Casualties During Marathon Events and Implications for Medical Support

Introduciton: Marathon runs conducted in tropical environments can result in high injury rates. This study was conducted to provide information about the burden of injuries in such environments, to aid planning for similar mass events, enhance medical support and improve participant safety. Methods: This was a retrospective review of casualty data from the Singapore Marathon races from 2013 to 2016. Patient Presentation Rates and Transport to Hospital Rates (THR) were calculated and correlated with heat index, derived from weather information. Injury types were also reviewed. The negative binomial regression was performed to investigate impact of heat index on casualty rates. The medical response plan is briefly described. Results: During the four-year period covered, heat index increased from 29o to 350. There were more casualties from the full marathon than other race categories. The THR was 0.3 to 0.68 per 1000 participants. Two participants had cardiac arrest. Negative binomial regression showed significant impact of heat index on casualty rate. Incidence rate ratio was 1.22 for severe casualties, which indicated that every 1 unit increase in heat index resulted in 22% rise in severe casualty numbers. Compared with 10km racers, half marathon racers experienced 1.58 times greater likelihood of all injuries and full marathon racers, a 3.87 times greater risk. Conclusions: Adverse weather conditions with high heat index can increase injury rates during strenuous physical activities such as the marathon. Applying careful measures to minimize the impact of heat and high humidity may help minimize such injuries.