People who suffer heart attacks or cardiac arrests in the vicinity of an ongoing major marathon are more likely to die within a month as a result of delays in transport to nearby hospitals, according to HMS researchers. The delays, they say, likely stem from widespread street closures that can hamper transportation in an emergency.
In the April 13 issue of the New England Journal of Medicine, the authors call for citywide strategies that ensure unimpeded access for medical crews within a certain radius of races, parades, and other large public gatherings.
“We have traditionally focused medical preparedness and emergency care availability to address the needs of race runners,” says the study’s senior author, Anupam Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy at HMS, “but our study suggests that effects of a marathon may spread well beyond the course of the event.”
The investigators examined 10 years’ worth of patient records analyzing death rates among those 65 years of age and older, within 30 days of having a heart attack or a cardiac arrest near a major marathon across eleven U.S. cities. They compared death rates among patients hospitalized on race day with those of patients hospitalized five weeks pre- and post-race.
Additionally, the researchers divided patients by zip code, comparing death rates among those living near the marathon with rates of those living in zip codes well outside of the event’s radius and thus unaffected by street closures.
Patients admitted to a hospital on race day were nearly 15 percent more likely to die within a month of suffering a heart attack or cardiac arrest compared with those admitted on a nonmarathon day or to a hospital outside of a marathon’s zip code area.
That spike translated into a nearly 4 percent increase in deaths among cardiac patients in marathon-day hospitals within the 30-day period. Thus, for every 100 patients with heart attack or cardiac arrest, three to four more people died within a month in the group admitted to a hospital on race day if they happened to go to a hospital near a race’s course.
The research also showed that ambulance transport was delayed by a little more than 4 minutes on marathon days, a 32 percent longer travel time compared with transports not delayed by marathons. Additionally, nearly a quarter of patients in the study got to the hospital without an ambulance. Although there are no records of the amount of time private transportation took, the authors suspect that many such trips would also have been delayed on marathon days.
The findings do not establish cause and effect between street closures and greater mortality, yet the researchers note that many studies have shown that even very small delays in getting care for cardiac arrest or heart attack can mean the difference between life and death.
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