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<!DOCTYPE html> <html lang="en" dir="ltr" xmlns="http://www.w3.org/1999/xhtml" xmlns:mml="http://www.w3.org/1998/Math/MathML"> <head prefix="og: http://ogp.me/ns# article: http://ogp.me/ns/article# book: http://ogp.me/ns/book#" >  <link rel="dns-prefetch" href="//d33xdlntwy0kbs.cloudfront.net" /> <link rel="dns-prefetch" href="//cdn.jsdelivr.net" /> <link rel="dns-prefetch" href="//www.google.com" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <link rel="dns-prefetch" href="//www.googletagmanager.com" /> <link rel="dns-prefetch" href="//rum-static.pingdom.net" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://www.medrxiv.org/sites/default/files/images/favicon.ico" type="image/vnd.microsoft.icon" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <meta name="type" content="article" /> <meta name="category" content="article" /> <meta name="HW.identifier" content="/medrxiv/early/2025/02/10/2025.02.05.25321727.atom" /> <meta name="HW.pisa" content="medrxiv;2025.02.05.25321727v1" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="Retrospective Study for Safer Management for Citizen’s Marathon: A Medical Support Perspective" /> <meta name="DC.Identifier" content="10.1101/2025.02.05.25321727" /> <meta name="DC.Date" content="2025-02-10" /> <meta name="DC.Publisher" content="Cold Spring Harbor Laboratory Press" /> <meta name="DC.Rights" content="© 2025, Posted by Cold Spring Harbor Laboratory. The copyright holder for this pre-print is the author. All rights reserved. The material may not be redistributed, re-used or adapted without the author's permission." /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Description" content="Background Although the number of individuals who enjoy sports every day is increasing owing to growing health consciousness, marathons pose health risks and can cause various types of health damage, including cardiac arrest. Furthermore, it is important to establish a system for predicting dangers and providing medical care in advance, including securing routes for transporting individuals in need of medical care during mass-gathering events. Objective This study aimed to investigate cases requiring medical care that occurred since the introduction of the full marathon at the Yokohama Citizen’s Marathon in 2015 and to examine the medical care system and its safety in relation to efforts to build a safer medical system for large-scale marathon races. Methods We retrospectively examined the incidence of health disorders and cardiac arrest during the Yokohama marathon race using the medical records provided by our committee from 2015 to 2024. Additionally, we retrospectively examined the changes in the medical support system. Results The total number of participants in the full marathon was 134,946 (total number of runners, 147,861), while the number of medical staff was 4,669 (total number of runners, 3.1±0.4%). There were 136 cases of emergency transport (0.1%), of which 27 required hospitalization (0.02%), and 3 cases of cardiac arrest during the competition (0.002%). All patients were quickly resuscitated on-site with cardiopulmonary resuscitation, and no deaths occurred. The patient presentation ratio (PPR), which represents the number of injuries and sickness per 1,000 runners, was 14.76 (range, 11.1–17.7), and the transport-to-hospital ratio (TTHR), which represents the number of emergency transports per 1,000 runners, was 0.96 (range, 0.4–2.1). Discussion Although the number of emergency transports increased and decreased owing to changes in the timing of the event and changes in temperature, it was possible to provide faster and more appropriate medical care to those in need of medical assistance. Analyzing these results annually and reviewing countermeasures to improve the medical support manual will lead to safer marathons. Such efforts will directly lead to a reduction in the number of emergency transports. In fact, the PPR was significantly lower in the current study than that in previous studies, while the TTHR was lower or similar to that in a previous study. Conclusion The Yokohama marathon is one of the largest marathons in Japan, and this study identified some participants requiring care on-course every year. Analysis of annual injury data has enabled better prediction and response to injuries, leading to safer marathon events. Most medical complaints were minor illness caused by dehydration or musculoskeletal in nature; however, there were life-threatening conditions such as CA that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. More detailed analysis of past race data under various environmental conditions is essential for running a safer large-scale citizen marathon, and the establishment of “All Yokohama” medical support system that includes local medical institutions, volunteer staff, fire departments, police, and medical staff contributes to running a safer citizen marathon. