June 19, 2017 - While we often focus on and analyze patient care inside of hospitals, the importance of infrastructure and how it can affect timely access to healthcare such as hospitals can be overlooked. With warmer weather here – and bringing with it more large outdoor events like parades and marathons – infrastructure and transportation take on unique importance for healthcare and public health readiness. Events like these almost always involve widespread road closures the disruption of infrastructure already in place and relied upon by the public. And road closures and unfamiliar detours can create delays in emergency care for patients who have acute medical conditions and live nearby venues hosting large outdoor events. Working in Washington, D.C. and knowing that infrastructure and roads are routinely impacted by large events, I wondered what the literature had to say on the healthcare impacts of these pre-planned events. A recent article from the New England Journal, Delays in Emergency Care and Mortality during Major Marathons, had some though provoking findings.
In this study researchers examined how the change in infrastructure during major marathons can delay the time it takes for a patient to travel to a provider, effectively prolonging the response time it takes for a patient to receive medical care. Researchers identified 11 US cities hosting major marathons and sought to determine if these major marathons are related to higher mortality (due to foundational changes) resulting from postponement of care. The study found that “an influx of spectators into marathon-affected areas could lead to increases in the rate of acute myocardial infarction or cardiac arrest among visitors hospitalized on marathon dates.” That is to say a surge in the number of people in the area could lead to more heart attacks and cardiac arrests. This in turn could stretch hospital resources and raise the rate of mortality. The study also took into consideration the number of patients who neglect or delay seeking medical treatment and care during marathons and in turn may have a “higher unobserved risk of death.”
Researchers also found the 30-day mortality in marathon-affected areas on marathon dates to be higher than on non-marathon dates (28.2% compared to 24.9%). Similarly, and perhaps more expectedly, they could ambulance transport times to be longer on marathon dates. Taken together, researchers concluded that these findings suggest widespread road closures and infrastructure disruptions during marathons adversely affect health outcomes in non-participating citizens who need immediate medical attention and care.
Studies and information like this are vital in creating emergency routes and systems during marathons (or any other public event that may create road blockage). Comprehensive emergency preparedness requires safe and non-hazardous routes that allow patients with a chronic condition to receive medical attention sooner than later. Identifying and socializing these alternate routes during marathons and other large scale events is important for healthcare preparedness.
These findings served as an important reminder for me that large scale public events impact both participants and community residents not participating in the event, and planning must account for both populations. We see our state and local emergency managers coordinating complex logistics operations for large scale events all the time. It’s encouraging to see studies affirming the interdependencies of sectors and vital role infrastructure plays in healthcare preparedness continue to come out and shed light on new areas. These findings will certainly be on the minds of the Healthcare Ready team this summer as various concerts, festivals, and other large scale public events take place.