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Chicago Marathon Serves as Proving Ground for Medical Director George Chiampas

Endurance Test

Hours before the sun comes up and any runner arrives at the start line for the Bank of America Chicago Marathon, George Chiampas, DO, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, has already covered the 26.2-mile course. As medical director, his race day begins at 3 a.m. when he does a final check of medical supplies and the 21 aid stations located at various mile markers along the event route.

“I have a massive responsibility to try to anticipate any possible scenario and ensure that all the resources are in place; it’s a humbling experience,” says Chiampas, who began volunteering in sports medicine while an emergency medicine resident at John H. Stroger, Jr., Hospital of Cook County and later completed a fellowship in the field at Resurrection Health Care.

“I’m also preparing to welcome the medical volunteers. It’s my job to stir up excitement and show appreciation for the 12-hour day they will put in  so that the runners have a safe and memorable marathon.”

This year’s race, which took place on October 7, marked the sixth with Chiampas as head of medical services. He oversees the provision of care for the 45,000 racers and 1.7 million spectators who may need it, and is in charge of as many as 1,400 physicians, nurses, physical therapists, medical students, and other healthcare volunteers.

“We’re proud of the work that Dr. Chiampas has done in his six years as the Bank of America Chicago Marathon medical director,” says Carey Pinkowski, executive race director. “He has recruited a team of medical volunteers that is second to none and the organization and structure that he has helped develop is a model for other marathons and running events world-wide.”

At the 15.3 mile aid station - from left to right: Annie Pearce (NMFF nurse), Lisa McElroy (surgical resident from Milwaukee working on 2-year research program at Feinberg), Eddie Gronko (Feinberg PA student), Monica Rho (RIC sports medicine physician), Rebecca Carl (sports medicine physician at Lurie Children's Hospital), Aisha Dharamsi (sports medicine fellow, Feinberg/Lurie Children's).

On average, the medical staff treats more than 1,000 individuals every year. Common conditions include dehydration, disorientation, heat-related injuries, and issues related to pre-existing health problems such as diabetes. With cooler than normal temperatures on race day this year, volunteers also saw several cases of hypothermia and patients with flu-like symptoms.

The majority of extremely ill runners get treated near the finish line. Sanjeev Malik, MD, GME ’07, assistant professor of emergency medicine, serves as team captain for the Intensive Care Unit stationed at the end. He and a group of about 50 volunteers typically see more than 40 individuals, mostly within a two-and-a-half-hour timeframe.

While most sports medicine doctors begin in family and community medicine, internal medicine, or pediatrics, Malik says the emergency medicine background he and Dr. Chiampas share is a boon in this environment.

“If there’s any medical setting that the marathon most relates to, it’s the ER,” he explains. “The ability to screen patients very quickly and treat life-threatening issues up front is a natural part of training for an emergency room doctor.

“What’s really gratifying,” he adds, “is that the people you’re treating have a life-threatening problem that in almost all cases is 100 percent reversible.”

Preparing for Possibilities

Of course, more serious issues do arise. According to a report published in the May 4 issue of the American Journal of Sports Medicine, between 2000 and 2009, 28 people (six women, 22 men) died during or within 24 hours of completing a marathon. A January 12 issue of the New England Journal of Medicine, co-written by Chiampas, reported that from January 2000 to May 2010, 59 marathon or half-marathon participants suffered cardiac arrest, with 42 resulting in fatalities.

While these occurrences are rare, Dr. Chiampas has prepared the Chicago Marathon to handle them. The event employs advanced life support (ALS) bike and golf cart teams, basic and advanced life support foot teams, and a fleet of 100 ALS ambulances. It exceeds community standards for the number of automated external defibrillators (AED) on a 26.2-mile course – having one for each aid station, ambulance, and bike team. For more advanced care, the main medical tents have cardiac monitors that allow medical volunteers to assess cardiac rhythm and core body temperatures.


Chicago Marathon executive race director Carey Pinkowski with this year's first-place male and female finishers.

