This Mass Casualty Event is Well Planned

Coordinating the emergency medical response program for the Boston Marathon is a daunting task that begins about six months before the annual race is run. When some 30,000 runners participate in the 115th Boston Marathon on April 18, more than 1,400 medical personnel and about 70 automated external defibrillators and monitor/defibrillators will be ready for emergencies anywhere along the 26.2-mile course.

And there will be emergencies, said Chris Troyanos, a certified athletic trainer who has been the event's medical coordinator for the past 20 years. Last year, when 27,000 official runners and roughly 3,000 unofficial "bandit" runners took part, about 1,100 people were treated in two main medical tents. Ten hospitals will be ready to accept patients when the medical teams bring them in.

"We're in constant contact with all of those hospitals," Troyanos said during an April 8 interview. He said cities' and towns' fire and police personnel, ambulance support, and additional hospitals in the area also assist, swelling the numbers of emergency medical professionals who take part.

Philips Healthcare loaned about 30 MRx monitor/defibrillators and 40 AEDs, 26 of which will be spaced one per mile in medical stations along the route.

"As long as I've been doing this, I've probably seen four or five running booms -- just popularity of running and marathoning. Along with that, we've had to adjust our medical program and our medical coverages based on the numbers of people we're seeing but also types of injuries and illnesses we're starting to see, as well," said Troyanos.

In the old days, the medical team worked from noon until around 6 p.m. The race now starts at 9:30 or 10 a.m., and Troyanos said he'll be on duty until 8 or 9 p.m. "We have to follow up with all of our hospital admissions and all of our runners still in [emergency departments]. Up until 2004, I always looked at it as a sporting event. I no longer look at it as a sporting event," he said. "I look at it now as a planned mass casualty event."

"My primary goal is to have a response time of less than four minutes to a downed runner anywhere on the course," he said. "If we do have a runner with a cardiac arrest issue, we can respond with the proper equipment, with properly trained individuals, in fairly short order. There are more AEDs coming in on ambulance units, from the cities and towns. I think when you look at it, we probably have more AEDs and electrical units than anybody else in the country."

Last year, at mile marker 25, a 62-year-old man from New Orleans went down with cardiac arrest. Troyanos said a physician who was watching the race jumped over the fence and immediately began CPR. Boston EMS arrived with a defibrillator within a minute, shocked the victim's heart twice, and restored a normal heart rhythm. He was in a hospital within an hour, and he went home three days later, Troyanos said. "With full cardiac arrest," he added, "these units are vital for us to have."

Philips is also the official emergency care equipment sponsor of the Indianapolis Motor Speedway, where the 100th Indianapolis 500 will take place May 29.This is not the only milestone athletic event of 2011 where Philips' emergency equipment will be present. Royal Philips Electronics also is the official emergency care equipment sponsor of the Indianapolis Motor Speedway and the IZOD IndyCar Series. That means its MRx units, HeartStart FRx AEDs, Pagewriter electrocardiographs, and other medical equipment will be on hand during the 100th Indianapolis 500 Mile Race on May 29, as well as the Brickyard 400 on July 31 and the Red Bull Indianapolis GP on Aug. 28.


What About Training Runners to Respond?
Troyanos does not expect bystanders to utilize the defibrillators but said he asked himself not long ago, Why aren't we training the runners to be emergency responders if something happens? "There are so many of them out there," he said. "Philips has helped with this; we're talking with the American Heart Association about the concept of sending out a video to all of our runners." Runners probably will be more inclined to render aid following the new AHA guidelines that encourage compression-only CPR, he said.

The second piece of this plan would be asking ambulance companies in each city and town involved with the Boston Marathon to link their community AED and CPR training with the race. More than a million spectators attend this marathon, forming a huge pool of potential responders who could render aid just like the physician who leapt to help last year's SCA victim.

Two runners have died during past runnings of the Boston Marathon. One was a 60-year-old Swedish man in 1996 who crossed the finish line, took two steps, and fell dead of cardiac arrest. That race was the 100th Boston Marathon, when about 42,000 runners took part. The other was a female runner in 2001 who died of hyponatremia (abnormally low level of sodium in the blood because of excessive water intake).

Hyponatremia is a relatively new medical concern for his team, Troyanos said, because today's runners take longer to finish than in years past, and they drink more water because they're out on the course longer.

Troyanos has been working the medical side of this event for 34 years. He heads a medical committee of 45-50 people. "This is a major team medical program. There are so many people involved . . . and they all work so well together," he said.

This entire medical operation serves as a real-time exercise for the hospitals and other participating agencies. They use the event to test their systems, including their patient tracking. Every runner's bib includes a bar code, and the code of any runner brought to a medical station is scanned. During the race, Troyanos can read on a monitor where any runner is in the system and, if he or she has been admitted to a hospital, where in the hospital the runner is being treated.

After each race, Troyanos meets with MEMA, the Massachusetts Emergency Management Agency, and other agencies involved in the marathon to discuss how it went. Troyanos also meets for the same purpose with his medical committee. A final report then goes to the Boston Athletic Association, organizer of the marathon.

He and other marathons' medical directors are members of the American Road Race Medical Society. Troyanos said he hopes the group will launch a website this fall to offer tutorials, medical lectures, and video training that will help colleagues provide effective medical care for any type of road race.

Posted by Jerry Laws on Apr 11, 2011


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