Medics and the London Marathon – 5 Questions to Race Medical Director Prof Sanjay Sharma

Siobhan Harris


April 22, 2019

The world's most popular marathon takes place on Sunday 28th April. More than 40,000 people are taking part in what will be the 39th London Marathon.

The 26.2 mile course will be tackled by elite runners and wheelchair athletes, but the vast majority will be amateurs lucky enough to have secured a place in the ballot. Many of them will be running in fancy dress for charity.

It raises more money for charitable causes than any other sporting event in the UK.


Prof Sanjay Sharma

Professor Sanjay Sharma of St George's, University of London is the London Marathon's medical director.

Medscape UK spoke to him about being in charge of co-ordinating medical support for the race.

What does your role as medical director for the London Marathon entail?

There are different elements to my job. The most important I would say is to recruit around 160 to 170 middle grade doctors. These doctors are screened for their skill mix. We need doctors who are medical intensivists and can deal with medical emergencies, cardiologists, and sports medicine doctors to deal with soft tissue injuries or joint problems. We also have physiotherapists and podiatrists.

The grade is important too. We need doctors who are senior enough to work independently. We have to make sure they are adequately qualified; we need evidence they work in the National Health Service and that they are registered with the General Medical Council. We also need to make sure they have their criminal records bureau check and that they are insured. So, it's quite a detailed process to make sure we have enough doctors of the right standard.

The Marathon works with the charity St John Ambulance; they are the main first aid provider for us and we have 1500 St John's volunteers who work with us.  We distribute our doctors at the 40 treatment centres around the course.

I also need to ensure that the medical kit is sufficient and there's enough distributed in all of the treatment centres, making sure all have a defibrillator.

We have three very major intensive therapy units right at the finish. We need to make sure we have all of the drugs for cardiac arrests or any other medical emergencies that arise. I need to make sure every single doctor has got a small pack of various medications that may be used to treat pain, inflammation and wasp or bee stings. They also carry Vaseline for chaps that can occur with running and they carry a special thermometer to check for heat stroke.

In what areas do you liaise with other directors? And what is the remit of medics on the ground? 

I work with the race directors so that I am aware of the contingence plans for extreme weather situations. Last year we had a temperature of 24 degrees Celsius. So, we had to make sure that runners would have enough water in case [they] became dehydrated and enough ice to cool people down.

I also need to work with the race directors to impart medical advice to runners and make sure the goody bags or recovery bags that runners pick up when they finished have got enough nutrients in them to keep them going after the race.

In addition, I work with the welfare team just in case there's a fatality or someone becomes terribly ill. The welfare team sits relatives down and it's their job to support them.

It's also my job to collate the information from all the hospitals where our admissions are taken, to work out what went well, what could have gone better and what lessons could be learned.

The aim of the medical services on the ground is firstly to provide life-saving interventions and transportation to definitive medical care.

[Then]To provide immediate minor treatment and discharge patients back to the marathon, or advise runners if they should pull out of the race when it is in the interests of their own health and wellbeing.

[And] To start treatment and provide guidance or onward referral to medical specialities for care after the marathon. Also to help those unable to complete the marathon (due to medical reasons) to reach the finish area to collect their belongings, and return home.

How long have you been doing the job and what are your biggest concerns on the day?

I started shadowing the original medical director Dan Tunstall Pedoe in 2002. I've been the full medical director since 2007. It'll be my 12th marathon as the full medical director and 17th in terms of general involvement.

Although we are getting better and better at predicting it, the weather is the main worry on the day. Especially the sudden switch in weather. Most of the marathons are run at temperatures between 11C and 15C. Our hottest marathon was last year when it reached 24C. The problem with marathons is not only are they pretty gruelling events but most people start training from November onwards and if you suddenly get a very hot day in April it can really catch runners out and cause a lot of work for the medical team.

The other thing that worries me is a fatality, not that they happen often but for me personally everything dissipates into nothing after such a catastrophe and team morale is low afterwards.

What are the most common injuries or complaints your team deals with on race day?

One in 20 people running the marathon makes contact with us for one reason or another.

The most common reason is because of blisters or a musculoskeletal problem, like a strain or a sprain. Four per cent will present with very serious problems, the most common of those serious issues is something called exercise associated collapse. It's not a collapse that necessarily denotes anything potentially fatal but is usually a collapse due to dehydration, fuel depletion, getting extremely hot or pure exhaustion. Exercise associated collapse affects about 1 in 100 of our runners. This year with around 41,000 finishers, we will have quite a few of those to deal with.

Is it easy to recruit doctors to be part of your team?

Because of current regulations imposed on major races and the fact it is a very visible race, we have to be selective. There was a time when any doctor could help out; they were doing their good Samaritan bit, giving up their Sunday to work for free, but as things have changed, we only take middle grade doctors, at least 4 years post qualification, which can make it difficult to recruit.

Saying that, I am medical director at a number of mass endurance events and the London Marathon is the one I have the least problem recruiting for. If we took all-comers we’d be oversubscribed.

At the finish we really need the most senior members and if we actually looked at the doctor profile we'd probably have more specialised consultants in that area than we do in most NHS A&E departments. It's probably the best place for a runner to become really ill as you've got expert doctors on hand.

It does require a lot of organisation. After the marathon we'll have a de-brief with the medical sub-committee and 6 weeks later we'll start planning for the next one.


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