The New York City Marathon, one of the six prestigious "majors" worldwide,1 typically features more than 50,000 runners, attracts an average of 2 million spectators, and is supported by more than 10,000 dedicated volunteers. As marathon runners pound the streets and cyclists push through grueling endurance races, a revolution in healthcare is unfolding behind the scenes. At the intersection of medicine and competitive athletics, point-of-care testing (POCT) enables real-time diagnostics that provide essential care on site, easing pressure on local hospitals and helping to ensure safety for all participating athletes. This benefit is essential at events where smaller and local healthcare systems could easily become overwhelmed. Studies show POCT can reduce the rate of unnecessary transports and admissions, keeping healthcare resources focused on critical needs.2
Effectively managing hydration challenges during the intense heat conditions of the marathon are medical experts tapping into the advantages of POCT technology. POCT is redefining how on-site event medical teams support athletes and event spectators, setting new standards for specialized medical care known as “endurance medicine.” It encompasses planning, staffing, and delivering healthcare services tailored to unique needs as well as addressing risks associated with the event and its attendees. This shift underscores the value of rapid testing in sporting events and speaks to a larger strategy: empowering medical professionals to keep athletes safe without overburdening local community healthcare resources.
This necessity to support communities on a broader scale, particularly in events with significant public attendance, has prompted sport federations like World Athletics3 and their related medical department and emergency medicine counterparts to adopt POCT into their own standardized medical care concepts and protocols. By doing so, they aim to enhance endurance events by focusing on providing on-site patient care and treatment. The World Academy for Endurance Medicine (WAEM),4 co-founded by World Athletics, provides the Race Emergency Medicine Course (REMC), a specialized training program for medical directors of mass-participation endurance events, focusing on protocols and best practices in endurance medicine. In different endurance events, such as those of the Paris 2024 Olympic Games, WAEM staff trained Paris 2024’s medical staff on how to use POCT devices for the “Marathon Pour Tous,” a mass-endurance race organized during the Paris Olympic Games. As World Athletics Health and Science Department Science Manager Frederic Garrandes explained:
“Intervention represents, to some extent, the failure of prevention. Following this training, the medical staff in Paris are now ready to rapidly identify and optimally treat these medical conditions, but it is essential to continue sending out the right prevention messages to both elite and recreational athletes competing in Paris.”
The growing demand for POCT in endurance events
The past few years have seen a surge in interest in POCT applications in sports medicine, particularly as they apply to endurance events. Marathons, triathlons, cycling, and mountain running races pose unique health risks, requiring medical teams to provide immediate and specialized care in sometimes remote locations. Traditionally, an athlete needing diagnostic tests would be taken to a hospital, but transporting patients during large-scale events can disrupt local medical services and add logistical challenges such as strain on local healthcare systems, transport coordination, or delays in critical care decision-making, potentially impacting the athlete’s health and recovery.
Recognizing this, race directors and medical teams now prioritize on-site solutions that provide rapid diagnostics. World Athletics, known for its commitment to athlete safety, is leading efforts to equip events with the necessary tools and protocols to support this approach. During the recent 2024 New York City Marathon, for example, POCT-equipped medical tents provided diagnostics on-site, enabling medical teams to treat symptoms such as dehydration, overhydration (and its secondary condition hyponatremia), manage heat-related illnesses, and even stabilize chest-pain issues without resorting to hospital transfers. This careful coordination ensures local hospitals can focus on community needs while athletes receive prompt care. By fostering faster treatment times and reducing stress on the local healthcare system, POCT benefits the athletes, spectators, and event organizers alike.
At the center of these advancements is a POCT blood analysis system that has gained popularity due to its versatility in providing lab-accurate blood gas, electrolyte, and metabolite (BGEM) results at the patient’s side in less than one minute from sample application.5 While other devices may require strict temperature control, the system’s test cards do not require refrigeration. This functionality is particularly useful for those trained in the field of endurance medicine, especially in varying temperature regions where determining hydration and sodium levels may escalate to life-or-death factors for the participating athletes. A portable, handheld device allows the medical team to quickly respond and deliver the right medical attention to every patient.
