Saturday, January 12, 2008

The Day The Dominoes All Fell Down....

Every so often, a memorable event will happen in sporting history that has no equal.

In the sport of running, there have been quite a few. Some times, the history will be exhilarating, like Alberto Salazar's courageous victories at the New York City Marathon. Other times, history may will be controversial, such as Katherine Switzer's bold statement when she entered herself in the 1967 Boston Marathon. But last year's Chicago Marathon would go down in history to be a catastrophic example of everything going wrong.

David Thigpen, a wonderful writer for the equally-heralded Runner's World, wrote in excruciating detail, the complete collapse that took place last October 7th in Chicago. Like, I had blogged earlier, I wanted to paraphrase his report, but sometimes the best way to honor a fellow writer is to quote him.

So without further adieu, I invite you all to enter the upside-down world of the 2007 Chicago Marathon, as told none better, than by David Thigpen. This article is a reprint from the February 2008, and I wholeheartedly recommend you buying this issue of Runner's World.


MELTDOWN-What REALLY Happened In Chicago
Peter Browne thought he was ready. All summer, the engineer from Mooresville, North Carolina had trained in warm weather for the LaSalle Bank Chicago Marathon under the supervision of a marathon coach, hoping to crack three hours for the first time. Browne has a huge emotional investment, too; race week marked the 20th anniversary of a motorcycle crash that had broken his back. He had worked all the way back from paralysis.

Early on October 7, armed with electrolyte replacement tablets and a white hat to stave off the sun, he confidently plunged in to the swarm of 36,000 runners. Browne, 42 and running his fifth marathon, quickly found his pace. He diligently gulped down water and Gatorade at every aid station. At the halfway mark, he was right on pace at 1:31.

But at mile 20, weakened by the intense heat, Browne began to slow. By mile 23, he was gripped by leg cramps. Less than a mile from the finish he was only a few minutes past his ambitious three-hour goal, but he began staggering and was caught by race volunteers who pulled him to the curb. "I sat down", Brown recalls, "and then just passed out." He wound up in an ambulance and then the emergency room at Mercy Hospital, where he spent the night being treated for dehydration and heat exhaustion.

The arc of Browne's day - from excitement to heartbreak, from racecourse to ER gurney - would be repeated scores of times. And even for many who avoided medical trauma, the marathon was a painful exercise that ended in frustration and bitter disappointment. Organizers had hoped to celebrate the race's 30th anniversary, boosting Chicago's bid to host the 2016 Summer Olympics. But by day's end, no one was in a mood to celebrate.




In the national media coverage that followed the event, there were only a few incontestable facts: It was Chicago's hottest October 7 in history, with temperatures peaking at 88F that afternoon; less than four hours after the start, with the mercury above 80F and some 30,000 runners out on the course, organizers announced that they were halting the race; and 185 participants required a trip to an emergency room, including one runner who died.

Beyond those facts, almost everything written about the marathon has been controversial, debatable, or at least very strange. There have been complaints about the performance of Executive Race Director Carey Pinkowski. There are conflicting stories about whether the
race was truly canceled, and whether the day was an outright disaster or a calamity averted. The event yielded a photo finish without photo-finish equipment, a woman who was sucker-punched in the face, and at least one potential lawsuit. In a word: chaos.

After conducting a lengthy investigation, Runner's World has assembled the most complete account of the marathon to date. Our reporting reveals new facts and paints a surprisingly complex picture. Race organizers, as well as many runners, underestimated the severity of the weather and its effects, and found themselves caught in the momentum of an event so large and complicated that halting it quickly was impossible. Only now can we say what really happened that day in Chicago.

Chicago is one of those cities that seem tailor-made for marathons. Laid out on a vast grid, it has miles of broad, straight avenues that stretch from one end of town to the other. The racecourse is flat and fast, with a peak elevation of 24 feet, making it mercifully free of punishing inclines like Boston's Heartbreak Hill, or New York's Verrazano-narrows Bridge. These conditions have made Chicago very popular with elite runners (eight of the 20 fastest times in the world have finished in Grant Park), mid-pack athletes looking to qualify for Boston, and first-timers looking for a relatively easy setting to achieve the goal of finishing.

Mother Nature often obliges the city with cool weather that abets fast times. October temperatures average 42 to 63F - nearly ideal - but on race days past, thermal gloves and wool hats have been out in force. The 2006 race saw cold rain.

