Thursday, August 2, 2018

At What Cost? The Price of Safety

Yesterday [July 31] I attended the Blue Ribbon Study Panel on Biodefense: The Cost of Resilience: Impact of Large Scale Biological Events on Business, Finance and the Economy. Former Representative Jim Greenwood facilitated this meeting with the panel’s co-chair, former Senator Majority Leader Tom Daschle. Panel members included Former Senator Joe Lieberman, Former Governor Tom Ridge, and Former Homeland Security Advisor Ken Wainstein. Testimony to the panel included Congressional Representatives; representatives from the pharmaceutical industry; FedEx; ExxonMobil; World Bank; and Dr. Lou Marcianci, Director of the National Center for Spectator Sports Safety and Security, from the University of Southern Mississippi.

It was truly an interesting day. In their discussions, the various presenters offered comments ranging from the need for federal oversight, financial support, integration of the public private partnerships in various areas and at various levels of the government involving biodefense, and more tactical discussions including the best way to remove a drone from a mass gathering. You are probably asking how this affects us as members of the International Institute of Race Medicine (IIRM).

Each of our events coordinates and communicates with law enforcement and emergency services. We participate in the development of the Incident Action Plan (IAP) and we develop our own Emergency Action Plans (EAPs) for severe weather, road closures, and a sentinel event. Most of this is behind the scenes; runners and spectators are not aware of all the planning and work that must occur to make our events safe. That safety, however, is costing more and more. Major events spend millions in law enforcement and emergency services. Before 911, local law enforcement supported the Marine Corps Marathon with a big smile and the promise of a shirt. In 2017, we were required to add blocking vehicles in several locations on our course.

For those of us who answer to boards, sponsors, governments, etc., what is the financial tipping point for us? Is there a registration fee ceiling that our participants will not exceed? As the number of events grow but registration numbers remain flat or decrease, how do we keep our events safe, exciting, and memorable for our participants and spectators without breaking the bank? I always comment that no one focuses on medical at our events except us, and I still agree with that statement. The expectation is we are trained, ready, and prepared to handle what comes our way. Runners do not plan to visit aid stations, enter emergency rooms or stay overnight at a hospital (or worse, not come home). As we continue to develop more robust safety plans and add specialty law enforcement and emergency services, how do we educate our customers? How do we mitigate risk? And how to we afford to stay in business?


Tuesday, May 8, 2018

Athletes with Disabilities: Safety Considerations

More and more physically challenged athletes are participating in traditional running events. Requests for entries for wheelchairs, handcycles, and “pushers” continue to increase. Renowned wheelchair athlete Craig Blanchette a former Olympian and pioneer in wheelchair racing, sued race owner Competitor Group, Inc. for gross negligence due to an injury at the 2014 Rock ‘n’ Roll marathon because race organizers altered the course without notifying him. A San Diego jury awarded him $4 million this week. Blanchette said that race organizers changed a portion of the course the morning of the race, on 11th Avenue near B Street, and did not inform him.

Some events do not allow wheelchair or handbikes in their events due to safety and security concerns. This note is from the Footlevers Blue Ridge Marathon website:

The Foot Levelers Blue Ridge Marathon course is designed as a road running course. Multiple athletes with disabilities have inquired over the years about completing “America’s Toughest Road Marathon” using handcycles and wheelchairs. In 2014, organizers permitted a trial run of the half marathon course with two athletes with disabilities using handcycles. One athlete was a pro handcyclist, and the other was a recreational handcyclist. After observations of the athletes on the course and feedback from the athletes, it was decided that having an open field of handcyclists would not be safe for the race, given the course layout, extreme terrain, and that steep portions of the course are not fully closed to vehicular traffic. Organizers have also consulted with professional wheelchair racers, and these athletes indicated that the grades on the course are too dangerous for safe competition of racing wheelchairs.

USATF provides guidance and has provisions in place for Athletes with Disabilities to compete in wheelchairs; however, USATF does not accommodate handcycles in competition. USATF has a very specific policy designed to assist race directors so they can deal with the complex questions surrounding disabled athlete participation. Members of the Road Runners Club of America (RRCA) should refer to the USATF policy on Americans with Disablities Act (ADA).

In 1979, the RRCA published “Guidelines for Wheelchair Athletes.” The purpose of these guidelines is to provide information for event directors and athletes. Hopefully, these guidelines will facilitate the inclusion of athletes with disabilities in road racing events and foster discussions among event directors, members of the disabled community, law enforcement and public safety personnel and others involved with a particular event. The guidelines are not intended to cover all events or situations.

While the safety of all participants in a running event remains the paramount concern of any event director, these guidelines will help event directors focus on real safety concerns related to a specific disability and not concerns based on false perceptions, stereotypes or generalizations about athletes with disabilities.

