Wednesday, October 3, 2018

Q&A with Dr. George Chiampas, Medical Director, Bank of America Chicago Marathon

In a few days, thousands of runners will take to the streets of Chicago for the 41st Bank of America Chicago Marathon. Today, Chicago Running Bloggers had the opportunity to talk with Dr. George Chiampas, an assistant professor in the Department of Emergency Medicine at the Feinberg School of Medicine at Northwestern University and Northwestern Memorial Hospital and the Medical Director of the Bank of America Chicago Marathon. Read on to learn more about his background, how to approach this year's race day based on predicted conditions, and what the medical team at the race does to keep participants safe and healthy.

Can you tell me a bit about your background: how you got involved with the Bank of America Chicago Marathon and how long you've been working on the medical team?
I'm a Chicago native, born and raised. My area of specialty within medicine is in emergency medicine and I'm also board-certified in sports medicine, so I have two different dynamics. I trained at Cook County in Chicago and then did a sports medicine fellowship locally as well. When I was a resident, I used to volunteer for the marathon for many years and found it to be a highlight. Towards the end of 2006 I was asked by the then-medical director with that background in sports medicine and emergency medicine to become the medical director in 2007. I've been the medical director since 2007.

You really got thrown into the fire, then. 2007 was probably a tough year for the medical team, I would imagine.
Obviously it was a year that was challenging. I think that, looking back, while it was challenging I think it also without question set the industry standards operationally, from an innovations perspective. Chicago now, for the last several years, is identified as if not the world leader, one of the top leaders in endurance events, operations, and medical safety. We really pride ourselves on doing things at an extremely high level.

Let's talk about this year. What does it take to get your whole team ready for all 45,000 runners on race day?
It's a year-round operation, not only for all of our staff but even in the medical and safety world. We have a committee that gets together with roughly 50 committee members. We have meetings throughout the year. We look at ways that we can continuously look at our event, be creative, be innovative, see how we can strategically change things that support our runners and the public safety so that we have a quality event come October. Some of those things entail looking at our supplies, restocking supplies, adding additional supplies, getting feedback from runners, and getting feedback from our medical staff from the previous year. In areas that we can implement new things, we absolutely do those for the next year. That's been across the year. Over the last six to eight weeks, it's ramped up.

This is without question one of the highlights for medical or healthcare providers across the city and the state. We have over 2,100 medical volunteers who are registered for this event. There's a buzz across the city, across the state as this is an event that's on a lot of people's calendars for a couple reasons. One, we have so many repeat volunteers, which hopefully highlights the fact that we do things in a really concise way, respectful of our volunteers, make sure that they have all the things they need to be able to function. Secondly, I think our medical volunteers connect with our runners. They connect with the cause or causes that runners are committed to. For us, this is a celebration along with the runners, the event, the city, and so we feel just as connected to it.

The race is only a couple days away now. Are there things you're doing at this moment to make sure that everything's ready for Sunday?
I'm talking to you from Grant Park. We've been here since about Monday. We track quite a few different things about 10 days before the event. We work in a very collaborative, coordinated effort with our city, state and federal agents. One of the key things we look at is factors that can impact our race, factors that can potentially be things we know we're going to deal with or more of on race day. One of the big things is the environment. We're watching the Weather Channel a little bit closer these last 10 days. That's one of the top five things that we're looking at because, through that, we also have to communicate various things to our runners to make sure they come prepared, they know what to expect, if they need to modify their pace, and if they need to adjust anything. We want to assist them by providing them with the most accurate information and communicating with them.

I got an email this morning letting me know the race is currently at a yellow status based on the forecast. It's hopefully not going to be as warm as last year, but 70 degrees still is a bit warm for a marathon, and there's the potential for rain. What kind of issues do you think people might encounter this year based on the current forecast? What are you expecting to perhaps see more of than sometimes?
I think this year's weather is something that's a little bit more volatile than we typically have seen. There's question of rain, there's question of clouds, there's question of increasing temperatures. One of the things that we looked at for this year in calling it yellow--and mind you, that Event Alert System, that color-coded system, is one that we developed in the marathon space in 2008. While we're talking in 2018 as if it's normal, it is because of all the efforts we've done on a communication side over the years that now that is our way to communicate to runners and provide that safety net. Secondly, with the yellow, what we're saying is we know, based on today's forecast, that the first part of the race, between 7:30 and hopefully noon or 1:00, that the temperatures and the weather may be very ideal. We may start in the low to mid 50s and gradually work up into the mid 60s and touch 70 maybe around 1:30, 2:00. Part of why we used yellow is because there's a chance of rain, and we want to make sure that runners are aware that they may need to be cognizant of slippery environments, slippery areas so they're aware of that in case that were to occur. There's a little bit of a dual message to our runners, additionally telling them to bring a change of clothes, make sure that they have a plan in place, and if they need to modify things as temperatures increase that they're flexible enough to do those things on race day.