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Yokohama City University Hospital, Public University Corporation Medical and Hospital Management Department, Clinical Research Promotion Division, Ethics Office (1-1-1 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan). After checking against internationally established research ethics guidelines, the judgement was determined that the study does not constitute "life science/medical research involving human subjects." I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript." /> <meta name="DC.Contributor" content="Fumihiro Ogawa" /> <meta name="DC.Contributor" content="Riichiro Nakayama" /> <meta name="DC.Contributor" content="Yusuke Nakayama" /> <meta name="DC.Contributor" content="Yoji Yuasa" /> <meta name="DC.Contributor" content="Tomohiro Kamagata" /> <meta name="DC.Contributor" content="Kohei Takahashi" /> <meta name="DC.Contributor" content="Ryosuke Furuya" /> <meta name="DC.Contributor" content="Shohei Imaki" /> <meta name="DC.Contributor" content="Ichiro Takeuchi" /> <meta name="DC.Contributor" content="Yokohama Marathon Management Committee" /> <meta name="article:published_time" content="2025-02-10" /> <meta name="citation_title" content="Retrospective Study for Safer Management for Citizen’s Marathon: A Medical Support Perspective" /> <meta name="citation_abstract" lang="en" content="<p>Background: Although the number of individuals who enjoy sports every day is increasing owing to growing health consciousness, marathons pose health risks and can cause various types of health damage, including cardiac arrest. Furthermore, it is important to establish a system for predicting dangers and providing medical care in advance, including securing routes for transporting individuals in need of medical care during mass gathering events. Objective: This study aimed to investigate cases requiring medical care that occurred since the introduction of the full marathon at the Yokohama Citizen Marathon in 2015 and to examine the medical care system and its safety in relation to efforts to build a safer medical system for large scale marathon races. Methods: We retrospectively examined the incidence of health disorders and cardiac arrest during the Yokohama marathon race using the medical records provided by our committee from 2015 to 2024. Additionally, we retrospectively examined the changes in the medical support system. Results: The total number of participants in the full marathon was 134,946 (total number of runners, 147,861), while the number of medical staff was 4,669 (total number of runners, 3.1%). There were 136 cases of emergency transport (0.1%), of which 27 required hospitalization (0.02%), and 3 cases of cardiac arrest during the competition (0.002%). All patients were quickly resuscitated on-site with cardiopulmonary resuscitation, and no deaths occurred. The patient presentation ratio (PPR), which represents the number of injuries and sickness per 1,000 runners, was 14.76 (range, from 11.1 to 17.7), and the transport-to-hospital ratio (TTHR), which represents the number of emergency transports per 1,000 runners, was 0.96 (range, from 0.4 to 2.1). Discussion: Although the number of emergency transports increased and decreased owing to changes in the timing of the event and changes in temperature, it was possible to provide faster and more appropriate medical care to those in need of medical assistance. Analyzing these results annually and reviewing countermeasures to improve the medical support manual will lead to safer marathons. Such efforts will directly lead to a reduction in the number of emergency transports. In fact, the PPR was significantly lower in the current study than that in previous studies, while the TTHR was lower or similar to that in a previous study. Conclusion: The Yokohama marathon is one of the largest marathons in Japan, and this study identified some participants requiring care on course every year. Analysis of annual injury data has enabled better prediction and response to injuries, leading to safer marathon events. Most medical complaints were minor illness caused by dehydration or musculoskeletal in nature; however, there were life threatening conditions such as CA that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. More detailed analysis of past race data under various environmental conditions is essential for running a safer large scale citizen marathon, and the establishment of All Yokohama medical support system that includes local medical institutions, volunteer staff, fire departments, police, and medical staff contributes to running a safer citizen marathon.</p>" /> <meta name="citation_journal_title" content="medRxiv" /> <meta name="citation_publisher" content="Cold Spring Harbor Laboratory Press" /> <meta name="citation_publication_date" content="2025/01/01" /> <meta name="citation_mjid" content="medrxiv;2025.02.05.25321727v1" /> <meta name="citation_id" content="2025.02.05.25321727v1" /> <meta name="citation_public_url" content="https://www.medrxiv.org/content/10.1101/2025.02.05.25321727v1" /> <meta name="citation_abstract_html_url" content="https://www.medrxiv.org/content/10.1101/2025.02.05.25321727v1.abstract" /> <meta name="citation_full_html_url" content="https://www.medrxiv.org/content/10.1101/2025.02.05.25321727v1.full" /> <meta name="citation_pdf_url" content="https://www.medrxiv.org/content/medrxiv/early/2025/02/10/2025.02.05.25321727.full.pdf" /> <meta name="citation_doi" content="10.1101/2025.02.05.25321727" /> <meta name="citation_num_pages" content="33" /> <meta name="citation_article_type" content="Article" /> <meta name="citation_firstpage" content="2025.02.05.25321727" /> <meta name="citation_author" content="Fumihiro Ogawa" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author_institution" content="Department