Pushing disabled athletes in a sport chair has become more and more popular. From time to time, RRCA members have struggled with having a “no stroller” policy and complying with ADA accommodations for events. If the persons seeking to enter the event meet any age restrictions placed on participation, then the event needs to make reasonable accommodations to allow a disabled athlete to be pushed in a wheelchair in the event by an able-bodied participant. This is in accordance with providing access to the event. Race organizers need to make decisions regarding registration of one or both athletes.

Should age restrictions apply as they do with able-bodied athletes? How do race organizers inform participants of terrain concerns or undesirable or non-negotiable terrain for a wheelchair? Concerns also include hairpin turns, elevations greater than 10% and steep hills that may increase speeds greater than 20 mph.

Recently the Marine Corps Marathon was informed by law enforcement agencies that wheelchair and handcyclists MUST have a reflective flag that is 4-6 feet in height to allow for visibility of the athletes in crowds. The MCM will be sending these athletes the information and requirements. What happens if the athlete shows at the starting line without the flag? Should they be pulled? Is it the responsibility of race organizers to place a flag on their equipment prior to the start?

What about requests for service animals to participate in events? Should organizers add veterinary professionals to the support staff?

These topics seem to be the third rail in many circles but it behooves all events to have the discussions to share their policies and better inform and work with athletes with disabilities to encourage fitness and participation where possible.

What are your thoughts? How do you interact with these athletes?

Wednesday, January 10, 2018

At What Age???


5k:  Ava Johnson, Megan Crum, Aaron Westrip, Daniel Skandera
10k:  Ava Johnson, Carrie Garritson, Aaron Westrip, Grattan O’Neill, Caleb Hymans
Half Marathon:  Tabitha Francks, Nasiya Jobe, Matthew Feibusch, Charlie Westrip, Grattan O’Neill
Marathon:  Mary Etta Boitano, Tabitha Francks, Julie Mullin, Kevin Strain, Wesley Paul, Charlie Westrip

According to the Association of Road Racing Statistics, each of these runners holds a world record time in the event listed. The surprising part of their record? Their age at the time; ranging from 3 (Aaron 5k) to no more than 12 years and several of these runners hold multiple age range records. When I reviewed published reports and comments and quotes from these runners and their parents, they all used the words “fun, family sport, exercising.” There was no mention of “punishment or because my parents made me.” Many families see it as bonding time and a chance to travel. In fact, youth half marathon times dropped quite a bit in 2016.

Nike has a website called Marathon Kids; the American Academy of Pediatrics (AAP) has issued statements in the past about distance running for children. Some physicians and coaches recommend no marathons until past the age of puberty. The AAP reports that sprint distance triathlons are a good thing because they incorporate “lifetime sports, short sensible distances, non-specialized training before puberty and have health and weight benefits.” There is a lot of confusion, concern and conflicting information.

However, for those of us who set policies for our events, council our race directors to say no to a parent of a 6 year old who wants to run our marathon what is the best answer? We know that our kids of today are not physically active – many are couch potatoes. We know schools have cut back on many non-academic programs including physical education and recess due to budget costs. We know 12% of our youth are seriously overweight and have health issues because of it. We also see more event weekends with kids activities added in to attract families and not just mom or dad runners.


So what is the answer? Is there one? How does your event answer this question?

Wednesday, December 6, 2017

Testing and Treatment

The 2017 Marine Corps Marathon was the second warmest on record and the second busiest in the medical tents.  Temperatures started at 53.2 degrees F and reached a max of 77.3 degrees F. WBGT readings done every hour at three locations on the course. With a low of 53.2 at 0800 and a high of 73.9 at 1400 on the course. Of our 42 transports 22 were heat related and one runner; a 61 yo female runner presented confused, with several bouts of nausea and vomiting and a serum sodium of 131 mmol/L.

Various references define hyponatremia as a serum sodium <135 mmol/L and critical hypernatremia as <120 mmol/L. Other risk factors include fluid intake, gender, exercise duration > 4 hours, pre-exercise over hydration, easy access to fluids on the course and temperature. Symptoms range from confusion, nausea, vomiting, confusion, seizures and unresponsiveness. Some runners have low serum sodium levels and no visible symptoms.

The discussion point I bring up is testing and treatment. Should all runners presenting with symptoms of hyponatremia have sodium levels tested prior to the introduction of an IV?  In cases where athletes are picked up on the race course and transported immediately by EMS service, should an IV be withheld until testing is complete? There are events that have few if any aid stations and protocols that do not cover all these possibilities. Would you start an IV on a runner in your aid station without a serum sodium level?