In regards to the rain and the temperature specifically, we most likely won't get a Boston sort of situation. It's not going to be 35 and rainy. From my perspective, I find it a little more complicated to figure out how to dress for warm and rainy versus cold and rainy. Cold and rainy, I know I want to stay warm and dry, but warm and rainy, I want to stay dry but I don't want to overheat. What are your recommendations on what you would tell runners to do to accommodate warmer weather and rain?
I would dress as if it's a warm day underneath, and then have something that you can shed if those temperatures increase or if you feel like you need to do that: something you can shed that you don't care if you drop it off and leave it on the street. At the start line, our community's aware that so many runners do come dressed that way, and then they shed those clothes. We take those and distribute them to local shelters in the area.

The feedback to runners for this weekend is to be flexible, even in your attire. Underneath, I would have what you'd wear typically for a 70, 75 degree day, and have that ability to shed that clothing so that you can adapt to the temperature if it gets to that. One of the biggest factors is the humidity, and with potentially having some rain or precipitation in the environment, that humidity may be a little bit higher than we'd like. Humidity is not a runner's friend. It's not our friend on the medical side. Hopefully that humidity drops down for everyone's benefit.

On race day itself, if a runner needs to stop at an on-course medical tent, what can they expect? What's the procedure when a runner does that?
We have 21 medical tents on the course, and another one a little bit off the course. There's one at every aid station. What you typically will see is a bunch of people that are smiling, cheering you on, but with the ability to support an individual from the most minor issue, like needing a Band-Aid or needing some blister care or maybe some Tylenol that we can provide, to even more serious conditions that has a wide spectrum. We are a very comprehensive, multi-discipline team. Each aid station, as far as the medical team goes, will have between 15 and 25 staff. There's communications capabilities back into our command center in Grant Park so we can have communications back and forth. There are resources like Biofreeze and medications, cots and chairs, and our ability to provide from the most minor to extreme circumstances if those occur.

For a lot of runners, the idea of going to the medical tent, especially while they're in the middle of the race, can be pretty scary. The expectation can be that if you go in there for anything more than a blister, someone's going to tell you that you're not allowed to finish the race. You put four and a half months of your life into training for this and you don't want to stop if you don't have to stop. What would you tell runners to ease their fears about visiting a medical tent?
Hopefully that's not the message, and that would be the first thing I would share with runners: that's to the contrary. Our goals and objectives from the medical team from start to finish is to advocate for our runners to be able to meet their goals. We're not acting in any way to take someone's dream away. Our goals and our objectives are to protect our runners. Now there are circumstances where we do have to intervene, and that is to the best interest of the runners. There are absolutely circumstances where runners have also turned around and said, "Thank you for doing that, because I wouldn't have stopped. I wouldn't have taken myself off the course." It, without question, is a delicate balance. Things like blisters and simple things and non-life threatening issues, runners should absolutely know that the medical tents are their advocates. That is a place that you want them to feel comfortable coming in. We know that we rapidly want to be able to address their issues and get them back out there as safely as possible.

What kind of tools do you have in the medical tents to help you determine whether something is serious or not serious?
We have quite a bit of technology and tools. Some if it includes being able to push in information with regards to complaints that we can see in our command center, but from a medical side, every aid station has an AED defibrillator and has a slew of of resources. Over the last two to four years we've been very fortunate. In our main medical tent in Grant Park, we've always used Abbott's i-STAT devices. Over the last two to four years we've been able to now, with our relationship with Abbott, to be able to extend that across the course. Now at every aid station, we have an Abbott i-STAT machine. In marathon medicine, when you talk about serious issues, runners can come into a tent and may actually be confused or altered and our ability to rapidly assess if there's a serious underlying circumstance to that can only be done sometimes by our ability to draw some blood and rapidly assess that individual's blood sugar, their sodium level, or other metrics that the Abbott i-STAT provides us. It has been a very welcome tool. I think our physicians across the course, our medical providers across the course have welcomed it. Sometimes we operated a little bit in the dark, but now to be able to have that on the course and in our Grant Park larger facilities, it really provides us a robust, comprehensive capabilities that impacts positively our runners and allows us to make some quick assessments, quick clinical decisions that get good outcomes.

Is there anything else you'd like to tell runners about what the medical team does, what you do, or just advice on how to stay healthy on race day?
I would finish off by again highlighting the fact that our medical team is a part of the runner's celebration. I hope that when the runners cross the finish line, they know that there's going to be quite a few medical personnel even before the finish line, at the finish line, and after the finish line, there to keep their head up and keep them walking. As you can imagine, when you cross the finish line you have this tremendous emotional experience. We're there to keep you walking, to check if anything's going on. We hope that we can work together with you to make sure not only do you get to celebrate the day and go home with your family and then come back and visit Chicago next year.