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Medical Supervision of Mass Sporting Events

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Textbook of Sports and Exercise Cardiology

Abstract

Physical inactivity is one of the major modifiable risk factors for non-communicable diseases (NCDs) and universal prescription guidelines for physical activity for all individuals include engaging in >150 min of moderate- to high intensity physical exercise weekly. Participation in mass community-based sporting events including park runs, road races (distances vary from 5 km to ultra-marathons), cycling events, swimming events, and events combining endurance sports e.g. triathlon is increasing, and the profile of participants at these events is also changing, with increasing numbers of older individuals and female participants. There is a known risk of medical complications during moderate- to high intensity exercise, and this risk varies according to the “risk profile” of the individual. These medical complications during exercise can vary from minor to severe life-threatening and also result in death from cardiac arrest and other causes. Medical staff, that are responsible for participant safety at mass community-based sporting events, need to be aware of the risk of medical encounters at events, causes and risk factors associated with medical encounters, and can design and implement strategies to reduce the risk of medical encounters at these events. In this Chapter we review the risk, definition and classification of medical encounters at mass community-based sports events, highlight the exercise benefit-risk paradox, and outline a step-wise plan to reduce the risk of medical encounters at mass community-based sports events. We explore the potential role of pre-event medical screening for mass sporting events and formulate a plan to implement medical care on race day for mass community-based sporting events. Finally, we present guidelines to minimize the potential negative effects of environmental stress, including air quality at mass community-based sporting events.

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Author information

Authors and Affiliations

  1. Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa

    Martin Schwellnus

  2. Department of Health and Science, International Association of Athletics Federations – IAAF, Monte Carlo, Monaco

    Paolo Emilio Adami

Authors
  1. Martin Schwellnus
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  2. Paolo Emilio Adami
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Corresponding author

Correspondence to Martin Schwellnus .

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    You are appointed as the chief race medical director for a large half-marathon (21.1 km) running event, where the expected number of race starters are about 45,000. The race will be held in a European city in May, and the city is at sea level. Based on current scientific data, which of the following statements are true for the type and severity of medical encounters that you may expect at this race?

    1. (a)

      I can expect that there will be 1–2 runners with sudden cardiac arrest during the race

    2. (b)

      About 5–10 runners will develop serious life-threatening medical encounters

    3. (c)

      I need to plan that there about 2000 runners will require medical attention

    4. (d)

      If the race is held at 2 pm in the afternoon rather than early in morning, it is likely that there will be fewer medical encounters

  2. 2.

    In your preparations for the race above (in question 1), where you are the chief medical director responsible for the medical care, which of the following are important considerations at the finish line area?

    1. (a)

      I need to deploy more medical resources and more staff at the finish line than along the course

    2. (b)

      At the finish line area, there should be a dedicated Triage Officer and team to direct the flow of casualties to the proper area for care

    3. (c)

      Equipment and supplies for obtaining vital signs, performing BLSD and ACLS should be available at the finish line.

    4. (d)

      There should be a high-care medical facility at the finish line

  3. 3.

    A 56-year-old female runner enters for a marathon for the first time. In preparation for the race she trained for about 10 weeks, with a weekly training distance that averages at 25 km per week. She is a type 2 diabetic, takes anti-depressant medication and has a chronic left rotator cuff impingement in the shoulder for which she uses occasional NSAIDs. What risk factors does this runner have of developing a medical complication during the race? What advice would you give her?

1.2 Answers

  1. 1.

    Question

    1. (a)

      Yes: The incidence of sudden death is about 1 in 100,000 entrants, but sudden cardiac arrest is 2–3 higher i.e. 1 in 30,000 to 1 in 50,000

    2. (b)

      No. The incidence of serious life-threatening medical encounters varies but is about 1 in 2000 race starters. Therefore, for a race with about 50,000 starters, you can expect about 25 serious life-threatening medical encounters

    3. (c)

      Yes. The incidence of moderate medical encounters (requiring medical attention) is about 1 in 50. You can expect about 1000 runners that will require medical attention

    4. (d)

      No. If the race is held at 2 pm in the afternoon, it is likely that the environmental conditions will be less favourable in May (spring to early summer in Europe). It is likely that the WBGT will be higher, and if it is above 18°, the risk of medical encounters increases (moderate risk). Higher WBGT will increase the risk even more.

  2. 2.

    Question

    1. (a)

      Yes. The number of medical encounters in the final quarter of the race is significantly higher in respect to other segments. Therefore, in the last 2 km of the course, medical staff and supplies should be increased.

    2. (b)

      Yes. A Triage Officer at the finish line area is very important to direct runners with medical complications to the appropriate treatment area—this should be a senior medical doctor with previous race medical care experience.

    3. (c)

      Yes. Equipment and supplies for obtaining vital signs, performing BLSD and ACLS should be available at the finish line.

    4. (d)

      Yes. There should be a high-care medical facility at the finish line.

  3. 3.

    Question

    This runner has a number of factors that increase her risk of an acute medical complication during the marathon. She is over 55 years, and is a diabetic and therefore, according to international guidelines, has ≥2 risk factors. The advice would be that she requires a full medical assessment before participating in moderate- to high intensity exercise. It is also important to determine if she has concomitant cardiovascular disease and other complications associated with diabetes. She also uses medications that may increase her risk of a medical complications during exercise, including anti-depressants and NSAIDs. Finally, her training and preparation for a marathon is not optimal because she only started 10 weeks before the marathon, and her weekly training of 25 km is less that what is advised to prepare for a marathon.

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Schwellnus, M., Adami, P.E. (2020). Medical Supervision of Mass Sporting Events. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_29

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