Medical Provision at the London Marathon

London Marathon 2023

The London Marathon is one of the most prominent marathons in the world, attracting thousands of runners from around the globe each year. The 2023 London Marathon lived up to the promises of being an exciting event through some of the city's most iconic landmarks and a competitive field of elite runners.

The 2023 London Marathon took place on April 23rd, and several members of BASEM were involved including BASEM Trustee Tim Allardyce, Lead Physio for the Course, and Sue Crewses-Smith, Lead Physio for the Finish. Overall physiotherapy lead was Liz Nicholls.

Sanjay Sharma was medical director, and Courtney Kipps and Jann Killops were deputy medical directors. Emma Painter, physiotherapist, was also the oversight and governance manger.

The medical provision at the London Marathon is a critical aspect of the event, ensuring the safety and well-being of all participants. The medical provision includes a comprehensive team of medical professionals and volunteers, as well as a network of medical facilities and equipment throughout the course.

The medical team at the London Marathon includes doctors, nurses, physiotherapists, and other healthcare professionals who are trained in providing emergency medical care. They are stationed at various points along the course, including the start and finish lines, and are equipped to handle a range of medical emergencies, from minor injuries to life-threatening conditions. My own physiotherapy team consisted of 50 physiotherapists and 55 students, and were placed between Mile 14 and Mile 25, and we covered 14 stations initially, which then increased to 15 stations half way through the marathon as another station reported they needed support. In addition, we provided two physiotherapists (in addition to a nurse) to sit on the Race Control Sweeper bus, to pick up the very last walkers who just could not make it around the course.

The medical provision was largely worked out of St. John’s Ambulance gazebos, set up as medical stations at numerous points along the route. This included mobile medical units, as well as defibrillators, oxygen tanks, and other emergency medical equipment. This year medical stations were also supplied with Women’s essentials including pads, wet sipes, and sanitary supplies as well as breastfeeding support at the halfway point and finish.

Fortunately, this year, conditions were favourable, with little wind, some rain, and not too hot. With heat being one of the things we worry about most, the rain was more than tolerable and is always a good exchange for a hot day which can see many runners dehydrated or suffer with heat stroke. We know from previous London Marathon stats that heat stroke accounts for around 20% of the hospital admissions, is predominantly males under 40, and there have been two previous deaths and four near fatal cases since 1981.

The medical provision at the London Marathon was designed to ensure that runners received prompt and effective medical care in the event of an injury or medical emergency. Runners who require medical attention can be treated on-site or those who were seriously ill could be quickly transported to a St. Thomas’s Hospital where the ECMO team were on standby. In addition, there were 39 static treatment centres on route, cycle responders (15 teams of two), 10 static treatment centres at the finish, 52 ambulances, two doctors at each treatment centre, 114 health care professionals (paramedics, nurses), 120 physios, and 62 podiatrists. In addition, there were students to support the physiotherapists who performed massage (if within scope of practice) and note taking.

One of the most common problems we saw, as physiotherapists on the course, was cramp, and several hundred runners stopped at the medical stations complaining of cramp, which was largely dealt with by the physiotherapists and students who perform stretching, advice and guidance. In most cases runners get on their way again, but severe cramps and muscle pulls are sometimes required for people to be medically withdrawn.

The London Marathon also provides medical advice and support for runners in the lead-up to the event. This includes information on injury prevention, hydration and nutrition, and other aspects of training and preparation that can help to ensure a safe and successful race. In addition, there was an excellent Marathon Medical conference for healthcare practitioners the day before the Marathon, with free tickets available for all.

Overall, the London Marathon was a huge success, with 49272 runners starting and more than 48000 finishers. My first marathon experience was running the mini marathon for Bromley in 1992 aged 12. I still have the T-shirt somewhere, with three orange figures doing warm-up stretches on the front, and on the back of the T-shirt, the slogan… A Day to Remember.