
Delays in Emergency Care and Mortality During Major U.S. Marathons - luu
https://www.nejm.org/doi/full/10.1056/NEJMsa1614073
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mattkrause
If delays of 4.4 minutes drive this effect, shouldn’t there also be massive
swings in mortality every day (rush hour), and at the end of the weeks?

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mlthoughts2018
Yes, but I’m not sure what that would matter. I suppose they needed to control
for time of day among marathons, but often they are all early on weekend days.

The point is to study the causal impact of having marathons vs not. Comparing
that effect to other times of week which does not contain a marathon is not
useful for much.

It could tell you if hosting a marathon is about as costly as having X more
rush hours’ worth of mortality or something, but does not relate to the causal
effect of the marathon.

For an example to compare, think about studying the impact on crime of
heatwaves in a winter month. Someone could say, but won’t there be spikes of
crime from heat in summer months? Yes, but why is it relevant — the point is
to know the effect of the heatwave.

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ProblemFactory
Effect size and comparison to other causes matters, because every study will
be used as evidence for some political argument.

This study ("Marathons kill people!") will be used to argue for banning
marathons in cities by people why are inconvenienced by the road closures.

A comparison to other common and accepted causes of traffic delays - or
positive health impact of marathons - will prevent this misuse.

A similar thing happens with wind turbines killing birds. Yes they do. But
radio towers, power pylons, agriculture, pesticide use, cars _each_ kill 100x
more, building windows 1000x more, and cats 10000x more. Yet it is still a
popular argument used by people who are against renewable energy for other
reasons, while nobody argues for banning skyscrapers.

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mlthoughts2018
I agree in general and even said exactly this in my comment (comparing effect
size in terms of X rush hours’ worth of mortality).

But in the specific case of policy adoption towards marathons, I don’t agree
that comparison matters much for interpretation.

Banning marathons is totally different than taking action to reduce generic or
rush hour traffic. Marathons are a purely recreational thing for society,
nobody has any sincere need for them, certainly no needs to be colocated with
dense urban areas.

Rush hour traffic is an emergent effect of necessary daily commuters and
operations of a city.

Disentangling what part of it is needed, what can be reduced, and how to
politically coordinate it is an entirely different situation.

In this sense, if banning marathons prevents even a tiny effect size on
mortality, it’s obviously worth it, no matter if it is only saving 0.1 rush
hours’ worth of mortality, or 0.01, or 0.001. Comparing with rush hour effect
size adds virtually nothing to the process.

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mattkrause
> If banning [something] prevents even a tiny effect size on [bad outcome]
> it’s obviously worth it

The same logic is why we now shuffle around in our socks at the airport. It is
a _terrible_ recipe for making policy.

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mlthoughts2018
Of course if you take it out of context it fails to generalize. Why would you
think it should generalize?

Nobody is saying this about [something] or [bad outcome], only about marathons
that demonstrate causal impact of higher mortality rate due to traffic impact
on emergency services.

It’s not a recipe. It’s weird to me that you’d even suggest such a non
sequitur concept.

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drcode
To me, the central question is whether marathon running is more popular
amongst parts of a community with more political clout, and whether this
explains the how participants manage to impose inconveniences (and potentially
more serious harms, as suggested in this paper) on the rest of the community
by staging a marathon.

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ip26
This is maybe a tangent but if everything collapses when one road is closed
that suggests a system lacking resiliency.

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ken
True, but you don't need a marathon to tell you that. Just go anywhere
downtown at rush hour on a weekday. Every 5 minutes, some driver will enter
the box before it's clear, and block the intersection both ways for everybody.

A couple months ago, a package truck crashed on the freeway a mile ahead of
me, and traffic didn't move for over 3 hours. Our roads are not designed with
redundancy as a primary concern.

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cma
Not exactly what you meant, but I believe the interstate highway system was
designed for redundancy for military mobility as a primary concern after WWII
because of how easily rail could be taken out.

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seminatl
Looking forward to all the contortions people will suggest so that we can do
literally anything except not ban cars on crowded marathon days, which is the
obvious and easiest solution.

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JohnJamesRambo
26.2 miles can be laid out anywhere in a rural or suburban area. Those of us
that run on country roads know that space is never a problem. There is no need
for it to be run in the heart of a city other than vanity and trying to leech
money from the attendees.

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ghaff
Not everything is about need. I don't see too many residents of NY or Boston
clamoring to get rid of their respective marathons because they're
inconvenient. You could say the same thing of other notable sports and other
events.

It's true they bring in money and it's also true that most residents are sort
of proud of them even if they don't participate. But I'm not sure how any of
those things are so horrible.

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mattkrause
Heck, it’s possible that urban marathons, by promoting fitness (etc), have a
net positive effect on health despite this.