Led by Pinkowski since 1990, and given indulgent support by the city, the marathon has grown at a breakneck clip to become one of the largest in the world. In 1994, 10,000 people registered. By 2000, it was up to 33,000. The 2007 event set a new record with 45,000 registrants, each of them forking over $110. The enormous field had the potential to present new crowd-control challenges even if the weather had been less extreme.

Organizers took concrete steps to prepare for a hot race day. The week before the event, they e-mailed a heat advisory to running clubs and other participants. They did so again on Saturday, October 6, and posted online advisories warning that high temperatures would demand extra hydration and caution. That same day, warnings were reiterated verbally at the expo.

The week before the race, Pinkowski met with the Chicago Fire Department (CFD) to secure additional resources: a ventilation fan, a giant misting machine, bike-patrol teams, and 22 open fire hydrants for spraying. Twenty-eight ambulances would be available, the most ever, and more would be on standby through a statewide system of ambulance sharing dubbed MABAS (Mutual Aid Box Alarm System). Pinkowski upped the number of drink servings from 1.6 million to 1.8 million, added ice and cooling sponges, and commandeered five air conditioned city buses to cool off overheated runners. But none of these precautions would turn out to be enough.
"It was hotter than fore casted, hotter than we anticipated," Pinkowski said in an interview 10 days after the race. "In the past we've had cold-weather issues." Out of habit he carried a jacket and gloves throughout the steamy day. "We were hoping for a light breeze or cloud cover."

But neither came. The day was sunny with high clouds and the rarest of conditions in Chicago: The wind was calm. In the stifling morning air - when the race started at 8am., the temperature stood at 72F in the shade, with 83 percent humidity-many competitors were having trouble keeping themselves cool before the race even started.

Melody Hopkins from Richmond, Virginia, recalls breaking in to a sweat on the walk to the start. Milling around in her start corral made her even warmer. "It took us 16 minutes to get from our corral to the starting line," she says. "I was drenched by the time we started -- just too many warmer bodies standing together." From the gun, the huge field -- 36,280 officially, meaning nearly 9,000 people elected not to run -- created problems.

Veteran runner Bill Jensen of Algonquin, Illinois, says he has never experienced conditions quite so bad. "It was horrible," says Jensen, who began his race with a 20:48 5K. "Normally I wouldn't even take a drink of water until after 10 miles. But at the first stop, I was taking two drinks, and like everyone else, I was dumping one on my head." He had never seen so many fast runners stop to get water at the first aid station of a marathon. In Chicago, that stop was located roughly 1.7 miles into the race, followed by two more: at 3.2 miles and 5.9 miles.





Things got even worse for slower runners. "The first three water stops were complete and utter chaos," says Hopkins, who covered her first 5-K in 33 minutes. "Every one was elbowing for an opportunity to grab some water, Gatorade, anything volunteers couldn't keep up. We grabbed our own cups and waited for someone to pour the water."

Where water was available, overheated runners grabbed multiple cups, depleting supplies more quickly than they could be replenished. "They were unloading them as fast as they could but they couldn't get the water out of the truck fast enough." say Canadian runner Benny Ralston. Not surprisingly, some stations ran out of cups. Volunteers were seen pouring water into the cupped hands of runners.

Some tables ran dry, forcing runners to go long distances between drinks. Runner Kathy Quikery of Chicago recalls "at mile three I couldn't find any water." She pressed on, but found nothing to drink between miles four and six. "By the time I got to mile six, I was in dire need of water," she says. Parched runners began ducking into convenience stores. Others plunged their heads in to public fountains usually occupied by pigeons.

Aid-station volunteers reported that seemingly inexperienced runners made the quest for fluids tougher than it had to be. At some stations, runners crowded the earliest water tables on one side of the road until they were out of control, while other tables nearby faced little demand.

Pinkowski admits that the pattern of water consumption caught his team by surprise: "People got thirstier more quickly. We had demand at water stations that we historically have never seen. Once we tried to get back into replenishing mode it was impossible to catch up."

