A Multidisciplinary Approach to Urgent Care for Long Distance Runners – JEMS.com

On May 3, 2014, over 20,000 runners gathered in Pittsburgh to participate in the Dick’s Sporting Goods Pittsburgh Marathon. The course takes runners through the neighborhoods of Pittsburgh, crossing numerous bridges and climbing several hills. EMS deployment along the course is coordinated by the city of Pittsburgh Bureau of EMS, with assistance from 25 additional agencies from throughout Allegheny County, Pa. EMS resources stationed along the course include 30 ambulances, five motorcycles, eight bicycles, nine EMS carts and four mobile EMS posts.

With the majority of our EMS personnel committed to the course route, the medical team found it difficult to adequately staff the surrounding area immediately before and after the finish line. Historically, over half of runners who’ve received medical care at the marathon have been triaged within the finish line area. Our solution to providing coverage for this area was the creation of the multidisciplinary rapid response team (RRT).

Goals

The acronym “RRT” is used to represent the team’s name as well as its mission: Recognize, respond and treat. The team’s priority is early identification of runners who may require medical assistance. For example, in the event of a cardiac arrest the goal is to be able to apply immediate CPR and an automated external defibrillator (AED) within seconds of onset.

The rapid response team helps ensure EMS service throughout the city doesn’t run short by providing care along the marathon route. Photo courtesy Pete Madia/Pittsburgh Marathon

Composition

The 65-member RRT is composed of physicians, certified athletic trainers (ATC) and members of the National Ski Patrol. All are certified in BLS care; members of the ski patrol are also trained in outdoor emergency care, which bridges the gap between medical responders with access to advanced equipment and wilderness search and rescue personnel, and athletic trainers possess expertise in sports-related injuries and emergency care procedures for race day. Six team members–two physicians, two ATCs and two ski patrolmen–have portable AEDs and each is given a portable radio to communicate with other members of the RRT and the communications tent. The radio frequency is also monitored by a division chief with Pittsburgh EMS who can dispatch prehospital care providers if needed. Two additional members of the RRT are designated as spotters and interact with other team members and EMS via radio.

Even if a runner is able to breathe appropriately, personnel will accompany them to the medical tent to undergo further care. Photo courtesy Charles LeClaire/Pittsburgh Marathon

Deployment

The RRT is split into two groups strategically placed up to one half-mile before the finish line to one quarter-mile after. Of the team members with AEDs, two are stationed prior to the finish line, two at the finish line and two at the end of the finish line chute. Personnel are also staggered on opposite sides of the race course at approximately 50-foot intervals. The spotters are placed on a bridge overlooking the finish line area so one can monitor incoming runners while the other monitors those passing through the finish line. Central command, EMS personnel and RRT members are constantly relaying information via radio communication throughout the race.

EMS carts strategically placed along the marathon route can be radioed when a nearby runner experiences a medical emergency. Photo courtesy Ronald Roth/Pittsburgh Marathon

Function

If a potentially ill or injured runner is identified by ground teams or spotters, they’re approached by an RRT member and asked how they feel. If the runner is unable to answer or appears to be too unstable to continue running, they’re provided assistance. Should the runner refuse care, RRT members along the course are alerted to monitor the runner as he or she continues.

Runners requiring immediate care are quickly triaged and moved from the course by two RRT members, who determine the mode of transportation. Depending on location and acuity, there are two methods of transporting runners:

1. Low-acuity runners can choose to walk or be placed in a wheelchair to be transported directly to the finish line medical tent via a dedicated transport lane at the finish line; or
2. Runners with higher acuity are placed onto EMS carts or stretchers and transported by ALS EMS providers to the finish line medical tent for treatment.

A runner who collapses or seizes is presumed to be a victim of sudden cardiac arrest until proven otherwise. The term “runner down” is transmitted over the radio with a precise location, and EMS and the closest RRT pair with an AED respond and begin BLS measures. If the runner is in cardiac arrest, CPR is initiated until the runner can be transported. If they have a pulse and are breathing appropriately, they’re transported directly to the finish line medical tent by EMS.

A Word on Boston

The bombings at the 2013 Boston Marathon presented a new challenge for the RRT. The team must now prepare for a mass casualty event that threatens not only runners, but the RRT and other first responders as well. In response, we’ve devised a plan that reinforces the safety of RRT members and prioritizes the treatment of victims, strengthening our focus on hemorrhage control application with commercial tourniquets.

Conclusion

The finish line of a long distance race is a challenging, fast-paced environment. Runners who require medical assistance in this setting must be recognized, responded to and triaged in a fast, efficient and safe manner. The RRT includes providers from several disciplines who are able to quickly provide care to injured or ill runners participating in the Pittsburgh Marathon. More importantly, the RRT concept allows our medical team to contribute successful instances of efficient race coverage without taxing limited EMS resources to other systems nationwide.