November 7, 2010
Doctor Prepared for the Worst at Marathon
By SHERI FINK

On Sunday morning at 7:30, Dr. Stuart Weiss, the medical director of the New York City Marathon, was holding a coffee with one hand, gesturing with the other, and moving at the stereotypically brisk pace of an emergency room doctor. Walking in and out of the white medical command tent in Central Park, he was focused, he said, on “What’s missing? What’s missing? What’s missing?”

It was an hour before the first wave of runners set off from Staten Island. Two dozen volunteers had arrived — phones were ringing, radios crackling — and a young woman jogged between tables set up for city agencies, New York Road Runners command staff and ham radio operators. “We’re the only ones around when the cellphones go down,” Steve Mendelsohn, the chief operator, said.

All the pieces were in place: the positions of more than a thousand medical volunteers, represented by multicolored squares of sticky paper (purple for nurses, green for massage therapists, fuchsia for attending physicians, including some of the most prominent emergency medicine specialists in the city) had been posted on large sheets, shifted around like chess pieces in recent days.

Hundreds of plastic-wrapped carts full of gauze, elastic bandages, saline and other supplies had been hauled into Central Park and to the sites of some 36 aid and medical stations set up throughout the week. The sky was a perfect blue and the temperature 35.1 degrees, said Mike Favetta, the first marathon meteorologist, hired by Weiss to monitor conditions that could affect runner safety.

On a flat dirt field next to the medical command was the centerpiece of the operation, a white-tented field hospital designated P1, nearly half the length of a football field, filled with 162 green cots and dozens of white plastic chairs for the runners expected to collapse or fall ill near the finish line.

In only his second year as the medical director, Weiss has introduced a new philosophy of treatment at the marathon. Medical volunteers are offering free emergency room-like care at a network of tented field hospitals, potentially saving runners a trip to a real hospital. At the same time, the volunteers are gaining real-life experience that could prove valuable in a disaster.

At 9:10 a.m. Weiss stood in P1 before a sea of red-shirted doctors, nurses, massage therapists, physical therapists and emergency medical technicians. The television monitor to his left showed the start of the professional women’s race. The tent filled with applause. “There they go,” Weiss said. “They’re running right for your tent here. When we’re in the emergency room, you don’t usually see them running to you.”

Medical professionals have long been aware of the hazards of marathon running. Legend has it that Pheidippides, the original marathoner, collapsed and died after running from Marathon to Athens. Three years after the marathon was revived in Boston following the 1896 Olympics, “ambulance corps” members on bicycles followed each of the 17 competitors.

Last year, Weiss took over the medical director’s job three weeks before race day. His arrival followed two years marred by race deaths. In 2007, Ryan Shay died during the United States Olympic marathon trials in Central Park, and the next year three New York City Marathon runners died, the first deaths related to the event in over a decade.

The day after being hired last year, Weiss flew to Chicago to see how the second-largest marathon in the nation handled its medical services. Weiss returned with a plan to take the medical tents beyond first-aid posts for the typical aches, strains, sprains and blisters, and it was fully in place for the first time this year.

At an orientation last week at a Manhattan hotel, Weiss paced before a screen and told volunteers that they would have the tools to treat runners with the most common and potentially life-threatening marathon-associated ailments: “too hot,” “too cold,” “too dry,” “too wet” and “wobble and fall down” (heat stroke, hypothermia, dehydration, low blood sodium and collapse).

The medical professionals this year had ice-water dunk tanks to treat runners who developed high fevers. Handheld i-Stat machines enabled them to analyze the chemistry of the runners’ blood, then dispense the right amounts of intravenous fluids, salts and sugar.

This represented a new philosophy for patient care at the marathon. Dr. Lewis Maharam, the marathon’s previous medical director, oversaw a drastic growth in medical volunteers who offered bandages, massages and pep talks to runners whose bodies and psyches were bruised.

But Maharam says field medicine at a big city marathon should stick to the basics. “Anything requiring more than first aid is transported to a hospital,” he said in a recent interview. “We don’t try to do medical care as if we’re out in the jungle. With an ambulance, within five minutes you can be at an emergency room where you can have more comprehensive care.”

