Increasing numbers of marathon running events are taking place around the world. The difficulty encountered in the management of mass gatherings, especially running in marathons, is how emergency services can deliver treatment in a timely manner. Therefore, for this kind of situation, preparation is the key to success in terms of patient management.

The aim of this study was to describe the presentation of cases at a start-finish medical post in an international marathon race set in a rural area.

All medical record forms were collected from the start-finish medical post of the Khon Kaen International Marathon (KKIM) 2020. The race took place on January 26, 2020. The data were coded by two authors, and in the case of different codes, the final codes were determined by discussion.

The total number of participants in this event was 16,489. Participants who used the start-finish medical post numbered 74 (44.8 people per 10,000). More than one-half of patients were male (41; 56.9%), while 31 (34.0%) were female. The age range of the casualties was from 17 to 88 years old. The rate of incidence for those who used this post was 44.8 per 10,000 participants. The greatest density of users was at 3.40 hours after the marathon had started. The common symptoms which were found consisted of 17 soft tissue injuries (23.0%), 15 instances of cramps (20.3%), and 11 musculoskeletal (MSK) injuries (14.9%). Almost all patients were discharged, and only two of the cases were actually admitted to the hospital. No statistical significance between males and females was found (OR = 0.81; 95% CI, 0.51-1.3). However, marathon and half-marathon runners had a higher risk of being casualties (OR = 3.49; 95% CI, 1.71-7.15 and OR = 3.51; 95% CI, 1.79-6.88).

The injuries of most of the patients who used the medical post at a start-finish point were mild. Distances which are longer than 20km increase the risk for getting injured. However, a prospective study and multi-session interpretation is recommended.

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs).

This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND.

Overall, 7.1% of athletes’ baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demographic characteristics (i.e., age, sex, and sport), although it accounted for only a small percentage of variance. Multivariate base rates are presented stratified for age, sex, and ND.

These data provide evidence of higher than normal rates of invalid baselines in athletes who report ND (based on both the standard and novel embedded validity indicators). Although ND accounted for a small percentage of variance in the prediction of invalid performance, negative consequences (e.g., extended time out of sports) of incorrect decision-making should be considered for those with neurodevelopmental conditions. Also, reasons for the overall increase noted here, such as decreased motivation, “sandbagging”, or disability-related cognitive deficit, require additional investigation.

Large-scale mass-sporting events are increasingly requiring greater prehospital event planning and preparation to address inherent event-associated medical conditions in addition to incidents that may be unexpected. The Bank of America Chicago Marathon (Chicago, Illinois USA) is one of the largest marathons in the world, and with the improvement of technology, the use of historical patient and event data, in conjunction with environmental conditions, can provide organizers and public safety officials a way to plan based on injury patterns and patient demands for care by predicting the placement and timing of needed medical support and resources.

During large-scale events, disaster planning and preparedness between event organizers, Emergency Medical Services (EMS), and local, state, and federal agencies is critical to ensure participant and public safety.

This study looked at the Bank of America Chicago Marathon, a significant endurance event, and took a unique approach of reviewing digital runner data retrospectively over a five-year period to establish patterns of medical demand geographically, temporally, and by the presenting diagnoses. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, coordination, and communication to ensure a safe and secure event.

The Chicago Marathon is one of the largest marathons in the world, and this study identified an equal number of participants requiring care on-course and at the finish line. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. As technology has evolved, the use, analysis, and implementation of historical digital data with various environmental conditions can provide organizers and public safety officials a map to plan injury patterns and patient demands by predicting the placement and timing of needed medical support, personnel, and resources.