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Fluctuation in the Weather Forecast
both Before and During the 2019 BAA Boston Marathon Made for Challenges
On April 12, three days
before the 123rd running of the Boston Marathon on Monday, April 15, the
BAA received a dire warning about the anticipated race day weather
conditions. They were told "with real confidence" that race day would
feature 38-41 degrees, heavy rain and wind out of the east from
20-30mph—conditions almost identical to 2018. The BAA sent out an email
blast to participants, which produced groans around the world. "The
early forecasts for the 123rd Boston Marathon on April 15 are showing
the potential for persistent rain, a headwind from the NE, and cold
temperatures." Participants might have felt the message was a year out
of date. As they had done in 2018, organizers abandoned the 25-minute
gap between the third and fourth waves, instead starting the fourth wave
immediately on the heels of the third wave, and braced themselves to
emulate their 2018 planning.
Race day featured warm
and humid conditions (70-degrees) with a threat of lightning,
thunderstorms and winds generally favorable out of the west (see Dave
McGillivray's Tips & Tricks column for dealing with lightning and storms).
These were certainly conditions carrying risks, but they were very
different ones than those forecast just a few days earlier. To
complicate matters further, the conditions varied greatly—from warm and
muggy, setting the stage for heat and humidity related injuries, to
cooler, rainy, windy conditions, setting the stage for
hyperthermia—during the eight-hour window between when the elite women
started at 9:30 a.m. and the bulk of the Wave 4 runners finished by 4:30
p.m. With lightning in the forecast, the potential for variability in
response at different parts of the course was a real possibility. The
localized lightning threat actually raised the possibility that runners
on one section of the course might be told to seek shelter, while others
a few miles further along would be allowed to continue. Based on the
2018 experience, the BAA had assigned more communications personnel,
increased the number of people to answer calls from along the course,
initiated GPS tracking of all buses on the course in order to deploy
them quickly to where they were needed, and developed pre-determined
messages about various contingencies.
plans were developed for before the start of the race and once the race
was in progress. Once the race is underway, communication with the
runners is the biggest challenge. The aid stations, located at
approximately two-mile intervals, are the vital points for on-course
communications with participants. The race course is overseen by four
divisional coordinators, 65 key medical volunteers and 1,800 basic
medical volunteers. Evacuation plans have to be developed for north of
the race course and south of the race course, since vehicles are not
able to cross the race course— which runs from west to east—due to the
flow of runners.
Implementation of any
emergency plan would be made by an "Executive Decision Group" operating
out of the main Unified Command Center at the finish line.
When it was all over,
the number of medical encounters was 2,217, about average. Early in the
race, runners tended to be treated for hypothermia, but as the day
progressed, they were treated for heat stroke and exhaustion. "We put
the runners through more climate changes than a trip around the world,"
said BAA CEO Tom Grilk. "It was probably the most difficult day to plan
for in history, at least in our experience."
"We were planning for
so many different types of races," said race director Dave McGillivray.
"It was a moving target all week long and it kept changing and changing
right up until we fired the gun for the start of the wheelchair race. We
really didn't know what we were dealing with."
The Spectator Experience
Before the weather
became the main story for the second year in a row, the BAA worked on
'upgrading the spectator experience" at the race this year. This
included making a number of visual changes at the finish line. The most
obvious was a good move to locate the stage where the winners receive
their laurel wreaths across the street from the spectator grandstand,
which allowed those in the grandstand to view the ceremony across the
street. Other smaller visual changes included moving the location of the
American flag to above the finish line bridge and moving the five
flagpoles for the flags of the five champions to the side of the
roadway. The organizers continue to evaluate the location of the timing
and scoring tent, which contains the finish line judges and other key
race personnel essential for the conduct of the race, but reduces the
visual experience. One race official also pointed out that "so much
tradition makes change hard." However the overall goal—still a work in
progress—is to enhance the experience down the entire length of Boylston
Street (the final 1/3 mile of the race) though the medal distribution.
The major pre-race
change for 2019 was the placement of a "fan zone" on the plaza near the
finish line featuring bands, games for children, and a bit of Boston
Marathon history for runners and spectators to soak up before race day.
With pleasant weather on Sunday, the day before the race, the plaza was
alive with people.
Race Director Dave
McGillivray summed up the challenges of the Boston Marathon course by
saying, "If I found the person who designed this course, I would wring
Notes from the International Institute of
Race Medicine (IIRM) Meeting
The IIRM hosted its
annual meeting of race medical personnel for a-day long symposium on
April 13 in Boston. Selected session highlights included:
Physically Challenged Athletes: The biggest barriers to
participation of physically challenged athletes are the cost of the
equipment and transportation. The breakdown by category of
physically-challenged athletes is 30% spinal injuries, 24% amputees, 20%
cerebral palsy and 26% other challenges. Poor weather conditions affect
athletes in this division far more substantially than able-bodied
athletes, as shown by the dropout rates at last year's Boston Marathon
held in cold, windy rainy conditions. The dropout rate among able-bodied
athletes in 2018 was about 3%; physically-challenged athletes had a 50%
Marathon Medical Stats: Shelly Weinstein of the Marine Corps
Marathon considers herself "data obsessed" when tracking medical
statistics at the event. She reported the following highlights.
The race has had 8
deaths since 1976, 6 cardiac arrests, 1 hyponatremia and 1 spectator
Weather is always the best indicator of medical activity. Recently
on a hot day, the race treated 1587 individuals and transported 87.
The average time each runner spent in the medical tent was 19
minutes. On a cold day, 359 runners were treated and 24 were
transported. The average time each runner spent in the medical
tent was 13 minutes.
About 40% of the
entrants each year are first-time marathoners, and 98.7% of all entrants
finish. A typical "medical encounter” rate is about 2%.
There is a
disproportionate level of activity at the medical station at the half
Hyponatremia: As slower marathon running often linked with charity
fundraising exploded in the 1980s, cases of hyponatremia or "water
intoxication" started to be reported. The first recorded case of
hyponatremia was in 1981. The person received fluids as treatment, which
is the worst possible intervention. Hyponatremia presents mostly in
runners out on the course for more than four hours who consume too much
fluid, which drives sodium levels down to dangerous levels (defined as
under 135). Runners with hyponatremia actually gain weight during the
event due to the excess fluids. Many events ask runners to record their
normal running weight on their bib numbers in order to help flag cases
of hyponatremia in the medical tent. One 90K event (about 55 miles)
reportedly had 27 cases out of 315 runners. In 2002, the Boston Marathon
had 13% of its runners finish with sodium levels under 135. The
increased prevalence of hyponatremia has transformed the hydration
advice for races lasting over 4 hours from "drink, drink, drink" in the
1980s to "know your own hydration needs and drink to replace the fluids
that you lose" today. Many marathons have actually reduced the number of
aid stations on the course from one every mile to one every two miles.
The medical dilemma is the symptoms for hyponatremia are very similar to
those of dehydration, but the treatment is radically
different—overloading a hyponatremic runner with fluids actually worsens
the condition. Therefore marathons should consider having an Istat, a
medical device that measures sodium levels quickly, to guide treatment.
The cost of an Istat is between $8,000 to $12,000.
The Institute of
International Race Medicine strives to be a central source of medical
information for road races. Membership is open to medical personnel at
all races of all sizes and distances. Details can be found at
Phil Stewart is the President of Road Race Management; Co-author
of "Organizing Running Events"; Director of the Credit Union Cherry
Blossom Ten Mile; Vice-President of PRRO; and a Race Announcer for
several prominent national events.