The death of 40-year-old Bend runner Billy Tufts during an off-road half marathon in June prompted emergency medical professionals and race organizers to brainstorm ways to prevent another fatality.
At least a dozen nurses and emergency care providers have volunteered to work these kinds of remote races, and they'll have new equipment — portable defibrillators and radios for communication — on the trails.
The goal is to shorten the time it takes a distressed athlete to get help, especially in the case of life-threatening emergencies.
A sad, frustrating day
Tufts collapsed midway through the 13.1-mile Dirty Half race that winds through a web of trails in the Deschutes National Forest. He had been running with his fiancee, Staci Carsten, 30, who, along with the help of an emergency room doctor and cardiac nurse who happened to be in the race, performed CPR on Tufts.
Tufts had a blockage in a major artery, Carsten said. In other words, he had a heart attack during the race.
Maybe nothing could have been done to change the outcome of that sad day, she said.
“But it would have eased my pain to have had help faster. It would have made it so much better,” she said. It was “really frustrating” waiting more than a half-hour for paramedics and search and rescue crews. Tufts was breathing for at least 20 minutes after he went down, while they pumped on his chest, she said.
Deschutes County Sheriff's deputies ran more than four miles to reach him with a portable defibrillator. But that was unnecessary, Carsten said. Tufts was closer to a different parking area, but paramedics didn't know exactly where he was or the most direct way to reach him, Carsten said.
“I don't want to take away from the idea that everyone tried very hard and did their best. It wasn't because they had to run four miles. It's because they didn't know how to get there,” she said. “There needs to be better information and reaction time.”
“If we had an AED sooner, he might have survived, but we don't know that for sure,” said Dr. Michael Widmer, a cardiologist with Heart Center Cardiology.
AEDs are automated external defibrillators, portable electronic devices that diagnose arrhythmias, or disturbances, in a person's heartbeat. The defibrillators can send a dose of electric energy to resynchronize a rhythm.
CPR can support blood circulation, but a defibrillator could have helped determine if it was an arrhythmia and whether an electric shock would have helped, Widmer said.
Filling a gap
Most races don't have emergency medical technicians on standby. This is not unique to Bend. Outside Magazine published an article on this topic earlier this year; it reported that doctors and paramedics across the nation are hesitant to volunteer because they fear medical malpractice lawsuits. Ultimately, it's the competitors who may pay the price.
In Oregon, those who volunteer medical assistance are covered under the Good Samaritan Act, a law meant to protect medically trained people from legal liability if they offer free medical care within their level of training, according to Widmer and Darin Durham, director of emergency services for St. Charles Bend and chapter president of the Central Oregon Emergency Nurses Association.
“Liability scares a lot of people,” Durham said. “Everyone is afraid they'll get sued.”
In many cases, including Tufts', when someone goes down in an event, another race participant helps.
The emergency room doctor and cardiac nurse who stopped to try to save Tufts were not obligated to provide that service, Durham said. However, once someone identifies themselves as a doctor or a nurse, they're obligated to care for the person until another qualified professional takes over.
In any case, Tufts' death pushed into gear a lingering discussion about a lack of medical personnel at events, Durham said.
Almost immediately, the Central Oregon Emergency Nurses Association, St. Charles Cardiovascular Services, the St. Charles Foundation and FootZone race organizers, who were in charge of the Dirty Half, discussed how to prevent another fatality on the trail. The St. Charles Foundation provided money to buy three new portable AEDs, which cost about $2,000 each. Durham's department is purchasing some radios because cellphones don't always work in these forested, far-off locations.
Almost a dozen nurses from the nurses association have signed up to volunteer at these types of events, namely, ones in places that emergency vehicles can't quickly access. Medical personnel are coordinating with various event organizers to determine which upcoming events need what number of volunteers and where they should be stationed on various routes.
“We want to be first responders in minutes,” said Durham.
Most frequently, Durham expects the volunteers will provide superficial first aid when runners scrape their skin or turn their ankles, or when mountain bikers crash and break a bone. But when it is more life-threatening than that, they will be especially glad to be within reach.
“Cardiac is not the most probable (incident), but it is the most devastating,” said Karen Doolan, St. Charles' manager of cardiovascular services. “If we do this for three years and save one person, it's worth it.”
Athletes and heart attacks
It's rare for runners or cyclists have heart attacks during athletic events, Widmer said.
“But the thing about Central Oregon is, we have so many athletes and so many events and races and so forth, as opposed to other parts of the state or country, we have a higher concentration of potential risk,” he said.
Across the country, the rate of deaths from myocardial infarction — heart attacks — in athletic events is probably between one out of 1,000 and one in 20,000, he estimated.
But in Central Oregon, it's probably higher than the norm because we have more events, more participants and probably more middle-age participants, he said.
It's especially shocking when an athlete dies of a heart attack. But athletes are more likely to ignore symptoms, Doolan said.
“Denial is huge. 'It can't be me. It's heartburn,' ” Doolan said. “That's a healthier population. That's why it catches people off-guard. You can look healthy and still have heart disease.”
Studies have shown that 81 percent of runners who died in an event had experienced prior symptoms.
Widmer said even athletes in their 30s and 40s are at risk for developing atherosclerosis, the buildup of cholesterol plaque in heart arteries.
There are two kinds of plaque: obstructive and nonobstructive, Widmer said.
Obstructive plaque slowly closes off the coronary arteries, which supply blood to the heart. People with this condition often experience chest pain or shortness of breath during physical exertion, when their heart rate and blood pressure goes up but the obstruction limits how much blood can bring nutrients and oxygen to the heart.
The other type of plaque is nonobstructive. It creates a thin crust over the gooey cholesterol and fat cells. Meanwhile, inflammation eats away at this crust so it gets weak and can rupture, allowing “all the junk on the inside of the plaque to seep out into the blood stream,” Widmer said. This can create a clot and a heart attack in a person with no previous symptoms.
“People who are athletic and have good blood pressure and cholesterol are less likely to develop plaque and less likely to develop heart problems. But low risk doesn't mean no risk,” he said. “Exercise is overall very good for the heart, and that's why we encourage everyone to do it.”
Participants who register for events such as the Dirty Half must sign waivers that say they are aware of the risks, that they're fit enough to participate and that they release race organizers of any responsibility for their health.
As part of this new effort to prevent another death, Doolan and Widmer want to add some advice on such waivers as well as on event websites, “and not in small print,” Widmer said, that “if you're experiencing these symptoms, do not run this race.”
Chest pain or discomfort during exertion is a sure sign to stop, Widmer said.
Other red flags that everyone should watch for: an unusual shortness of breath, feeling dizzy, light-headedness, fatigue, passing out.
Doolan added that some symptoms are atypical. “I've had people say it was back pain, not chest pain. In women it's even more atypical,” Doolan said. It could be pain in the jaw or shoulder, for example.
“(Billy Tufts) was a fit 40-year-old who had a heart condition.... He was active, an avid mountain biker,” said Carsten, who is now trying to reconfigure her future without the man she planned to marry.
The company Tufts was working for donated some money to the Central Oregon Trail Alliance, a nonprofit, volunteer mountain biking group, Carsten said. She is brainstorming with COTA other programs that could help athletes off the beaten track who are in trouble, even if it's just with dehydration. She envisions a volunteer bike patrol on certain foot or bike races. She said she knows that event planners do their best and that there's a lot to do. But there's always something else that could be done, she said.
“We're all kicking into gear. Nothing gets done until something horrible happens. If that's what this does, makes it safer for everyone in the future, that's more than I could ask for,” she said. “I'm thankful that people try to make things better.”