George Chiampas, DO, certainly keeps busy: he’s an assistant professor of emergency medicine and orthopedic surgery at the Northwestern University Feinberg School of Medicine and regularly publishes research focused on issues in sports medicine and emergency care, and when he’s not researching or teaching, he’s working as the medical director for the Bank of America Chicago Marathon. Dr Chiampas recently spoke with Medical Bag about his experience overseeing medical operations for one of the most well-known marathons in the world.
This interview has been lightly edited for length and clarity.
Medical Bag: How long have you been working as the medical director for the Chicago Marathon?
Dr Chiampas: I’ve been the medical director for the Chicago Marathon since 2007. Before that, I volunteered as a physician. I have a little bit of a unique background where I have both emergency medicine and sports medicine experience. Then in 2007, I was brought on as medical director.
What’s your “day job” when you’re not working on the Chicago Marathon?
That’s a very good question. I wear quite a few hats: I serve as the chief medical officer for US Soccer. I’m an assistant professor of emergency medicine and sports medicine at Northwestern University and Northwestern Medicine in Chicago. I’m also the medical director for the Bank of America Shamrock Shuffle and a team physician for the Chicago Blackhawks.
What does the medical team for the marathon look like? How many physicians are involved?
It’s probably one of the most anticipated events for all [healthcare] disciplines — for the city of Chicago, as well as in the state of Illinois. Especially for physicians with an interest in sports medicine [who may see] truly unique medical conditions they may not encounter on a day-to-day basis. Environmental issues, acute injuries in sports — all of those are at the forefront on marathon day. It’s an exciting day. The overall medical team is anywhere between 1700 to 2100 medical volunteers. From a physician perspective, we have somewhere between 180 to 250 physicians.
What’s the biggest challenge you and your team have faced during a marathon?
In 2007 we had extreme heat and humidity and had to cancel the event about 2 and a half hours in. That marathon was extremely challenging, but what came out of it was that the decisions we made highlighted runner and public safety. Since 2007, there has been a string of events and stories we’ve seen that, because of our decisions in 2007 — and advances in race medicine — other large-scale events have been implementing these world-class operations, logistics and communications processes, and protocols. We’re really excited about some of the things we have done over the last 10 years at the Chicago Marathon. It has truly driven best practices.
What kind of training do you recommend for physicians who aspire to work in a similar position?
When I first started volunteering, I didn’t have a sports background. Sometimes you come in thinking you know more than you know — that saying, “you don’t know what you don’t know” really is true in this aspect. For example, we [physicians] don’t see heat stroke frequently, if ever — so young individuals electively participating in an exercise, reaching temperatures of 108 or 109 degrees is something that truly challenges a physician.
Dealing with exercise collapse and rapidly trying to decipher if it’s a benign collapse or a more severe or life-threatening collapse is something that is also really impactful as a physician. Having the opportunity to manage individuals who are pushing their limits — being able to support them and provide them care. I think the best advice is truly understand medical conditions that marathon running entails — things like heat stroke, hyponatremia, or exercise-associated collapse, because you may not see that the other 365 days a year.
What’s one piece of advice you have for fellow marathon medical staff?
Without question, this is a truly a collaborative event between nursing staff, physical therapists, emergency medical technicians, nursing students, medical students, physicians assistants, nurse practitioners, as well as city emergency medical services and first responders. There’s an opportunity to be open and collaborate with all of those disciplines during a large-scale event that highlights your city and promotes wellness. That’s something you take in and enjoy. Be an example for everyone and highlight what’s so special about being a healthcare provider and also a physician. It’s a tiring day, but at the end of the day, everybody can’t wait for next year.
In terms of medical care on race day, what are the top concerns, and what are the key systems in place to treat those concerns on-site?
The Chicago Marathon has 45,000 to 50,000 participants and 1.7 million spectators. With that many people running, the chance of there being a sudden cardiac arrest is something that is real. Our ability to respond in an efficient and timely manner is critical. That is front and center with what we do and how we train. Hyponatremia, environmental issues, and sudden cardiac arrest are the top 3 conditions that we focus on.
What’s the one piece of medical equipment you always have on hand that can make a difference in treatment?
An automated external defibrillator. That is, without question, the leading device that we absolutely have.
You recently published an article in Prehospital Emergency Care1 about medical care at vertical running events. What are the main differences in the types of medical emergencies you see at these events compared with marathon events?
It was an interesting study because we’ve been working on the Hustle Up the Hancock event at the John Hancock Center, one of the tallest buildings in Chicago. Some of the things that come up when doing vertical events is that participants are in a tight space. Some of the issues we discovered when looking at vertical events are things like respiratory issues and anxiety because of the close spaces.
You’ve also published research on the Chicago Model2 for mass participation events. Can you give us a quick overview of the Model? If there is one key piece of takeaway advice from the Chicago Model, what would it be?
The Chicago Model describes how Chicago manages events with regard to a unified command approach. What that entails is bringing together all of the stakeholders and all of the resources —technology or communication for example — into one location where city agencies, event staff, and others can working collaboratively. Having a unified command approach in running a large-scale event and how we have defined it is what the Chicago Model is. When you have that in place, your ability to respond, communicate, adapt, and be flexible is, without question, the best practice. That is what the Chicago Model is. That’s what we’ve been using since 2008 and what you’re seeing across marathons from New York to Boston to globally. They are all adapting the Chicago Model.
How have data analytics and technology improved race day safety?
We’ve been able to work with Northwestern University students and fellows to get creative in looking at the data of our runners and the analytics of it. One simple example is our ability to determine where our runners are on the course based on predictive modeling. We take information from the runners — such as their pace, their finish time based on other races, and their previous history of marathons — and can predict how the marathon will evolve. This allows us to be more effective with where we put our resources on the course and how we move our resources to follow the runners. Additionally, if the runners are not in the areas where they should be, that would give us information so we can act on that from a safety perspective.
Any other closing remarks?
As a physician, I think one of the messages is to think outside the box and be creative with your skillset. Sometimes by stepping outside of our comfort zones we can be as effective — if not more effective — in other arenas. I’ve been fortunate. I took a chance, a leap of faith, as a physician because it was a nontraditional path, and I’ve been fortunate to be able to have these opportunities. We need more physicians to take that leap of faith.
- Nash CJ, Richards CT, Schweiger G, Malik S, Chiampas GT. Medical care at a large vertical running event. Prehosp Emerg Care. 2018;22(1):22-27.
- Basdere M, Ross C, Chan JL, Mehrota S, Smilowitz K, Chiampas G. Acute incident rapid response at a mass-gathering event through comprehensive planning systems: a case report from the 2013 Shamrock Shuffle. Prehosp Disaster Med. 2014;29(3):320-325.