The people admitted on marathon and nonmarathon days were the same with respect to age, race, sex and their chronic conditions. The hospital admission volume was the same, too. None of the people were actually running in the marathon. There weren’t a lot of out-of-town admissions, either.
What was different was the time it took for patients to get to the hospital. Although the miles driven by ambulances were the same on all days, the transport times were 4.5 minutes longer while the roads were closed for the race. Some transports were very long because of road congestion. Further, many patients drove themselves to the hospital, and they might have seen even bigger delays than ambulances.
“Marathons and other large, popular civic events are such an important part of the fabric of life in our big cities,” said Dr. Anupam Jena, associate professor at Harvard Medical School and lead author of the N.E.J.M. study. “But the organizers of these events need to take these risks to heart when they are planning their events, and find better ways to make sure that the race’s neighbors are able to receive the lifesaving care that they need quickly.”
I’ve written in the past about how emergency personnel who administer advanced life support may not be providing any benefit above basic life support. That shouldn’t lead anyone to think that basic life support isn’t miraculous.
When people receive CPR from emergency personnel outside the hospital for cardiac arrest, their 30-day survival rate doubles. Even in the hospital, a patient who experiences a delay in getting defibrillation of about one minute has almost a 20 percent absolute decrease in surviving to the point of a hospital discharge.
But the time it takes to get to the hospital is critical as well. In fact, one of the reasons that researchers say basic life support may be as good as, if not better than, advanced life support is that the shorter and simpler protocols lessen the time spent in the field and reduce the time it takes an ambulance to get someone to the hospital. Better emergency response times are often cited as one of the main reasons that the rate of heart disease deaths has continued to drop in the United States.
Too few Americans are trained in CPR or know where to find an automated external defibrillator. Defibrillators have become so easy to use that almost anyone can do it. Patients who have cardiac arrest but who get rapid CPR and defibrillation can double their chance of survival.
Each minute of delay decreases the chance of survival by up to 10 percent. It’s bad enough that events like marathons can delay the time it takes emergency personnel to get to a victim. Those stuck in cars have almost no access to lifesaving interventions.
We devote a significant amount of time worrying about protecting participants and spectators from disruptive events in our cities. It may be that we need to spend just as much, if not more, time worrying about everyone else.