The misery and confusion along the racecourse all but overshadowed the drama unfolding at the very front of the pack. In a riveting duel, Kenyan Patrick Ivuti and Morroccan Jaouad Gharib swapped the lead repeatedly. As they sprinted the final five meters, Ivuti swerved beside Gharib and leaned into the tape for an apparent photo finish. But like all marathons, the line at Chicago isn't equipped with the kind of high-tech equipment that can determine close finishes at track meets. The close read 2:11:11, but it was not clear who had won.



That crucial decision fell to Pat Savage, DePaul University's track-and-field coach and the marathon's head referee, who had positioned himself besides the finish line seconds before the leaders hit the tape. "I've never seen a finish like that in all my years," says Savage, adding that he's witnessed more than 100 marathons. "But it was clear from my position that Ivuti won."

The women's race was no less exciting - or strange. Adriana Pirtea of Romania entered the homestretch with a seemingly insurmountable lead. She even began waving to the crowd. But defending champion Berhane Adere of Ethipia was closing fast. Down by about 100 meters with 300 to go, Adere swung around two men to the opposite side of Columbus Drive and sprinted for the finish line to finish at 2:33:49, three seconds ahead of Pirtea. Savage, who saw the finish up close, notes that Adere never actually broke the tape because confused officials were holding it on Pirtea's side of the road.

While the fastest runners were generally experiencing a hot but unremarkable race, mid-packers who successfully made it beyond the mile 10 began falling prey to the conditions. Chicagoan Arthur White, 40, reached mile 15 around 11 a.m. "I saw people laid out on the ground with bleeding knoees, looking like they had just collapsed," he recalls. "A lot of them were young guys. I saw one guy completely encased in ice."




After reaching mile 19 at about 11:30am, Hopkins was cramping badly and beginning to fade, but she remembers the unforgettable scene. "People were lying on the sides of the road, in the road, just about anywhere they could find a spot," she says. Spotting a Gatorade stop, she turned towards it. Then she collapsed. A spectator reached out, broke her fall, and helped her to a medical tent. "I could hear runners screaming and crying in pain," says Hopkins.

Second-time marathoner Robin Johnson of Geneva, Illinois, had trained six months for the race, but at mile 10, she began to shake violently and then blacked out. She awoke with two IV's in her arms, a heart monitor on her chest, an oxygen mask over her face, and critically low blood pressure. Johnson was taken to an emergency room to get her blood pressure back up. She was released later that day.

Probably the most bizarre ordeal was endured by Shelley Gallant, a five-time marathoner from Flower Mound, Texas, who was running near mile 11 when she noticed the crowd ahead of her parting. A young man suddenly appeared, flailing his arms, screaming incoherently, and running against the tide of runners.

"I just happened to be right there and he punched me," Gallant remembers, still shocked. "Right in the face. He just gave me a hook. Knocked me silly." After about 20 minutes, she got back up to run and made it to mile 20 before she decided to walk to the finish. She never did find out the identity of her attacker of why he clocked her.

After watching the elite finish, Pinkowski and Medical Director George Chiampas returned to the command center to survey the data coming in. They didn't like what they saw. They joined Fire Commissioner Ray Orozco, Office of Emergency Management Executive Director Tony Ruiz, and other city official to talk over the situation. "At 10:30 we saw a spike in 911 calls," says CFD spokesman Larry Langford. "We knew we needed more ambulances." At 11:24 they activated MABAS, requesting 10 more ambulances.

Over the next hour, this happened twice more as they called for a total of 30 additional ambulances. Alhtough Pinkowski says he became concerned during the first hour of the marathon when medical stations along the course began filling up quickly, the repeated MABAS calls for relatively small numbers of ambulances suggest that marathon organizer didn't fully grasp the magnitude of what was happening until the crisis was in full swing.


At 11:30, recalls Chiampas, they saw that about 1,000 runners had finished - roughly 75 percent fewer sub 3:30 times than in 2006. And runners were using dropout buses more than in past years. "But at this point, about half of the cots in the medical tent [at the finish] were empty," says Chiampas.

Just a few hours into the race, temperatures had climbed more than 11 degrees to 83. On shadeless streets it felt even hotter . Numerous runners noticed a digital sign on a bank in the Pilsen neighborhood that read 92F. The American College of Sports Medicine (ACSM) has published guidelines to prevent exertional heat illness during competitions like marathons. These standards use a weather metric called wet-bulb globe temperature, which factors in humidity, radiant heat, and ambient temperature. The ACSM guidelines urge that competitive events be cancelled when wet-bulb numbers exceed 82F. According to Pinkowski and Chiampas, Chicago, like many marathons, did not have a specific protocol in place regarding hot-weather cancellations. In any case, the wet-bulb temperature in down town Chicago at 11:30 was precisely 82.

