Today’s the day of Boston’s most famous footrace, the 119th Boston Marathon, which boasts more than 30,000 runners and spans five cities. But those aren’t the marathon’s most impressive numbers; it’s the medical operation surrounding the marathon that left us feeling inspired about healthcare innovation in the field.
Chris Troyanos, the Boston Athletic Association’s medical coordinator, has been planning and executing the Boston Marathon’s complicated logistical plan for 39 years. The massive operation includes 10 hospitals, 15 i-STAT portable blood analyses systems, 28 medical tents, 300 beds, 300 pounds of ice, 700 IVs and 1,600 volunteers – and that’s just the beginning.
When Tragedy Strikes
Troyanos, a certified athletic trainer and sports medicine consultant, was there for the 2013 Boston Bombing. In fact, his brave volunteer team triaged and likely saved more than 90 people after the bombs exploded near the finish line. When asked if he’s changed anything since then, Troyanos says that the massive scale of the operation is the best kind of preparedness drill.
“We were just able to, in a sense, flip a switch very quickly after those bombs went off,” Troyanos says. “What happened wasn’t exotic – we did basic first aid. When I talk about race organization, we’re planning for a mass casualty event already with the number of people we plan to treat.”
Today, the organization of the medical tents looks very much the same as it did two years ago, Troyanos says, but with increased security and more passionate runners.
Race Day Challenges
Troyanos worries about two health conditions, in particular, when it comes to race day: overheating and overdrinking. One condition in particular, overdrinking (called hyponatremia) requires complicated medical analyses that are rarely done in the field. When someone is suffering from severe hyponatremia, an IV could kill them.
That’s where the portable i-STAT machines that Troyanos loves so much come into play. He integrated them into his protocols several years ago and swears by their flexibility, portability and trustworthy point-of-care service.
“The i-STAT has a broad portfolio of tests for point-of-care devices,” says Katie Mims, Associate Director of Clinical Affairs at Abbott, the company that makes the i-STAT. “From a marathon perspective, they’d be looking for conditions like heart function and dehydration. The i-STAT can test for sodium levels and markers of severity.”
The i-STAT is a hand-held device a bit bigger than an old car cell phone. With two drops of blood, the machine can test for a variety of conditions, many of which Troyanos needs to test for in the field. For hyponatremia, in particular, sodium levels can help him and his volunteers create an treatment plan, often rushing the patient to a nearby hospital.
Troyanos has also worked to innovate in other ways on the race course. When a man dropped on the course from cardiac arrest several years ago, several physicians hopped the fence to give him CPR until the emergency team arrived. Using this model, Troyanos has trained many of the Boston Marathon runners to act as first responders for their neighbors, “filling the gap” of emergency care.
He’s also streamlined protocols from his medical tents to nearby hospitals, and has worked to integrate a Boston-based healthcare system that can be extremely silo-ed on every other day of the year. During the 2013 marathon, our local hospitals were credited which quick response times and incredible teamwork, which we know now can be attributed to Troyanos’s pre-race planning.
The Big Picture
Troyanos says his biggest challenge on the course is also an incredible thing: last year, 97 percent of the 36,000 runners on the Boston Marathon course finished the race, even after visiting the medical tent for injury, heat illness and dehydration.
“We treated a lot of people who said ‘I’m doing this, no matter what,’” Troyanos says. “We needed closure, and it was important for us to send a message to the world, to anyone who thought they could take out freedom: we weren’t going to allow that to happen.”
Jenni Whalen is the Executive Assistant of Editorial at Upworthy. She was previously MedTech Boston's Managing Editor and has an MS in Journalism from Boston University, as well as a BA in Psychology from Bucknell University. Whalen has written for Greatist, Boston magazine, AZ Central Healthy Living and the New England Journal of Medicine, among other places. She has also worked as a conference planner, ghost writer, researcher and content developer.
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