let others participate. I see some of my elders who are fit and healthy still playing golf and tennis. They are carrying on.

I listened to my good friend who is a respiratory therapist in New York City and the stress she was under in April and May. I was proud to see the USNS COMFORT and MERCY deploy to assist and then disappointed when I saw the low numbers of cases, and maybe how those staffs could have been used to assist in nursing homes across the country.

I look at the vast number of events that have been cancelled and the small race operators who cannot pay their staff or issue refunds; they will not survive this year. I feel for the BQ’ers who will not have the experience of a lifetime in Boston this year. Event after event is cancelled. Some are successfully turning to virtual events and rejoicing in the runners who post their medals and family finish lines.

I miss my volunteers. We are in June and I have not seen any of my loyal medical volunteers since last November. I miss the exhaustion of planning, packing, and rehearsing for the big events. I spend my day working on countless courses of action for hosting an event. We have a small one planned in August, maybe 200 runners. I am worried about heat stroke and breathing issues and of course, the cardiac issues we are seeing associated with post COVID-19 infections.

I plan, check equipment, order some new items, and set up training and meetings. Fire/EMS is too busy to talk and plan right now. COVID-19 and social unrest are their immediate concerns.

Do we change our waivers? Do we require anyone who had COVID-19 to get clearance from a cardiologist? Do we take participants’ temperatures? Should athletes be tested before they come to an event?

I informally reached out to our past marathon medical volunteers to get a sense of what they are thinking. No formal surveys, just asking if they would come and "If yes, did they have any question and if no, why not?" Fifteen percent responded in just a couple of days. The physicians were split 50/50, many saying no because of travel restrictions from their organizations. Most nurses said yes and wanted to know about our Personal Protective Equipment (PPE) standards. Some stated that if our event were to happen, we must deem it safe.

What does safe mean to you? That one is hard to grapple with. Many decisions are before us. Some are in the grey zone while others are based more on ethics and morals. I know others are worried, too. And they are uncertain. I ask that we keep talking and supporting each other and working together to reach decisions and answers that are best for each of our circumstances.

I also ask, "How are you feeling?"

The Medical Impact of Unofficial Runners

There are many reasons participants cheat at races. Most of the time it is unintentional, occasionally it’s about ego or proving prowess or trying to obtain an entry into a prestigious event like the Boston Marathon. In 2015, Runner’s World discussed this phenomenon in an article called “How Common Is Cheating at Marathons?” and analysts like Derek Murphy of Marathon Investigation report on those who cheat.

As the medical lead for the Marine Corps Marathon, I review the data after our events to look for injury trends, heat stroke body temperatures, and other relevant information to improve our support. We often receive runners in the medical tents who are not registered as participants. These are not large numbers; in the last three years we have averaged fifteen medical “bandits.” However, if we were to extrapolate those numbers to the full field, we would be looking at almost 400 bandit participants. Nevertheless, let us focus on the effects these runners can have on medical services.

These bandit athletes may have purchased a bib or swapped with someone. If a runner receives a bib through swapping, once he/she enters the aid station, there is a delay in identifying the athlete because there is no match in the database. If the athlete is conscious, we work to get their demographics with emphasis on age and date of birth and any past medical history. If the athlete is unresponsive, however, trying to obtain personal information or next of kin data is impossible. When this unidentified athlete is transported to a hospital for further care, they must then be listed as a Jane or John Doe. We have no way of contacting family members nor obtaining pertinent past medical history. Additionally, for events like the Marine Corps Marathon which uses a live tracker database, we cannot find the registered runner because we are looking for a person not in the event.

We had a case where a runner was picked up off the course and transported directly to one of our hospitals. There were several runners at this emergency room and we were providing updates to our liaison and the medical team about the participants. The information we sent for one athlete was based on the information in the database but, unfortunately, it was incorrect. She was listed as a 42-year-old female. The medical staff thought they were taking care the female shown in our database, and we reached out to her next of kin. But it was not her; instead, it was her 36-year-old friend. It then took additional time to get in contact with the bandit’s family.

What if bib swapping involves a minor? Most registrations require parental consent for a minor. What if we need to obtain consent from that parent for care? Other considerations might include winning an age group or award—protecting the participant’s own race history and records and insurance claims could be complicated if the runner is using someone else’s bib.

We do not want to discourage athletes from receiving care; the medical team, as always, will care for those in need regardless of who they are. But these types of cases certainly make it more difficult for us to do our job. We all need to work to educate our participants about the risks of bib swapping and running as bandits.

A Tale of Two Races in One Day

Like many of the Marine Corps Marathon runners this year, October 27, 2019, will stick in my mind for a long time. In my 16 years as the medical coordinator, it was the first time it rained- buckets- 2.5 inches, rivers of water on the road and then the sun came out and it was hot. We hit 80 degrees near the end of the race.  Runners were in water above their ankles at miles 12-14. The water was running like rivers on the side of the road, so all the runners were crowding into the center of the road to lessen the impact of the water. At least we did not have the predicted thunderstorms. However, we did have the Vice President of the United States show up unannounced to watch his son and then stay for an hour to congratulate thousands of runners. 

The impact of the weather on the runners was significant. Cold, wet, and windy conditions produced lots of hypothermia. We had core body temperatures as low as 91 degrees and many in the mid 90s. The bright side to running in the cold and wet was the number of Personal Records (PRs) being set that day. The seasoned runners wore garbage bags on their bodies and shoes until the start of the race. Some had sandwich bags with extra socks to change during the event. Many discarded layers and layers of clothing as the miles went by. Then at 11:13 AM that big yellow ball of heat rose from the clouds and the puddles started to dry up, more clothes were shed and  body temperatures began to rise……….. 106, 107, 108.