of Emergency Medicine, Yokohama City University, School of Medicine" /> <meta name="citation_author_email" content="fumihiro@yokohama-cu.ac.jp" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-7069-9334" /> <meta name="citation_author" content="Riichiro Nakayama" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author" content="Yusuke Nakayama" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author_institution" content="Department of Emergency Medicine, Yokohama City Minato Red Cross Hospital" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-5691-7964" /> <meta name="citation_author" content="Yoji Yuasa" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author_institution" content="Department of Emergency Medicine, Keiyu Hospital" /> <meta name="citation_author" content="Tomohiro Kamagata" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author_institution" content="Department of Emergency Medicine, Keiyu Hospital" /> <meta name="citation_author" content="Kohei Takahashi" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author_institution" content="Department of Emergency Medicine, Yokohama Municipal Citizen’s Hospital" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-6670-0283" /> <meta name="citation_author" content="Ryosuke Furuya" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author_institution" content="Department of Emergency Medicine, NHO Yokohama Medical Center" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-0751-6267" /> <meta name="citation_author" content="Shohei Imaki" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author" content="Ichiro Takeuchi" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_author_institution" content="Department of Emergency Medicine, Yokohama City University, School of Medicine" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0001-7125-5017" /> <meta name="citation_author" content="Yokohama Marathon Management Committee" /> <meta name="citation_author_institution" content="Medical Committee for Yokohama Marathon" /> <meta name="citation_reference" content="Fields KB, Sykes JC, Walker KM, Jackson JC. 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Br J Sports Med. 2007;41(8):469–80; discussion 80." /> <meta name="twitter:title" content="Retrospective Study for Safer Management for Citizen’s Marathon: A Medical Support Perspective" /> <meta name="twitter:site" content="@medrxivpreprint" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:image" content="https://www.medrxiv.org/sites/default/files/images/medrxiv_logo_homepage7-5-small-test-up.png" /> <meta name="twitter:description" content="Background Although the number of individuals who enjoy sports every day is increasing owing to growing health consciousness, marathons pose health risks and can cause various types of health damage, including cardiac arrest. Furthermore, it is important to establish a system for predicting dangers and providing medical care in advance, including securing routes for transporting individuals in need of medical care during mass-gathering events. Objective This study aimed to investigate cases requiring medical care that occurred since the introduction of the full marathon at the Yokohama Citizen’s Marathon in 2015 and to examine the medical care system and its safety in relation to efforts to build a safer medical system for large-scale marathon races. Methods We retrospectively examined the incidence of health disorders and cardiac arrest during the Yokohama marathon race using the medical records provided by our committee from 2015 to 2024. Additionally, we retrospectively examined the changes in the medical support system. Results The total number of participants in the full marathon was 134,946 (total number of runners, 147,861), while the number of medical staff was 4,669 (total number of runners, 3.1±0.4%). There were 136 cases of emergency transport (0.1%), of which 27 required hospitalization (0.02%), and 3 cases of cardiac arrest during the competition (0.002%). All patients were quickly resuscitated on-site with cardiopulmonary resuscitation, and no deaths occurred. The patient presentation ratio (PPR), which represents the number of injuries and sickness per 1,000 runners, was 14.76 (range, 11.1–17.7), and the transport-to-hospital ratio (TTHR), which represents the number of emergency transports per 1,000 runners, was 0.96 (range, 0.4–2.1). Discussion Although the number of emergency transports increased and decreased owing to changes in the timing of the event and changes in temperature, it was possible to provide faster and more appropriate medical care to those in need of medical assistance. Analyzing these results annually and reviewing countermeasures to improve the medical support manual will lead to safer marathons. Such efforts will directly lead to a reduction in the number of emergency transports. In fact, the PPR was significantly lower in the current study than that in previous studies, while the TTHR was lower or similar to that in a previous study. Conclusion The Yokohama marathon is one of the largest marathons in Japan, and this study identified some participants requiring care on-course every year. Analysis of annual injury data has enabled better prediction and response to injuries, leading to safer marathon events. Most medical complaints were minor illness caused by dehydration or musculoskeletal in nature; however, there were life-threatening conditions such as CA that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. More detailed analysis of past race data under various environmental conditions is essential for running a safer large-scale citizen marathon, and the establishment of “All Yokohama” medical support system that includes local medical institutions, volunteer staff, fire departments, police, and medical staff contributes to running a safer citizen marathon. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Yokohama City University Hospital, Public University Corporation Medical and Hospital Management Department, Clinical Research Promotion Division, Ethics Office (1-1-1 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan). After checking against internationally established research ethics guidelines, the judgement was determined that the study does not constitute "life science/medical research involving human subjects." I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript." /> <meta name="og-title" property="og:title" content="Retrospective Study for Safer Management for Citizen’s Marathon: A Medical Support Perspective" /> <meta name="og-url" property="og:url" content="https://www.medrxiv.org/content/10.1101/2025.02.05.25321727v1" /> <meta name="og-site-name" property="og:site_name" content="medRxiv" /> <meta name="og-description" property="og:description" content="Background Although the number of individuals who enjoy sports every day is increasing owing to growing health consciousness, marathons pose health risks and can cause various types of health damage, including cardiac arrest. Furthermore, it is important to establish a system for predicting dangers and providing medical care in advance, including securing routes for transporting individuals in need of medical care during mass-gathering events. Objective This study aimed to investigate cases requiring medical care that occurred since the introduction of the full marathon at the Yokohama Citizen’s Marathon in 2015 and to examine the medical care system and its safety in relation to efforts to build a safer medical system for large-scale marathon races. Methods We retrospectively examined the incidence of health disorders and cardiac arrest during the Yokohama marathon race using the medical records provided by our committee from 2015 to 2024. Additionally, we retrospectively examined the changes in the medical support system. Results The total number of participants in the full marathon was 134,946 (total number of runners, 147,861), while the number of medical staff was 4,669 (total number of runners, 3.1±0.4%). There were 136 cases of emergency transport (0.1%), of which 27 required hospitalization (0.02%), and 3 cases of cardiac arrest during the competition (0.002%). All patients were quickly resuscitated on-site with cardiopulmonary resuscitation, and no deaths occurred. The patient presentation ratio (PPR), which represents the number of injuries and sickness per 1,000 runners, was 14.76 (range, 11.1–17.7), and the transport-to-hospital ratio (TTHR), which represents the number of emergency transports per 1,000 runners, was 0.96 (range, 0.4–2.1). Discussion Although the number of emergency transports increased and decreased owing to changes in the timing of the event and changes in temperature, it was possible to provide faster and more appropriate medical care to those in need of medical assistance. Analyzing these results annually and reviewing countermeasures to improve the medical support manual will lead to safer marathons. Such efforts will directly lead to a reduction in the number of emergency transports. In fact, the PPR was significantly lower in the current study than that in previous studies, while the TTHR was lower or similar to that in a previous study. Conclusion The Yokohama marathon is one of the largest marathons in Japan, and this study identified some participants requiring care on-course every year. Analysis of annual injury data has enabled better prediction and response to injuries, leading to safer marathon events. Most medical complaints were minor illness caused by dehydration or musculoskeletal in nature; however, there were life-threatening conditions such as CA that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. More detailed analysis of past race data under various environmental conditions is essential for running a safer large-scale citizen marathon, and the establishment of “All Yokohama” medical support system that includes local medical institutions, volunteer staff, fire departments, police, and medical staff contributes to running a safer citizen marathon. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Yokohama City University Hospital, Public University Corporation Medical and Hospital Management Department, Clinical Research Promotion Division, Ethics Office (1-1-1 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan). After checking against internationally established research ethics guidelines, the judgement was determined that the study does not constitute "life science/medical research involving human subjects." I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. 