Intended for healthcare professionals


Having advanced resuscitation facilities at end of marathons does not guarantee survival

BMJ 1999; 319 doi: (Published 28 August 1999) Cite this as: BMJ 1999;319:581
  1. L C Luke, consultant in accident and emergency medicine
  1. Royal Liverpool University Hospital, Liverpool L7 8XP

    EDITOR—I feel great sympathy for the parents of Anna Loyley, who died suddenly after finishing the Bath marathon.1 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 defibrillator Nevertheless, the scapegoating of the doctors (and presumably the St John Ambulance workers) involved in the case is depressing.2 The parents' campaign to have advanced resuscitation facilities, paramedics, and doctors at all marathons held outside a stadium may be logical in relation to this case but is otherwise Utopian.

    Given the 26 miles of a marathon course and the numbers usually involved, runners are unlikely ever to be comprehensively protected Most sudden sporting deaths result from ischaemic heart disease, complex cardiac conduction disorders, or cardiomyopathy, which may be resistant to conventional resuscitation.3 Even in apparently ideal circumstances (for example, witnessed cardiac arrest in a large emergency department) survival rates may be less than 50%.4

    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 to ban participants with the vaguest history of giddiness, breathlessness, or angina related to exercise. Tragically, this is 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 the cost-benefit ratio involved must be assessed realistically. The benefits to society of sporting and other events are great. People seeking to eliminate risk should recognise that they may also eliminate the amateurism and altruism that are in such short supply in our society


    • a Competing interests Dr Luke has been involved in accident and health hazard prevention at venues out of hospital in Liverpool and in miscellaneous preventive exercises


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