We had several runners with hyponatremia, hypothermia, hyperthermia, heat stroke, and blisters. In fact, the blisters and abrasions were everywhere due to the rain. We also had more falls and fractures than our average race due to wet leaves, water, and hidden surfaces. We transported 36 runners; there were reports of several more going to the emergency departments on their own later that night.

What is the take home message from this day? When planning, you need to be prepared for anything and everything. We needed last-minute orders for more ponchos for the roaming medical staff. Generators can short out in pouring rain, making lights dim. Floors in aid stations get slippery and muddy and the gear gets muddy. Runners are muddy and very wet. Tape does not stick; walking on crutches can be hazardous. Paperwork and bibs get wet, tear, and can get lost.

You need to be prepared and you need to be flexible. The best-laid plans may have to be scrapped once you cross the start line. The key is having leaders who can make good decisions in short order and having prepared plans that can flex and adjust. We were given less than a 10-minute notice that the VP wanted to come by. The security plan and egress plan for medical had to flex. He then wanted to stay, chat, and congratulate runners (all during the height of the finish). We did take the opportunity to highlight our medical teams—opportunity knocked!

As any of us who plan, coordinate, provide logistics, and support all the other pieces of events can tell you, lots of preparing, planning, formulating, and rehearsing can go a long way to be ready for anything on the big day.

"That's a full-time job?"

I routinely get that response when someone asks me what I do for a living. It is usually preceded by my statement, “I’m the medical operations coordinator for the Marine Corps Marathon Organization.” I then further explain we have seven event weekends throughout the year, with 18 events ranging from one-mile fun runs to a triathlon and now an ultra. Our participants range in age from five to eight-six. The raised eyebrow stays, as they wonder what it takes to host and execute an event. These comments emanate from runners and non-runners alike.

For runners, the experience is typically this: they visit the exposition, pick up their bib and t-shirt, shop from a few vendors, maybe sightsee, eat a good dinner, and then hope to sleep well before they toe the line. On race day, hopefully, they cross the finish and receive their bling, get some food fuel, hang out for a beer, and talk about their times. A few will earn an award. Many will have used porta-potties and taken water or food from a station along the course. Some will visit the aid stations; some will lose contact with their running buddy and go to lost and found. But most have no appreciation of the behind-the-scenes Herculean efforts undertaken to be “race day ready” or as we call it here at Quantico MISSION READY!

Each event has its own signature and theme and identity and uniqueness. What we all have in common are the checklists and policies and protocols that need to get done in preparation for race day. The end of the event is just the beginning for race organizations. Media posts go out. All the equipment and supplies need to be packed up. The clean-up—oh the clean-up. Cups and trash and discarded clothing all need to be picked up and disposed of properly. Usually, the day after the event, permits and venues have to be secured for the next year. Phone calls start coming in about lost items, missed timing mat check points, and ill-fitting t-shirts. In the following week, bills need to be paid to law enforcement, Fire/EMS, and vendors. Participant feedback is solicited. Reports are completed to note what improvements are needed for next year.

For several of our organizations, there is already another event to be planned and executed. Marathon planning is year-round. There are so many aspects that need review, completion, and verification. Organizations have different structures, yet we all deal with finances, business, marketing, sponsorship, logistics, vendors, security, legal, medical, timing, and results. Each of these areas has a multitude of smaller areas of focus to complete. So yes, it is a full-time career.

I invite you to share your “ah ha moment” of what you learned about marathon planning that you didn’t know before and I invite to come spend some time with me or other coordinators to see and experience all the moving parts.

Where are the Bandaids?

“…needed more bandaids,  …..the supplies seemed to be short on bandaids, …..we couldn’t find the bandaids.” These were some of the feedback comments we received as we closed out our 2018 Marine Corps Marathon this year. As the medical coordinator, the comments initially made me a bit annoyed, but then I sat back and thought there are some more fundamental issues here in the planning and executing of large venue events.

Our warehouse of medical supplies and equipment holds several thousand dollars’ worth of various consumable supplies. We have bandaids, we have roller bandage gauze, we have 4 x 4 sterile and non-sterile gauze. We also have Tegaderm™, Opsite™, New Skin™, Coban™, sticky back felt, moleskin, Durabond™ and many other wound care dressings. There are so many more dressings and bandages available on the market.

Care in the field is very different than care in the clinic. That includes your supplies. Most of our events rely heavily on our volunteers. They are the key to our success in our medical tents. They come with a lot of enthusiasm and giving hands and many of them come with little understanding of supplies that are most useful in the sporting environment.

Adhesive bandages with gauze pad center (the generic definition of bandaids or Band-Aids™) work in many environments but not once an athlete is sweating. They just don’t stick, they don’t work over a joint or in a shoe. Sometimes you can use benzoin of tincture, betadine or other glues to make it stick better but there are better supplies that work in the athletic environment.

Our role in educating our volunteers and staff includes protocols and algorithms but I think it also means giving them a bit more lay of land in the logistics area. We stock eight types of tape—some for the musculoskeletal practitioners, some for the IV’s and the duct tape—in case everything else fails. Some might say that is way too many. For our events these are the ones we use and our AT’s and PT’s like and have asked for over time. We train our supply petty officers and they pack their gear but on race day they cannot be everyone where in the tent.

So maybe for next year I’ll create a go-by with a catalogue of our supplies and how they can be used.