“I think this is one area we have definitely led in the area of marathon medicine,” says Chiampas, past president and current advisory board member of the World Road Race Medical Society. “I know that the ability to start CPR and have access to an AED is the difference maker, and I ensure that our medical teams have what they need, where they need it, to respond to the worst possible situations. We’ve set best practices here that other races around the world have followed, which has saved lives.”

Taking it one step further, the head team physician for Northwestern University athletics worked with the Northwestern Simulation Technology and Immersive Learning group to develop two videos, one for medical volunteers on how to treat sports-related conditions and the other for 12,000 non-medical volunteers on chest compressions and how to use an AED. And Chicago Cardiac  Arrest Resuscitation Education Service (CCARES), a group he co-founded that promotes increased bystander CPR education and training, had a presence at this year’s marathon expo, which more than 130,000 people attended.

“There should never be a situation where a person collapses from sudden cardiac arrest, the leading cause of death in the U.S., and someone or a group just watches and waits for an ambulance,” says Chiampas.

Dr. Charlie Pierce, a third-year emergency medicine resident at Northwestern, and Lanty O'Connor, program manager of the Feinberg Simulation Technology and Immersive Learning lab (1st and 2nd from left), were both part of the Chicago Marathon Code Team.

Improving Mass Event Safety

Such thorough preparation and commitment to education stems in part from lessons learned in 2007, Chiampas’ inaugural year as medical director. That October day, temperatures steadily climbed from the 70s to the upper 80s, causing more medical issues than normal. As the heat and humidity took their toll, race organizers made the unprecedented decision to cancel the event mid-race. Challenged to communicate this news, event organizers used police helicopters and more than 800 police officers stationed along the course to inform participants.

“Retrospectively, the critics now agree that we did the right thing,” Chiampas says. “Our event and city agencies were pushed to handle a mass situation, and overwhelmingly, we did a tremendous job. I feel what and how Chicago dealt with it at the time, and also what we’ve put in place since, has transformed not only race medicine, but also large-scale events in general.”

Today, the marathon employs a flag system to signal course conditions, and runners receive regular e-mails on race safety and training before the event. A new electronic patient tracking system allows volunteers to offer better information for families looking for participants receiving medical attention. Additionally, event officials and leads from the medical team, city, and police and fire departments meet throughout the year to discuss emergency action planning, ensuring a unified front if called into action.

These changes have made the Chicago marathon one of the safest mass sporting events in the world, Chiampas says, adding that he shares safety insights with the medical directors for the World Marathon Majors – Berlin, Boston, Chicago, London, New York, and the newest addition, Tokyo – who meet regularly to discuss best practices, most recently at the 2012 Summer Olympics in London.

Dr. Chiampas has also written about how the safety and emergency response systems used at the marathon can help government officials design their community disaster response programs. In a 2011 report for the American Medical Association’s Journal of Disaster Preparedness, he contends that major mass sporting events provide an opportunity to test and develop best practices for such occurrences.

“In reality the marathon is a planned disaster,” the ER doctor explains. “With 45,000 runners, we know a 2 percent minimum will require some medical care in a span of five to seven hours. Our work shields the EMS and hospitals from being overwhelmed, and helps protect a city which still has to function. It tests the hospitals, EMS, and preparedness for communication, for weather, and, unfortunately, for terrorists. It is very difficult to practice this or even try to simulate these events; the marathon provides a perfect opportunity to learn.”

In fact, the City of Chicago has used these lessons to prepare for the 2012 NATO summit, Barack Obama’s election night, and Lollapalooza, a huge, annual three-day concert.

A Chicagoan born and raised, Dr. Chiampas feels a sense of pride in having had such a positive impact on the city he loves. Reflecting on the marathon, he shares these final thoughts: “For me, our volunteers and their commitment to the well-being of runners and spectators define the human spirit of the marathon. Sometimes I think of the lives we touch and just feel grateful that I get to be a part of it.”