At least 21 runners died in United States marathons from 2000 through 2009, most from heart problems. Seven more died a day later. Those results from a study published in 2012 sound scary, until you consider that this was out of more than 3.7 million participants.
A recent study suggests that the far bigger cardiovascular danger is not faced by runners, but by older people who live in the cities where marathons are occurring and might be delayed from receiving care. For runners, there are always medical personnel on hand to assist them. For spectators, there are always law enforcement workers guarding against terrorist attacks and other threats. But for others, the findings show that we need to think about how big civic events affect the connection between transportation and health care systems.
In the new study, published in The New England Journal of Medicine, researchers looked at the 11 American cities with the biggest marathons from 2002-2012. They gathered data on Medicare patients admitted to a hospital on the day of a marathon, versus the same day of the week five weeks earlier and five weeks later. Then they looked at 30-day mortality — the percent of people admitted to a hospital who died in that period — for those patients who were admitted with acute myocardial infarction or cardiac arrest.
What they found was concerning. Patients admitted on a marathon day had a 28.2 percent chance of dying within 30 days. The rate for those admitted on nonmarathon days was 24.7. That’s a significant absolute difference, as well as a large relative one.
The people admitted on marathon and nonmarathon days were the same with respect to age, race, sex and their chronic conditions. The hospital admission volume was the same, too. None of the people were actually running in the marathon. There weren’t a lot of out-of-town admissions, either.
What was different was the time it took for patients to get to the hospital. Although the miles driven by ambulances were the same on all days, the transport times were 4.5 minutes longer while the roads were closed for the race. Some transports were very long because of road congestion. Further, many patients drove themselves to the hospital, and they might have seen even bigger delays than ambulances.
“Marathons and other large, popular civic events are such an important part of the fabric of life in our big cities,” said Dr. Anupam Jena, associate professor at Harvard Medical School and lead author of the N.E.J.M. study. “But the organizers of these events need to take these risks to heart when they are planning their events, and find better ways to make sure that the race’s neighbors are able to receive the lifesaving care that they need quickly.”
I’ve written in the past about how emergency personnel who administer advanced life support may not be providing any benefit above basic life support. That shouldn’t lead anyone to think that basic life support isn’t miraculous.
When people receive CPR from emergency personnel outside the hospital for cardiac arrest, their 30-day survival rate doubles. Even in the hospital, a patient who experiences a delay in getting defibrillation of about one minute has almost a 20 percent absolute decrease in surviving to the point of a hospital discharge.
But the time it takes to get to the hospital is critical as well. In fact, one of the reasons that researchers say basic life support may be as good as, if not better than, advanced life support is that the shorter and simpler protocols lessen the time spent in the field and reduce the time it takes an ambulance to get someone to the hospital. Better emergency response times are often cited as one of the main reasons that the rate of heart disease deaths has continued to drop in the United States.
Too few Americans are trained in CPR or know where to find an automated external defibrillator. Defibrillators have become so easy to use that almost anyone can do it. Patients who have cardiac arrest but who get rapid CPR and defibrillation can double their chance of survival.
Each minute of delay decreases the chance of survival by up to 10 percent. It’s bad enough that events like marathons can delay the time it takes emergency personnel to get to a victim. Those stuck in cars have almost no access to lifesaving interventions.
We devote a significant amount of time worrying about protecting participants and spectators from disruptive events in our cities. It may be that we need to spend just as much, if not more, time worrying about everyone else.