Defibrillators and Medical Volunteers

[John Quigley]

Greeting from the Republic of Ireland!
I'm looking for advice on having medical volunteers/personnel and defibrillators (AEDs) available at small races (low numbers). At what level are these strongly recommended?

I've been directing for 8 years and never had an issue (generally 200-300 runners). In the past two weeks, two races in the region have had coronary incidents, one fatal (10K) - incident happened around the Mile mark. The proximity of a defibrillator (not provided for/on behalf of the race) was crucial in saving the life of the second individual (5k - athlete had finished race without difficulty/distress several minutes before).

Naturally these have galvanized many of us into action and we intend getting AEDs for our events - finding people willing to be trained will be harder!

Many local races have only a handful of runners, for example, one (5k) which intentionally doesn't advertise/promote attracted forty three (43) athletes. No medical provision was made. Obviously its nice to have trained personnel but, for a small event in a rural area, hospital 25 miles away, where do we, as directors say that paramedics are essential. 100 participants? 200?

Clearly, for longer distances and/or high numbers, paramedical assistance is essentially mandatory. What do you guys think, based on the numbers I'm talking about in races between 5k and 5 Miles? This is Ireland, so weather is rarely greater than 15C (65F) during a race.

[pstewart]

I would hate to see race directors saddled with the expectation that a 200-300 person race should have an AED. One major event medical director once told me that races of that size shouldn't be expected to have more than some basic first aid supplies on hand. The downside is that if you have a cardiac incident and don't have one, you can expect that some lawyer is suddenly going to set that standard. It's called the cycle of rising medical expectations.

So, if you can amortize the cost over a number of events, it might be worth looking into. I believe some of the devices have become so simple that minimal training is needed.

[John Quigley]

I would hate to see race directors saddled with the expectation that a 200-300 person race should have an AED.

Thanks for the response. I agree fully but wanted to get a feel for what you guys in the States are doing. However we in Cork, Ireland are probably going to ramp up our provision and grade races according to the level of medical assistance available/provided. I think a lot hinges on the location of events and the proximity of emergency medical services. Given that you have under 4 minutes from the incident to initiate CPR and shock with the AED, if you haven't got it on site, you've probably lost the patient.


One major event medical director once told me that races of that size shouldn't be expected to have more than some basic first aid supplies on hand.

Agreed but when, in a 130 competitor 5k, you see a colleague collapse just 10 feet away, in the finish area, 2 -3 minutes after finishing, it does get you thinking of what can/should be done. CPR was initiated within 30 seconds and a defibrilator was sourced within 3 minutes, with medical oxygen a further 3 mins later. Thankfully the athlete is making a good recovery. Another athlete died 8 days earlier, 1 mile into a 10k. He was a national class master and a former senior international. Lightening strikes twice!!



The downside is that if you have a cardiac incident and don't have one, you can expect that some lawyer is suddenly going to set that standard. It's called the cycle of rising medical expectations.
This is the key point. I agree that small races shouldn't be obliged to provide other than basic first aid, however large events that make only the same provision are, in my opinion negligent. Question is, though, where is the transition from optional to obligatory.


So, if you can amortize the cost over a number of events, it might be worth looking into. I believe some of the devices have become so simple that minimal training is needed.

Well the approach I've taken on this is I'm looking initially for sponsors, followed by donations and, if all else fails, subscriptions from runners. In the last 24 hours, I've had two tentative offers of AEDs, one from a factory that is closing down and the other from a pharmaceutical company. Neither offer is firmed up, but its a start.

All our races, except our local marathon, are organised on a 100% voluntary basis. Within a 30 mile radius of Cork, approx. 40 races are held annually. Most are in the 200-300 range. A few are in the 1000-3000 range. One of these, the Ballycotton 10 www.ballycottonrunning.com is held in a tiny little fishing village, one road in, same one out. 25 to 30 miles to the nearest hospital. 3000 runners - entry limit reached within a week of opening.

The two incidents mentioned earlier have galvanized us into action on the provision of our own AEDs and I spoke on the matter at a race presentation last night. In a hall of approx 200 people I asked how many had CPR training. About 15-20 raised their hands. I then asked everyone else to look around at these and see how few people they were relying on. The look of shock, at the small numbers of CPR trained, on the faces of very many of the others was very, very noticable. A strong point had been made

To conclude for now, we are going to set up a care community within the running fraternity (regional umbrella body, clubs, race organisers and individuals). This will include CPR training, AED training , provision of several AEDs and the development of several protocols and scenarios. It will be interesting to see how it pans out. I'll keep you posted on developments

[Tom Filippone]

The running club I belong to in Maryland, Montgomery County Road Runners, bought an AED to use in all of its races that it puts on each year (around 30 races). Our club offers classes in CPR and the use of the AED and has trained a dedicated group of volunteers. The club subsidizes the cost of the CPR training--I am not sure how the AED training was conducted. The races are divided among the volunteers who can work those races. Most of our club races have 100-250 runners. The AED hasn't been needed yet, but it was a decision to be on the safe side.

