The Director, Suner, Provides Commentary for a manuscript published in the NEJM

April 13, 2017

Please read the comments by Dr. Selim Suner MD, MS, FACEP provided for Reuters regarding an important manuscript published  in the NEJM, yesterday. (Source manuscript:

The full comments are below:

"  The investigators from Harvard and Utah School of Medicine have looked at pooled national registry and Medicare databases to show that there is in an increased incidence of 30 day death from cardiac arrest or acute myocardial infarction in patients transported from locations on marathon routes to nearby hospitals during large urban marathons in the US.  The investigators estimate an increase of 3.4 deaths per year in this population.  Looking at a National Emergency Medical Services Database, the investigators show that there was a 4.4 minute delay in ambulance transport times urging marathon running hours.  (Likely even longer delays for then 1/4 of patients who were taken to the hospital by other means--by self transport). The investigators performed extensive analysis to control for confounding factors and postulate that the increased transport time, or delays in transport to the hospital related to road closures and other factors related to the marathon event.

This is a retrospective study from multiple pooled National databases and therefore can only show association and not causation.  Even though the authors performed extensive analyses to account for confounding variables which could have accounted for the differences observed, they may have missed variables which are important.  For example:  the authors did not look at daily temperature or ozone levels which may have been higher on marathon days accounting for increased death in this population.  Also, there may have been increased volume in the emergency departments during marathon days making care for people with myocardial infarction less than ideal.

The data are believable and the results important.  In Rhode Island, we have an annual air show at a location with only one road in and out.  We plan for this event and provide an onsite medical care facility with a field hospital and emergency physicians capable of taking care of emergencies.  We also have air transport on standby for those patients requiring urgent transport to the hospital.  We have shown in a prior study that having this facility on-sister reduces the number of patio ends requiring transport to the hospital."