Maharam resigned several weeks before the 2009 marathon. He said that balancing the work with his patient practice and acting as medical director for a growing Rock ’n’ Roll marathon series outside New York City had become “too much of a burden.”

Mary Wittenberg, the president and chief executive of New York Road Runners, said the timing of Maharam’s departure the year after three marathon deaths was “definitely coincidence.” But the organization’s leaders were interested in taking medical services to a different level. “We were really fortunate to find a medical professional that has as strong of an operational and crisis management background” as Weiss does, she said.

At 12:45 p.m. inside tent P1, volunteers applauded as each sore, injured runner arrived. Virginia Tufaro, an assistant director of nursing at Jacobi Medical Center in the Bronx, stood by the entrance wearing a white smock labeled “Medical Captain.” “This is their final cheer,” she said.

Within 10 minutes, the cheering had stopped. The cots were filling. Everyone was working.

“Does anyone know who won?” a runner sitting on a cot asked. A podiatrist standing next to him said he was not sure.

Runners began arriving every minute, every half a minute, then one after another after another. Some winced, others looked bewildered, a few smiled. Some shivered. Others were shiny with sweat. They pushed the wheels of their racing chairs. They took slow steps on trembling, stick-thin legs.

They had run 26.2 miles, but once inside the medical tent, some could barely walk two more steps. They sat on the nearest open cot.

As the runners entered, triage officers zapped their bibs with a barcode reader that fed a system aimed at tracking patients and helping families locate them. The system is similar to one the New York Fire Department might one day adopt for use in mass casualty incidents, said Division Chief Fredrick Villani. The marathon, he said, “probably has the most amount of resources dedicated to managing the medical consequences of any one event” in New York City.

That offers city agencies, medical professionals and others a chance to practice for something even bigger. The marathon is akin to a “planned disaster,” said Chris Mercado, the director of health services for the American Red Cross in Greater New York. The organization contributed around 150 CPR-trained volunteers and licensed medical professionals to the marathon effort. “It keeps us sharp,” Mercado said.

For hours, the influx to tent P1 continued.

“This one to major!” a triage officer called out. “She’s having an asthma attack.” The runner managed to smile and say she was all right as a volunteer guided her to a curtained-off intensive care area toward the back of the tent. Within minutes she received a breathing treatment, something not available in earlier years. It might have saved her a trip to the hospital.

A middle-aged man lying under a gray blanket wore an oxygen mask, and the volunteers connected him to a HeartStart MRx, a portable heart monitor that doubles as a defibrillator, on loan from Philips for the marathon. “Your EKG looks pretty good,” a doctor told the runner.

But there were limits to what care the volunteers could provide. “We got one coming out!” a man in a Fire Department uniform bellowed. A runner with a suspected ankle fracture was being taken to a hospital. The tents did not have X-ray equipment or supplies for casts.

The stream of runners in distress raised a question: Could a marathon possibly be good for runners’ health? Studies going back more than a century have demonstrated numerous changes in runners’ physiology after a marathon. But whether most suffer any long-term negative consequences is unknown.

New York Road Runners takes the position that the health benefits of preparing for a marathon outweigh the medical risks of running one. The organization claims tax-exempt status in part based on the marathon’s being a “health care program.” “There is so much good and higher-level physical fitness that’s a result of aiming for the marathon,” Wittenberg said.

In the past, the race organizers have not generally welcomed research into the medical effects of marathon running. That is another thing Weiss aims to change. He has invited research proposals for next year’s race.

By 6:30 p.m., the Fire Department had transported 26 runners from the network of field hospitals and aid stations in Central Park to hospitals. Those stations had treated more than 2,000 patients, some more than once, and released all except 87 of them. The volunteers in P1 alone had treated more than a quarter of them. Many others were cared for at medical stations outside the park.

Earlier, in P1, a physical therapist had guided a runner to the discharge desk. His bib was scanned and he was offered papers with follow-up instructions. He took them, then turned to the therapist and thanked her. He hugged her before walking out