At 11:35, race organizers and city officials gathered to make a remarkable decision. Chiampas says Pinkowski asked him what he recommended. "I told him I thought we should cancel the event," says Chiampas. "And then everyone agreed, and Carey made the call."

Agrees Pinkowski, "It was unanimous to pull the plug. This was not an easy decision. It was heartbreaking. But we had no options. We realized that we had lots of people who had not yet reached halfway." The CFD committed new resources and assumed a larger role in communications, but the formal management of the crisis did not effectively change.

Within minutes, race and city officials established a diversion point, with a fluid station and medical personnel, just past the midway point. The thousands of runners who hadn't yet reached that corner of Adams and Halsted would be rerouted east to the finish (and to more medical resources and fluids). Given the weather conditions, which were only getting worse, the descision to pull the slowest, least-fit participants off the course surely prevented many more casualties that afternoon.

But whether the course was truly closed and the race over for runners already past the diversion point remains unclear. At 11:35, about 1,400 participants had crossed the finish line. That means that more than 20,000 people were between the diversion point and the finish line - in a potentially dangerous no-man's-land.

Police officers on the course were instructed to tell runners to stop. That message was also issued from bullhorn-equipped cars and a bullhorn-equipped helicopter that had been sent aloft for the job. But many runners didn't understand how or why the race could have been called, so they kept moving. In some cases, runners reacted to the news with belligerence, yelling insults at the officers delivering them. Although police set up barricades in the streets, dozens of runners jumped over them or simply went around.



After being told by course marshals and police that the race had been stopped, many runners felt betrayed when the later saw the clock had not stopped after all. This raises questions about the meaning of the organizer's claim that more than 25,000 runners finished. According to race rules, finishes are registered for runners who cross each 5-K checkpoint. After the race was canceled at 11:35, the 25-K and 30-K mats were deactivated, so finishes were refistered for anyone who hit each checkpoint minus those two. Race officials insist that they later "scrubbed" their database, pulling about 4,000 runners whose splits indicate they didn't cover the full course. But they stand by an official total of 25.534 finishers - meaning roughly 24,000 people "finished" the race after it was canceled.

Some runners say the confusion robbed the race of all meaning. "It wasn't much of a celebration. At the finish line, a guy was handing out medals to anybody," says kathy Quickery. "He tried to hand one to my friend who didn't run."

Other overheated runners who were told they would find buses found none and walked from the halfway point back to the finish. "At mile 20, I found out that the race was called," says Quickery. "Policemen said stop running, there would be buses at mile 21. But there were none there - they said go to mile 22. No one knew what was going on. I finished in 5:25."




After she checked out of the midecal tent and was helped to a bus, Melody Hopkins says it filled up quickly and began turning passengers away. A mile from the finish, the driver told everyone to get off becayse the road was blocked. In her weakened state, Hopkins walked the last mile to the finish.

Cancelation of the race didn't mean an end to the medical emergency. Throughout the day, sick runners continued to arrive at 12 hospitals in Cook County. At the University of Illinois Medical Center, 30 runners were treated, five were admitted, and three kept overnight. At Northwestern memorial Hospital, 53 runners came into the emergency room.

Some 300-plus 911 calls would eventuall come in. An out-of-town medical director said he received calls from doctors working in Chicago who were in a panic, complaining about inadequate medical supplies. Matthew Weingold, a hand surgeon from Greensboro, North Carolina, running his marathon, left the course at mile 17 and headed for a medical tent with leg cramps. "All the cots were full and everything was depleted - the salt tablets, bananas, everything," he recalls. "It seemed like things were spiraling out of control quickly."



Still, there's eveidence that the competence of medical personel prevented a catastrophe. According to Chiampas, doctors in the main medical tent and out on the course treated "six to 10 cases" of hyperthermia - people who could have suffered kidney failure, heart problems, brain damage, and even death if their temperatures hadn't been lowered quickly. Carrie Jaworski, who is head team physician at Northwestern University and helped run the main medical tent, recalls one runner who came in with a 107F temperature. She says medicall staff immediately immersed him inice water, carefully monitoring his safetyand vital signs until he was stable for transport. "There's no doubtwe saved lives," says Jaworski. "And if the race hand't been stopped, the city's EMS system would have been overwhelmed."

