Medical rules are needed in marathons in the United Kingdom

EDITOR—Dyer reports that two junior doctors, Andrew Murphy and Lesley McKee, went to the aid of a marathon runner who collapsed and died as she crossed the finishing line of a half marathon.1 Dyer reports Dr Murphy as saying that if he was faced with a similar emergency in future he would “just walk on by.” We understand his comments.

It should not have been necessary for a doctor who had just finished a gruelling half marathon to take part in a resuscitation attempt. Emergency medical assistance should remain the responsibility of race organisers and those hired to provide emergency medical care. Our daughter collapsed at a public event where competitors had paid for medical assistance in their entrance fee. The organisers should have employed a doctor qualified to deal with such an emergency, especially as another young person had died at the finish line in the previous year's event.

If everything had been done correctly to save Anna that would have been the end of the matter. The absolute tragedy of Anna's death is that she collapsed at the finish line close to St John Ambulance staff with a modern automatic external defibrillator, which could have quickly provided the defibrillating shock she needed to survive.

Evidence given at the inquest showed that, although the staff reached her within less than a minute, they did not diagnose cardiac arrest or follow the correct defibrillator procedures. The first seven minutes of the resuscitation attempt is well documented by the internal defibrillator electrocardiograph and audiotape recording, which showed continuous ventricular fibrillation, but no shock was given despite the machine's prompting the operator to do so.

UK Athletics 98 rules require only that there be a qualified medical officer and an emergency medical centre to cope with two emergencies per 1000 people at the finish. There is no information on the degree or quality of care required. Neither do they specify the need for advanced life support or advanced cardiac life support, the role of medical staff, or what is meant by emergency.

In France, medical rules are comprehensive and legally binding. They call for a high degree of mobility of a doctor skilled in resuscitation, paramedical ambulances, and an effective means of radio communication. Since their introduction in 1992 only eight people have died in out of stadium running events throughout France.

A campaign was launched on 8 March, the anniversary of Anna's death, requiring the sports minister to compel organisers to provide advanced life support at these strenuous events. It is backed by Don Foster, MP for Bath, and we welcome support from the medical profession. The current haphazard system which puts bystander doctors in such a difficult position should not be allowed to continue.

Some 70 athletes have died in the past 10 years in the United Kingdom at these events. Information on them is being compiled by Rob Perkins (email: rob{at}newsquick.co.uk tel 0121 684 3222; fax: 0121 684 3224). Please contact him if you have any information or would like more details of the campaign.