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class="highwire-article-citation highwire-citation-type-highwire-article node942991" data-node-nid="942991" id="node-942991--22007586727" data-pisa="medrxiv;2025.02.05.25321727v1" data-pisa-master="medrxiv;2025.02.05.25321727" data-apath="/medrxiv/early/2025/02/10/2025.02.05.25321727.atom" data-hw-author-tooltip-instance=""><div class="highwire-cite highwire-cite-highwire-article highwire-citation-medrxiv-article-top clearfix has-author-tooltip" > <h1 class="highwire-cite-title" id="page-title">Retrospective Study for Safer Management for Citizen’s Marathon: A Medical Support Perspective</h1> <div class="highwire-cite-authors" ><span class="highwire-citation-authors"><span class="highwire-citation-author first hw-author-orcid-logo-wrapper" data-delta="0"><a href="http://orcid.org/0000-0002-7069-9334" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Fumihiro</span> <span class="nlm-surname">Ogawa</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Riichiro</span> <span class="nlm-surname">Nakayama</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="2"><a href="http://orcid.org/0000-0002-5691-7964" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Yusuke</span> <span class="nlm-surname">Nakayama</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Yoji</span> <span class="nlm-surname">Yuasa</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Tomohiro</span> <span class="nlm-surname">Kamagata</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="5"><a href="http://orcid.org/0000-0002-6670-0283" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Kohei</span> <span class="nlm-surname">Takahashi</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="6"><a href="http://orcid.org/0000-0002-0751-6267" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Ryosuke</span> <span class="nlm-surname">Furuya</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Shohei</span> <span class="nlm-surname">Imaki</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="8"><a href="http://orcid.org/0000-0001-7125-5017" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Ichiro</span> <span class="nlm-surname">Takeuchi</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-collab" data-hwp-id="collab-1">Yokohama Marathon Management Committee</span></span></span></div> <div class="highwire-cite-metadata" ><span class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">doi:</span> https://doi.org/10.1101/2025.02.05.25321727 </span></div> </div> <div id="hw-article-author-popups-node-942991--22007586727" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Fumihiro Ogawa </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Medical Committee for Yokohama Marathon</span></div><div class='author-affiliation'><span class='nlm-sup'>2</span><span class='nlm-institution'>Department of Emergency Medicine, Yokohama City University, School of Medicine</span>, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, <span class='nlm-country'>Japan</span></div>MD, PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Fumihiro%2BOgawa%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ogawa%20F&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AFumihiro%2BOgawa%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link"><a href="http://orcid.org/0000-0002-7069-9334" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Fumihiro Ogawa</a></li><li class="author-corresp-email-link last"><span>For correspondence: <a href="mailto:fumihiro@yokohama-cu.ac.jp" class="" data-icon-position="" data-hide-link-title="0">fumihiro@yokohama-cu.ac.jp</a></span></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Riichiro Nakayama </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Medical Committee for Yokohama Marathon</span></div>MD, PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Riichiro%2BNakayama%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nakayama%20R&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARiichiro%2BNakayama%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Yusuke Nakayama </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Medical Committee for Yokohama Marathon</span></div><div class='author-affiliation'><span class='nlm-sup'>3</span><span class='nlm-institution'>Department of Emergency Medicine, Yokohama City Minato Red Cross Hospital</span>, 3-12-1, Shin-yamashita, Naka-ku, Yokohama, <span class='nlm-country'>Japan</span></div>MD, PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Yusuke%2BNakayama%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nakayama%20Y&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AYusuke%2BNakayama%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this 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href="/content/10.1101/2025.02.05.25321727v1.full.pdf+html" class="panels-ajax-tab-tab" data-panel-name="biorxiv_tab_pdf" data-target-id="highwire_article_tabs" data-entity-context="node:942991" data-trigger="full.pdf+html" data-url-enabled="1"><i class="icon-file-alt"></i> Preview PDF</a><a href="/panels_ajax_tab/biorxiv_tab_pdf/node:942991/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li></ul></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="biorxiv_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://www.medrxiv.org/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-biorxiv_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2 class="">Abstract</h2><div id="sec-1" class="subsection"><p id="p-3"><strong>Background</strong> Although the number of individuals who enjoy sports every day is increasing owing to growing health consciousness, marathons pose health risks and can cause various types of health damage, including cardiac arrest. Furthermore, it is important to establish a system for predicting dangers and providing medical care in advance, including securing routes for transporting individuals in need of medical care during mass-gathering events.