Hospital-based event medical support for the Baltimore Marathon, 2002-2005.

OBJECTIVES: We present a four-year, cross-sectional epidemiologic description of injuries and illnesses among Baltimore Marathon participants and the evaluation, treatment, and disposition of those conditions by an on-site event medical team led by physicians and staff from an urban, academic emergency department. METHODS: We analyzed data from injuries encountered during the marathon. Subjects presenting to a medical aid station along the course route or at the finish line were defined as "injured or ill" and were prospectively divided into two groups: 1) a brief-encounter group and 2) an extended-encounter group. Data collected included gender, presenting complaint(s), assessment, treatment(s), and disposition. RESULTS: Three percent (N=1,144) of approximately 33,700 total participants over four years presented to medical aid stations during the Baltimore Marathon between 2002 and 2005. Most participants (66%) did not require a full clinical evaluation. Common complaints encountered were dehydration (32%), musculoskeletal injuries (25%), and cutaneous wounds (20%). Transport to the hospital was required for 4% of all injured participants, and 61% returned to the race. CONCLUSIONS: Most injuries/illnesses encountered at the Baltimore Marathon in 2002-2005 were minor, although some were serious enough to require transport to a hospital. The year with the highest average race-day temperature had the highest observed injury rates and the highest number of hospital transports. These results help to improve understanding of the types, severity, and distribution of injuries commonly sustained by marathon participants and may guide decisions regarding the appropriate distribution of emergency medical resources at such events.

Injury and illness aboard an Antarctic cruise ship.

OBJECTIVE: The objective of this study was to determine the incidence and patterns of injury and illness among passengers aboard a cruise ship in Antarctica. METHODS: Demographic data on passengers were collected for all participants aboard Antarctica cruises on a single ship during the Antarctic summer cruise season of November 2004 through March 2005. Medical logs from each of 11 cruise trips were reviewed for presentation of injuries and illnesses. RESULTS: A total of 1057 passengers were included in the study, of which 47.4% were male. The mean age of the passengers was 54 years (+/- 16.5 years). The overall incidence rate of injury and illness was 21.7 per 1000 person-days. Motion sickness was the most common condition, comprising 42.3% of all medical encounters by the ship physician, followed by infectious diseases (17.2%) and injury (15.0%). The incidence rate of injury increased significantly with age, whereas the incidence rate of motion sickness decreased significantly with age. There was little variation in the incidence and patterns of injury and illness between genders. CONCLUSIONS: Most illnesses and injuries were due to the motion of the ship, and a large proportion of the passengers aboard the cruise ship in Antarctica were elderly. Injury among older passengers is of special concern.

Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study.

BACKGROUND: The ability to provide medical care during sudden increases in patient volume during a disaster or other high-consequence event is a serious concern for health-care systems. Identification of inpatients for safe early discharge (ie, reverse triage) could create additional hospital surge capacity. We sought to develop a disposition classification system that categorises inpatients according to suitability for immediate discharge on the basis of risk tolerance for a subsequent consequential medical event. METHODS: We did a warfare analysis laboratory exercise using evidence-based techniques, combined with a consensus process of 39 expert panellists. These panellists were asked to define the categories of a disposition classification system, assign risk tolerance of a consequential medical event to each category, identify critical interventions, and rank each (using a scale of 1-10) according to the likelihood of a resultant consequential medical event if a critical intervention is withdrawn or withheld because of discharge. FINDINGS: The panellists unanimously agreed on a five-category disposition classification system. The upper limit of risk tolerance for a consequential medical event in the lowest risk group if discharged early was less than 4%. The next categories had upper limits of risk tolerance of about 12% (IQR 8-15%), 33% (25-50%), 60% (45-80%) and 100% (95-100%), respectively. The expert panellists identified 28 critical interventions with a likelihood of association with a consequential medical event if withdrawn, ranging from 3 to 10 on the 10-point scale. INTERPRETATION: The disposition classification system allows conceptual classification of patients for suitable disposition, including those deemed safe for early discharge home during surges in demand. Clinical criteria allowing real-time categorisation of patients are awaited.

Incidence of injury in professional mixed martial arts competitions.

Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. In 2001, Nevada and New Jersey sanctioned MMA events after requiring a series of rule changes. The purpose of this study was to determine the incidence of injury in professional MMA fighters. Data from all professional MMA events that took place between September 2001 and December 2004 in the state of Nevada were obtained from the Nevada Athletic Commission. Medical and outcome data from events were analyzed based on a pair-matched case-control design. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. A total of 171 MMA matches involving 220 different fighters occurred during the study period. There were a total of 96 injuries to 78 fighters. Of the 171 matches fought, 69 (40.3%) ended with at least one injured fighter. The overall injury rate was 28.6 injuries per 100 fight participations or 12.5 injuries per 100 competitor rounds. Facial laceration was the most common injury accounting for 47.9% of all injuries, followed by hand injury (13.5%), nose injury (10.4%), and eye injury (8.3%). With adjustment for weight and match outcome, older age was associated with significantly increased risk of injury. The most common conclusion to a MMA fight was a technical knockout (TKO) followed by a tap out. The injury rate in MMA competitions is compatible with other combat sports involving striking. The lower knockout rates in MMA compared to boxing may help prevent brain injury in MMA events. Key PointsMixed martial arts (MMA) has changed since the first MMA matches in the United States and now has increased safety regulations and sanctioning.MMA competitions have an overall high rate of injury.There have been no MMA deaths in the United States.The knockout (KO) rate in MMA appears to be lower than the KO rate of boxing matches.MMA must continue to be supervised by properly trained medical professionals and referees to ensure fighter safety in the future.