A unified front: the integration of labs and POCT
The rise of POCT in endurance sports doesn’t replace the critical role of clinical laboratories. Rather, it highlights a powerful partnership. Clinical laboratories are essential for training medical teams on POCT protocols, ensuring result accuracy, and providing a secondary level of analysis when necessary.6 Laboratories are also partnering with diagnostic manufacturers on standardized protocols for deploying POCT in various settings. This symbiotic relationship between POCT at event sites and laboratory support is shaping a future where diagnostic testing extends seamlessly from hospital labs to racecourses and beyond.
POCT offers a valuable solution for large-scale events by delivering rapid results within minutes, significantly reducing turnaround times compared to traditional laboratory testing. Such a swift response is particularly critical in time-sensitive environments such as marathons and concerts where prompt detection and intervention can prevent emergencies and optimize health management in a crowd.
The Future of POCT in endurance medicine: A transformative journey
The evolution of POCT is set to revolutionize endurance medicine, bringing forward cutting-edge innovations designed to meet increasingly complex and diverse diagnostic needs. With advancements in miniaturization, intuitive design, multiplexing, and advanced connectivity, POCT is paving the way for seamless diagnostic solutions in decentralized settings beyond traditional hospitals. Compact and portable POCT devices are becoming indispensable for events held in remote or crowded locations, such as medical tents or athlete recovery zones. Their optimized footprints allow for easy transport and deployment, even in space-constrained or high-pressure environments. These devices are also engineered with intuitive interfaces, ensuring that medical personnel with varying levels of expertise can operate them confidently and efficiently.
The integration of multiplexing capabilities further elevates the value of POCT in endurance events. By enabling simultaneous testing of multiple biomarkers from a single sample, these devices streamline diagnostics, reducing the need for repeated blood draws and minimizing discomfort for athletes. This efficiency not only enhances the athlete’s overall experience but also optimizes the utilization of medical resources during large-scale competitions.
Connectivity features in modern POCT solutions allow real-time data sharing with medical teams and electronic health records (EHR). Immediate access to test results ensures rapid decision-making, a critical advantage when timely interventions are necessary to address potential health concerns during events.
Achieving widespread adoption of POCT at endurance events requires a holistic strategy, including the following:
- Public health education: Workshops focused on early intervention at endurance events, raising awareness about the benefits of POCT.
- Athlete empowerment: Training programs that teach athletes and their supporting staff to self-monitor using POCT devices, empowering them to make informed decisions about their health during competitions.
- Research collaborations: Partnerships between sports organizations and academic institutions to study the long-term impact of POCT on athlete safety and performance, driving evidence-based improvements in protocols.
As organizations explore the application of POCT in other large-scale events like festivals and concerts, the lessons from endurance medicine will serve as a blueprint. The combination of emerging technologies and evidence-based approaches will not only enhance athlete safety and performance but also set the stage for a transformative era in endurance medicine.
References
1. Vitti A, Nikolaidis PT, Villiger E, Onywera V, Knechtle B. The "New York City Marathon": participation and performance trends of 1.2M runners during half-century. Res Sports Med. 2020;28(1):121-137. doi:10.1080/15438627.2019.1586705.
2. Kneifati-Hayek JZ, Incze MA. Reducing Unnecessary Admissions in the Emergency Department. JAMA Intern Med. Published online 2024. doi:10.1001/jamainternmed.2024.7075.
3. World Athletics home page. Worldathletics.org. Accessed January 24, 2025. https://worldathletics.org/.
4. World Academy for Endurance Medicine home. Worldathletics.org. Accessed January 24, 2025. https://worldathletics.org/waendurancemedicine.
5. epoc® Blood Analysis System. Accessed January 24, 2025. https://www.siemens-healthineers.com/en-us/blood-gas/blood-gas-systems/epoc-blood-analysis-system.
6. Brun M, Füzéry AK, Henschke B, Rozak K, Venner AA. Identifying sources of error and selecting quality indicators for point of care testing. Pract Lab Med. 2021;25:e00216. doi:10.1016/j.plabm.2021.e00216.
