Medical rules are needed in marathons in the United Kingdom
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.1285 (Published 08 May 1999) Cite this as: BMJ 1999;318:1285All rapid responses
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Dear Editor
It is impossible not to feel great sympathy for the parents of Anna
Loyley who died suddenly after finishing the Bath marathon. The details
are unclear but it seems to be accepted that her sudden cardiac death
might have been avoided through appropriate use of the (available)
automatic external defibrillator1. Nonetheless, the scape-goating of the
doctors (and presumably the St John Ambulance workers) involved in the
case is depressing2. The parents' campaign to have advanced resuscitation
facilities, paramedics and doctors at all out-of-stadium marathons may be
logical in relation to this case, but it may be otherwise Utopian. Given
the 26 miles (plus) of a marathon course and the numbers usually involved,
it is unlikely that runners could ever be comprehensively protected. Most
sudden sporting deaths result from ischaemic heart disease, complex
cardiac conduction disorders or cardiomyopathy which may be resistant to
conventional resuscitation3. Even in apparently ideal circumstances (e.g.
witnessed cardiac arrest in a large emergency department), survival rates
may be less than 50% 4. So it is far from clear that deploying doctors and
equipment at the finishing lines of races would achieve the inevitable
survival that the Loyleys' campaign implies. In reality, if anything
should be done to prevent sudden sporting deaths, it is the prohibition of
participants who have the vaguest history of exercise-related giddiness,
breathlessness or angina. Tragically, such clues are often obvious in
retrospect.
Sophisticated cardiological screening or deployment of advanced
resuscitation teams might or might not diminish the risks of running, but
some risk is inescapable in all human enterprise and there must be a
realistic assessment of the cost-benefit ratio involved. The benefits to
society of sporting and other events are great. Those seeking to eliminate
risk should recognise that they may also eliminate the amateurism and
altruism which are in such short supply in our flabby society.
L C Luke
Consultant in Accident and Emergency Medicine
Royal Liverpool University Hospital
Prescot St
Liverpool L7 8XP
1 Loyley P, Loyley P. Medical rules are needed in marathons in the
United Kingdom. (Letter) BMJ 1999;318:1285-9
2 Dyer C. "Good Samaritans" face grilling. BMJ 1998;317:1100 (24
October)
3 Whittington RM, Banerjee A. Sport-related sudden natural death in
the city of Birmingham. J R Soc Med 1994;87:18-21
4 White SP, Guly HR. Survival from cardiac arrest in an Accident and
Emergency department: use as a performance indicator? Resuscitation
1999;40:97-102
Competing interests: No competing interests
Rules and standards governing long distance race medical coverage.
Dear Editor,
In our quest to learn the facts surrounding our daughter's death, we
discovered two important things among many of which the UK running
community seem totally unaware. These relate to existing regulations and
medical rules applicable to race organisers.
On the regulatory side, we learned that long distance race organisers
must comply with the 1992 Management of Health and Safety at Work
Regulations. Under these regulations, those organisations which plan and
organise competitive long distance running events are required to conduct
an appropriate risk assessment evaluating known or likely health risks and
to implement reasonable precautions which minimise the probability of
death or serious injury. This is true both to meet regulatory
requirements and to comply with general "duty of care" legal standards.
Given the known risk of sudden cardiac arrest, race organisers are
required by regulation to implement medical coverage strategies designed
to minimise the risk of death from this hazard.
We also discovered that race organisers are already required to
comply with existing comprehensive medical rules which apply to all long
distance races in the UK. These rules are contained in the International
Amateur Athletic Federation's comprehensive guide entitled the IAAF
Medical Manual for Athletics and Road Racing Competition (Medical Manual).
The IAAF Medical Manual recognises the known risk of sudden cardiac
arrest and provides a staightforward,common sense framework for road race
organisers who are responsible to plan for and manage sudden cardiac
emergencies which are likely to occur during long distance running events.
The Manual requires appropriate physian medical involvement; delivery of
basic life support services - including proper CPR - within 4 minutes by
sufficient numbers of appropriately trained and authorised personnel;
delivery of advanced life support services - including defibrillation,
administration of cardiac resuscitation drugs, airway intubation and
oxygen - within 8 minutes by sufficient numbers of appropriately trained
and authorised personnel; and promt availability of transport in advanced
life support ambulances.
The experience of the London Marathon confirms that appropriate
medical coverage does save lives. Historically, professional medical
assistance made available at the London Marathon has resulted in a 50
percent survival rate for victims of sudden cardiac arrest. This is
equivalent to in-hospital survival rates.
This information is extracted from our latest campaign letter. The
complete article can be obtained by e-mail from loyley.int@dial.pipex.com
or by fax 01225 444153.
Yours sincerely,
Phillip and Pauline Loyley
Competing interests: No competing interests