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cozzyd
I wonder if they properly controlled for the Boston Marathon bombing. Although
there were amazingly few direct casualties given the circumstances, the extra
strain on the hospital system may have had substantial second order effects.

~~~
maxerickson
They did not include 2013 in their analysis.

They also typically found ~11 hospitalizations of Medicare recipients for
heart attacks on a study day and included ~12,000 hospitalizations, so 1 day
wouldn't impact the data that much anyway.

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jonstewart
How’s this compare to weekday rush hour, though?

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erentz
It looks like the study doesn’t have data that would enable them to determine
that. The marathon event presents a known day where there is disruption, which
they can see in ambulance transport times. They then can see in Medicare data
patient outcomes based on days. Looks like they’d need much more granular data
on admission times, etc from the Medicare data set which probably is not
possible.

That said you can probably infer from everything we know that if ambulance
transport times are longer during rush hour then patient outcomes are also
worse.

~~~
JshWright
In theory that data exists. The NEMSIS data set includes transport timestamps
and locations (allowing you to determine some sort of "rush hour impact
score"), and enough identifying information follow up with the pt's outcome.

There's no unified dataset linking the two though, so it would be a fair bit
of work.

[https://nemsis.org/media/nemsis_v3/release-3.5.0/DataDiction...](https://nemsis.org/media/nemsis_v3/release-3.5.0/DataDictionary/PDFHTML/EMSDEMSTATE/NEMSISDataDictionary.pdf)

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NotSammyHagar
They article says on marathon days it took 4.4 minutes to get to the hospital,
with similar number of incidents as on regular days. That's believable. That
would also be true if there was a parade or a big football game.

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in3d
No, it doesn’t. It says it took 4.4 minutes _longer_.

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NotSammyHagar
right, sorry, that was a typo, you are of course correct it was 4.4 minutes
longer. doesn't change my thought, does it?

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notadoc
> 2757 deaths in 11,074 hospitalizations

That seems like a high death rate for hospitalizations, does it not? Would be
interesting to see the breakdown of admissions and cause of death.

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beerandt
It's probably for emergency only admits, and probably also includes DOAs.
Which would make it more understandable.

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cm2012
This is amazing research.

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ycombonator
Why can't these people run far away from cities and suburbs ? There are plenty
of remote roads. Sort of like Dakar.

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h_r
They could possibly do this but the logistics would be messy. For large
marathons, people travel to the destination from all over the world and book
hotels in the city where they can easily get to the start location. Also,
seeing the city while running the marathon, however inconvenient to others, is
part of the attraction of the location.

If the actual marathon course is somewhere remote from the city, it's unlikely
such a place would have the hotel space for all the runners, and transporting
them to/from the site would be a massive undertaking in itself. Chicago has
about 45,000 runners every year. Then there are all the volunteers who need to
get to and from stations around the course.

I'm not saying any of this to discount the argument that marathons impose a
huge inconvenience, only that moving them elsewhere isn't so cut and dried a
solution.

~~~
ghaff
>people travel to the destination from all over the world and book hotels in
the city where they can easily get to the start location.

Or at the end. The Boston Marathon actually starts pretty much 26 miles to the
west of downtown in a suburb/exurb. So runners do need transportation to get
to the start. It's not really accessible by public transit but I imagine there
are buses in addition to people just getting rides from friends/family.

It _is_ held on a (state) holiday and a lot of Boston companies give the day
off. (And companies out by the start like EMC do as well because their parking
lots are used.)

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uberduber
Seconds count. We already know that speed bumps kill 9 for every 1 life they
save, due to ambulance delays. Ambulances are heavy and can't go over speed
bumps very quickly. The 1 life they save is from someone not going so fast.

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JshWright
I'm not so sure that's a thing we "known". I didn't have any luck tracking
down the origin of that stat (it looks like it may be from a study in Boulder
CO, but other than the same sentence referencing it that seems to show up in a
bunch of articles, I can't find actual study).

I'd be very surprised if that was actually a rigorously proven stat.

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uberduber
You may be right. It's been a while. I remember reading a news article some
place where they had the stats before they put them in, and found out after
that ambulance times were delayed and the death rate went up, and then they
tore them all out at great expense. The other ones I remember seeing are more
like the one linked below. I think they proved the speed bumps result in
ambulance delays, and assume deaths based on a rate. I also recall not being
able to find any solid data that the speed bumps save lives.

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JshWright
Absent some solid evidence, I just don't buy it (based on a fair bit of
experience as a paramedic). Speed bumps don't slow you down that much, and
"seconds" really aren't that important.

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uberduber
Interesting, I have a few friends who were formerly EMTs and when I spoke to
some former paramedic acquaintances, they seemed to believe the speed bumps
were detrimental in certain specific medical cases, things like cardiac arrest
and aortic aneurysms.

I'm in SoCal and some of these neighborhoods are just full of speed bumps, so
maybe it's all of those seconds adding to minutes? Also there are different
types of speed bumps, some don't slow you down at all and others you go 5mph
and feel like you're ruining your suspension. Or maybe there's some other
confounding factor? Do you only have a few where you live?

