May 2019 Issue 420

The Latest in Road Running for Race Directors and Industry Professionals

A Little Bit of Everything

Fluctuation in the Weather Forecast both Before and During the 2019 BAA Boston Marathon Made for Challenges

By Phil Stewart

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 Participants might have felt the message was a year out of date.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.

Different contingency 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 his neck.”

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:

Participation by 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% dropout rate.

Marine Corps 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 death.

  • 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 marathon mark.

Exertional 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.

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