THE WORST NEWS WAS YET TO COME. CHAD SCHIEBER, 35, a Midland, Michigan, police officer made it to mile 18 before collpasing and ultimately dying. Deaths in long distance races are rare but not unheard of. After the 2007 ING New York City Marathon, for instance, a 50-year old runner died of cardiac arrest. And elite runner Ryan Shay died that same weekend during the Oympic Trials. Shieber was the first Chicago fatality since 2003.

It was first reported that he was a victim of dehydration and had collapsed near the corner of Ashland and Roosevelt. later reports indicated that he had a heart defect called mitral valve prolapse (MVP) and may have died en route to the hospital becayse his ambulance got lost. The case grew stranger when the Chicago Office of Emergency Management (OEMC) denited that any 911 calls had come in equesting help for Schieber. A TV reporter produced evidence of at least two such calls.

A CFD lieutenant, joined by a doctor from Alexian Brothers Medical Center who was running by, attended to Schieber shortly after he collapsed. The found him not breathing and without a pulse, and they began administering CPR. A few minutes later, an ambulence from the suburban town of Niles, responding to the marathon's request for assitance and en route to a staging area, was flagged down by runners. The Niles EMT's lifter Schieber onto a stretcher, put him on IV drip, wrapped him in ice, and defibrillated him five times.

The driver then encountered trouble finding an emergency room. According to Jay Judge, an attorney retained by the Village of Niles, the driver, who had not yet received instructions or directions, couldn't reacha dispatecher by radion to get directions to the nearest ER, so he flagged down another ambulance. Judge denies that the crew ever got lost, but in fact, the crew did bypass two closer emergency rooms before taking Schieber to Jesse Brown VA Medical Center, which isn't part of the city's emergency network. Transport took about eight minutes. OEMC denies that a request for directions was ever received. I November, Niles obtained a court order requesting the City of Chicago to preserve its 911 tapes (normally kept for only 30 to 90 days) in case a legal dispute would arise.

The doubts attendant upon Schieber's death have left his family in a state of linbo, As this issue went to press, the fmaily had not filed any legal action, but had retained an attorney. "We're stillwaiting for the rsults fo the detailed autopsy," says Schieber's brother, Ty.

Three days after the race, newspapers reported that the cause of death was MVP, a heart-valve defect that causes pumping abnormalities. Then a secondary debate sprang up among cardiologists and other experts who pointed out the the heart condition, whih is present in approximately 7 million Americans and is typically harmless, is highly unlikely by itself to cause death.

But in an interview with RUNNER'S WORLD, the medical examiner who performed Schieber's autopsy on October 8 expresses no doubts about the cause of ddeath. That physician asserts that Schieber's death was triggered by congestive heart failure related to a severe form of MVP that caused fluid buildup in his lungs.

According to the physician, who asked not to be identified, "Chad had a very significant form of MVP. He did not have a rupture, but he had abnormalities in the filling of the heart chambers. He was going into prefressive heart failure due to an acute backup of fluid in the lungs. We ran chemical tests to determine if there were signs of dehydration, and they came back normal. There is no question in my mind what killed him."

There were no other contributing conditions, the examiner says, but the demands place on his heart by running the marathon clearly tipped him over the edge. As this issue went to press two months after the race, the Cook County Medical Examiner's office had yet to make public the final detailed autopsy report.

THE TROUBLE ON THE RACECOURSE turned a spotlight on Pinkowski, and in the days following the event, provoked heated finger-pointing about what happened and who was at fault. In the immediate aftermath of the race, Pinkowski almost certainly inflammed runners and the media by deflecting responsibility for the chaos and denying reports of aid stations run dry. He later insisted that the blame for the water and Gatorade shortages should fall on overheated runners who had dumped extra cups on their heads.