</p></div><div id="sec-2" class="subsection"><p id="p-4"><strong>Objective</strong> This study aimed to investigate cases requiring medical care that occurred since the introduction of the full marathon at the Yokohama Citizen’s Marathon in 2015 and to examine the medical care system and its safety in relation to efforts to build a safer medical system for large-scale marathon races.</p></div><div id="sec-3" class="subsection"><p id="p-5"><strong>Methods</strong> We retrospectively examined the incidence of health disorders and cardiac arrest during the Yokohama marathon race using the medical records provided by our committee from 2015 to 2024. Additionally, we retrospectively examined the changes in the medical support system.</p></div><div id="sec-4" class="subsection"><p id="p-6"><strong>Results</strong> The total number of participants in the full marathon was 134,946 (total number of runners, 147,861), while the number of medical staff was 4,669 (total number of runners, 3.1±0.4%). There were 136 cases of emergency transport (0.1%), of which 27 required hospitalization (0.02%), and 3 cases of cardiac arrest during the competition (0.002%). All patients were quickly resuscitated on-site with cardiopulmonary resuscitation, and no deaths occurred. The patient presentation ratio (PPR), which represents the number of injuries and sickness per 1,000 runners, was 14.76 (range, 11.1–17.7), and the transport-to-hospital ratio (TTHR), which represents the number of emergency transports per 1,000 runners, was 0.96 (range, 0.4–2.1).</p></div><div id="sec-5" class="subsection"><p id="p-7"><strong>Discussion</strong> Although the number of emergency transports increased and decreased owing to changes in the timing of the event and changes in temperature, it was possible to provide faster and more appropriate medical care to those in need of medical assistance. Analyzing these results annually and reviewing countermeasures to improve the medical support manual will lead to safer marathons. Such efforts will directly lead to a reduction in the number of emergency transports. In fact, the PPR was significantly lower in the current study than that in previous studies, while the TTHR was lower or similar to that in a previous study.</p></div><div id="sec-6" class="subsection"><p id="p-8"><strong>Conclusion</strong> The Yokohama marathon is one of the largest marathons in Japan, and this study identified some participants requiring care on-course every year. Analysis of annual injury data has enabled better prediction and response to injuries, leading to safer marathon events. Most medical complaints were minor illness caused by dehydration or musculoskeletal in nature; however, there were life-threatening conditions such as CA that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. More detailed analysis of past race data under various environmental conditions is essential for running a safer large-scale citizen marathon, and the establishment of “All Yokohama” medical support system that includes local medical institutions, volunteer staff, fire departments, police, and medical staff contributes to running a safer citizen marathon.</p></div></div><h3>Competing Interest Statement</h3><p id="p-9">The authors have declared no competing interest.</p><h3>Funding Statement</h3><p id="p-10">This study did not receive any funding</p><h3>Author Declarations</h3><p id="p-11">I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.</p><p id="p-12">Yes</p><p id="p-13">The details of the IRB/oversight body that provided approval or exemption for the research described are given below:</p><p id="p-14">Yokohama City University Hospital, Public University Corporation Medical and Hospital Management Department, Clinical Research Promotion Division, Ethics Office (1-1-1 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan). After checking against internationally established research ethics guidelines, the judgement was determined that the study does not constitute "life science/medical research involving human subjects."</p><p id="p-15">I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.</p><p id="p-16">Yes</p><p id="p-17">I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).</p><p id="p-18">Yes</p><p id="p-19">I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.</p><p id="p-20">Yes</p><div class="section data-availability" id="sec-29"><h2 class="">Data Availability</h2><p id="p-67">All data produced in the present work are contained in the manuscript.</p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-biorxiv-copyright" > <div class="pane-content"> <div class="field field-name-field-highwire-copyright field-type-text field-label-inline clearfix"><div class="field-label">Copyright </div><div class="field-items"><div class="field-item even">The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.<span class="license-type-none"> All rights reserved. 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