[JimG]

Here are some personal stories that might provide some perspective:

A few years ago we had a runner die at one of our races. While it was later determined that an AED probably wouldn't have saved him, we launched a campaign to buy one. By putting out a jar at several subsequent events, we were able to collect almost all of the money necessary to buy one (some local clubs chipped in the rest). The device is on my "to bring" checklist along with clock, timer, water, etc. And I bring it to other races I'm not directly involved with as well. My hope is that it will continue to gather dust and never be used, but if it's needed, it's on hand. Given the "greying" of the running population the incidence of medical problems probably will increase rather than lessen.

Last month another runner had a heart attack 2 miles into a 5K. The chief of police was running next to him and started CPR; an ER doctor was heading out for his cooldown and joined in. Fortunately there were EMTs on station who arrived and administered AED treatment. The end of the story is the guy survived, and actually came back a week later to walk the last mile of the race, in the company of the police chief and the MD.

An AED isn't a cheap piece of equipment (but it's in line w/ an electronic timer or digital clock) and if it's used once and saves someone, like it did in the aforementioned race, it's priceless.

[JamesM]

I agree. The time has come for us to be more sensible about first aid.

Here in the USA the fear of litigation installs a paralysis in the population that has to be seen to be believed. Very few take first aid training and the general tendency is to step back and let the pros do it, even at the cost of lives lost.

Here we are beating out chests about how wonderful our events are, how we are encouraging the couch potatoes to get of their buts and enjoy running, but we are not preparing for the obvious consequences.

Or club normally, (not always) pays a lot of money to have an ambulance (actually a fire truck/emt/homeland security/donut eating truck) at our events. This could be seen as a good thing, or just another way to abdicate our responsibly for the health and safety of our runners.

The delay in getting the aid to the right place can be compounded by the fact that most volunteers have had NO training what so ever in first aid. Most could not recognize the difference between a heart attack, and the normal collapse and throw up of a runner in the finish chute.

I think clubs should work on first aid training and AED training. Now that AED's are getting low cost it should be part of the standard procedure. If not purchased then rented for the occasion.

'AED rental sponsored by Mutual Life, we care for you.' (And would prefer not to pay out a death benefit.)

I don't see why insurance policies that are issued through RRAC don't start to require some common sense first aid training and equipment.

A couple of years ago, a local race had a man drop dead 100 yards in front of the finish line. Some of the pack just jumped over him.

Most marathons have a medical director and a medical tent with medical staff at the finish line. We have all been there, catching them as they cross the line and putting them in wheel chairs to be rushed off for medical. But it's not just the finish chute that needs medical help. I was running the Disney Marathon a few years ago a man died at mile one.

It seems that most of the very large races will have some one die of a heart attack at some point, maybe not this year but at some point. A quick google for "heart attack" and marathon, running race or 5K will bring lots of listings.

After urging people to race their hearts out, we don't do much in directly coordinating and providing timely medical help for them if they do have an attack. On the one had we are hoping that some one will call an ambulance and on the other we are telling people that it is against the rules to run with ipods and phones. (The two are becoming one, so lets not split hairs.)

This issue has been the elephant in the room for some time now. Maybe every water stop captain needs first aid training, and every stop should be linked by radio to a medical coordinator. Even for a little 250 man 5K.

The current system at most races, to wait till it happens and wing it, is not conducive to providing life support in the first couple of critical minutes.

Clubs need to get first aid training to as many of their members as possible, and to have the correct tools on hand. It just makes sense.

[John Quigley]

Thanks for the responses,
We're still in the process of sourcing defibrillators. Hopefully we will get one each from a factory thats closing down and also a pharma company. We've also been in discussions with a Healthcare Insurance Co about sponsoring several. Either way, they're in the pipeline.

I'd be interested in hearing how Tom and JimG deploy their defibs. Do you keep them at the finish line? What sort of communication protocol have you set up? etc. We don't want to reinvent the wheel here and also realise that no two race courses/settings are the same.

Our first stab at this is to have our defib at the finish and have an ambulance with defib follow towards the back of the pack. All stewards/officials to be issued with a contact sheet for defib/ambulance and a course map showing steward names & locations (they get this for my own Club's events at present). I think we'll have to sit down and think about how we get word back to the defib locations VERY quickly and also get the units to the scene asap.

We gave a talk on defibs after a recent race and and the race winner, an M.D., said that "after four minutes, you're chances of recovery are only 10%. With a defibrillator that rises to 80%!"

We were due to give another post-race talk on the matter last week but the race director said "No! That's for small races! We have two ambulances and an onsite medical facility!" Guess what! There were two RTAs in the area during the race and BOTH ambulances were diverted to these by the police. 5 Mile race, 300 runners. No medical incidents, other than cramp to the prerace favourite.

As JamesM said
The delay in getting the aid to the right place can be compounded by the fact that most volunteers have had NO training what so ever in first aid. Most could not recognize the difference between a heart attack, and the normal collapse and throw up of a runner in the finish chute. At our recent coronary incident, a spectator & I, both CPR trained, were the first on the scene and had assessed the individual when two leading athletes, both spectating, rushed up and said "Leave him, we're trained!" So so started to rise (to let them take over) They then said "Just leave him", meaning do nothing! Luckily before we could react again another person had already literally jumped in and started CPR. One of the "Leave him!" athletes had to be restrained form interfering with the CPR. We lost about 20-30 vital seconds with this misguided?? intervention. BTW the individual left hospital after a week or so.