When a reported asked if there was anything he could have done better, Pinkowski responded: "No. We aniticipated the weather. I'm very proud of the way things went." This triggered an outpouring of protest from runners like Kathy Quicklery, who delivered one of the more tempered reactions. "I'm not pleased with the race director not apologizing and there not being enough water," she says. "He has a responsibility for the first runner and the last runner in the back of the pack"

That feeling was affirmed by Thomas Hill, president and codirector of the Oklahoma City Memorial Marathon, who ran Chicago on October 7: "Carey puts on a great race, but his press statement could have been more tactful. When he got on TV Sunday afternoon, he alienated every runner on the course. You can't blame the guy out on the course for trying to stay cool."

In the aftermath, many runners complained that there simply hadn't been enough aid station on the course. Fifteen water and Gatorade stations were spread out roughly every other mile, the same arrangement that race had used in years when temperatures were far lower. "Stops at each mile would have softened the blow." says runner Melody Hopkins.

Runners aslo complained about the cooling buses and the misting station, which had been placed well beyonf the point where most runners began to falter. Tim Christopher of Oak Park, Illinois, remembers spotting the first cooling buses "at mile 23 or 24. It was too late at that point."

By compairson, the ING New York City Marathon, analogous to Chicago in terms of size, offers fluids at every mile, starting at mile three, and has a contingency plan to operate spray station every mile in hot weather. To be fair, there's some concern that more frequent aid stations might lead to the incidence of hyponatremia (potentially dangerous water intoxication). And misting station are also controversial, both because they don;t lower body temperatures and because some runners find they cause blisters. Still, there's little doubt that more aid stations in Chicago would have been welcomed by overheated participants and that misting stations would have diminished how many cups of water runners poured over their heads.

The way organizers placed cooling equipment near the race's end suggests they underestimated the effects of the heat and humidity. Pinkowski insists that placing misting stations up front "would have helped but not changed the results."

In the days and weeks after the marathon, the questions kept coming. For instance: Should the race have been canceled-or at least started earlier in cooler hours, as is done in Miami, Orland, and Honolulu? Leaving aside the logistical question of notifying 45,000 runners that the race time was changed or canceled altogether, official now say no consideration whatsoever was given to either of those possibilities.

It is clear that the huge field, the unexpected worsening of weather conditions, and the water problems set in motion a cascade of events that organizers could not recover from quickly. But the crisis that gripped Chicago could have happened in almost any large event where high heat and humidityare extraordinary.

"This was a learning experience," Pinkowski says. In the months after the race, all the involved city agencies were scheduled to meet with the marathon staff for a postmortem on the staff's performance and to provide recommendations for 2008.

The Chicago marathon will survive, and so will Pinkowski's tenure (in a press release days after the race, he vowed to be back to direct the 2008 marathon). He predicts that the marathon's reaction to the crisis will augur well for the city's Olympic bif. "As far as how the city can activate itself in a challenge, it is a great illustration of what a city can do," he says.

Wheterh or not taht is true, it is almost certain that constructive change will come out of the events of October 7. For one thing, marathon organizers in other cities are looking very closely at what happened in Chicago to make future races safer. Oklahoma City is developing a new organization that will be a clearinghouse of safety guidelines and disaster protocols that can be used anywhere. "We're reworking out catastrophe plan," says Steve Karpas, speaking on behalf of the Houston Marathon. "This was a wakeup call to every marathon."

Whatever accountability should fall on the shoulders of race organizers, every runner should examine the question of individual responsibility. Although 8,700 registrants didn't show up at the starting line on race day, many others who did were unprepared. Others ran through warning signs even as their bodies began to shut down. "I chose not to stop and paid the price for my own decision," admits Peter Browne. "Many people forget this is an athletic endurance event and treat it as a day-long parade. When conditions get demanding, this attitude can be dangerous. The conditions were prohibitive, but that is no fault of the marathon."

2 comments:

DGA said...

I think Pinkowski should be fired or leave town while he has a chance. The race was a calamity because the organization was poor and irresponsible. The International Marathon Committee (IMC)should penalized the city of Chicago with the suspension of its 2008 Marathon. That will teach the local Chicago officials and politicians a lesson in civility.
Now...the runners who entered the race at that temperature registered at the starting line must have an IQ below George Bush's level. You know better that probably the first most important factor in running a marathon is the weather. Feel very bad for the people who died and ended up in hospitals, though. Pinkowski is the polish version of the Pink Panther, need I say more.

DGA said...

I meant to say...NEED I SAY MORE?