The 2014 Boston Marathon will have the largest American Red Cross support of any local action in recent memory. While traditionally used in disaster relief situations, the organization, working in conjunction with the Boston Athletic Association and area medical professionals, has beefed up its event staff for race day.
"We have a 65 percent increase in event staff over past years, and it is all EMT-level people and above," ARC director of volunteers for Massachusetts Bob Bowers said. "At the request of the BAA, there are a lot of really highly skilled people, and they are enhancing the medical stations tremendously this year."
The ARC will provide a total of 400 volunteers along the course, including the addition of a group of mental health professionals. At least two mental health staff members will be at each of the marathon's 26 medical stations as well as the finish line. These volunteers will be wearing blue vests with the word "Psych" written on them.
The ARC will also be widely distributing a card with a support telephone number on it in case someone experiences postrace psychological trauma and needs to talk to a mental health professional.
"I can speak to it personally," Bowers said. "Everyone last year had the same experience with certain sounds triggering certain emotions. We want to assure people that they are all right and help them process the emotions."
Bowers describes each of the course's medical tents as mini MASH units. Eleven will be capable of administering IVs, up from five in 2013.
While the ARC has previously provided race volunteers who could treat the standard athletic injuries, this year it recruited people who can handle anything from an ankle sprain to severe trauma. The majority are registered nurses and EMTs.
"I would say of the 158 people who volunteered last year, 75 to 80 percent came back," Bowers said.
The field size has increased from roughly 27,000 in recent years to 36,000 registrants for 2014, which has also led to changes in the medical program.
"In a normal year, we have roughly 1,400 BAA medical volunteers," Troyanos said. "This year, we've increased it to have 1,900 medical volunteers from start to finish."
The finish-line tents have been expanded. Tent A, the larger unit closest to the finish line, will be about five feet wider while Tent B, which is located down St. James Avenue, will double in size to roughly the size of a football field.
"That will allow us to have 220 cots in Tent A and 170 in Tent B," said Troyanos, who has spearheaded the Boston Marathon medical coverage for nearly 20 years. "It was a shock to the system in what we saw, visualized and experienced last year, but the care that we delivered was not unusual in the sense that it was simple first aid hemorrhage control."
The past two Boston Marathon races have been especially challenging for the medical staff. The two pressure-cooker bombs that exploded near the finish line in 2013 killed three people and injured 264. In 2012, the unusually warm weather affected more than 2,300 participants who had to seek treatment for heat-related ailments. To supplement the medical staff on course this year, the BAA and ARC will have an additional 120 disaster relief volunteers on call who can quickly mobilize in the case of an emergency.
After the bombs went off last year, Boston cellphone towers jammed due to the surge of wireless calls and messages. This year, the ARC has created a three-part plan for being able to continue to connect under any circumstances.
The first is the classic form of communication for the day, walkie-talkies that will operate on their own frequency. The second is a new texting component that can relay information, like requests for extra supplies, and will be coordinated with the help of Chicago Event Management, the company that puts on the Chicago Marathon. (The Chicago Marathon implemented this texting element to its race last fall, and both races are working together to learn how to maximize its potential at their marathons.)
The third option is the telephone landline. On race day, Stephanie Walsh, who oversees the IT volunteer effort for the ARC, will have three landlines dedicated to her at race headquarters.
Finally, a health-focused runner tracking program is being distributed throughout the course this year. The medical tents that have IV stations will have the ability to scan a runner's bib, and the staff there will be able to view that person's medical history as it pertains to the race. The scans will also create a database of what is transpiring throughout the course.
"We will get hourly statistics for the Boston Department of Public Health about how many people are coming in for treatment and the number of transports to area hospitals," Walsh said. "The Department of Public Heath can then keep their pulse on what is happening health-wise and the hospitals can get a warning about when they might get inundated."
This technology provides a number of important benefits. First, it allows the medical professionals to better understand the health needs of each runner who seeks treatment. Second, it will give the Boston Department of Public Health the chance to compile the data and use it to more strategically coordinate medical attention where it's most needed in future races. Third, it will help with runner and family reunification.
"Imagine if a family member is waiting at the finish line for a loved one and the runner doesn't cross the line," Walsh said. "The family member panics because they don't know where that person is. Now, with the bib number having emergency contact information for each runner, we can contact family members to let them know what has happened to their loved one."
Marathon Monday falls on Patriots Day, a holiday in Massachusetts, but for hundreds of medical professionals pitching in for the race, it will be a 12-hour workday. Bowers, Troyanos and Walsh all said that the only issue they had with coordinating the medical personnel volunteer effort this year is that, due to such an outpouring of support from the community, they had to turn people away because they are fully staffed.
According to Troyanos, the biggest change the medical team will make at the finish line tent has to do with its décor.
"In the weeks after the bombing, people from all over the world made and sent us about 30-40 quilts to show support for Boston and the marathon," he said. "We are going to hang them on the walls of our medical tents to show our volunteers that they aren't alone and that there are a lot of people thinking about them."