Unreported in the news: Was the death of a runner in the Milo Marathon due to the organizers' negligence?

I found the following email in my inbox last night.

X. X. X. X. X. X



REMUS FUENTES died of multiple organ failures as result of heatstroke secondary to severe dehydration two days after he ran the 21K in the recent 34th Milo Marathon last Sunday, July 4, 2010.

His death was the result of fatal mistakes, incompetence and negligence in the event organized by Organizing Team.

My son, 37-year-old Remus ran the 21K together with a running buddy when he collapsed at 19.9 kilometer mark. There was none of organizer’s ambulance nor marshalls to respond in the incident. Policemen hailed for a taxi and they, together with his buddy, assisted in bringing him to the nearest hospital, Ospital ng Maynila. At the ER, the diagnose was suspected heart attack. My wife and me, upon being informed by his younger brother, Roy Fuentes, who also ran the 21K, rushed to the hospital and saw that Remus in coma, had seizures and struggled breathing in spite of hand-pumped oxygen and dextrose attached. His body temperature was 40 degrees C and when asked, the medical attendant told us he had fever. She introduced paracetamol intravenously twice at interval of about 15 minutes. Remus continued having seizures even until the arrival of Medical City doctor & ambulance attendants that we have arranged for his transfer. The Medical City doctor attending said his status was unstable, contrary to the earlier advice to her by the Ospital ng Maynila ER doctor. They rushed him with the ambulance to Medical City at about 11:30 AM. There, a series of tests were done, including blood chemistry, CT scan, etc. Cardiologist told us his heart was strong and no intervening medicine was necessary. Blood Chemistry results showed positive findings on creatinin level, an indication of kidney failure. They suspected liver failure too. To stop his seizures, Remus was put on full sedation for 12 hours. Kidney functions further deteriorated after 36 hours. Blood pressure and heart rate went erratic. Doctors attending him in the ICU asked our permission to do dialysis and blood transfusion to stabilize his blood pressure. Seven hours later, ICU nurse wake us up and asked us to rush to the ICU. We saw 18 medical people around him, several taking turn doing the CPR. Failing to revive him, the doctor asked our consent to stop the CPR after 15 minutes. We begged them to continue hoping for miracle. 30 minutes further, doctor told us again that all numbers in the monitoring “were bad” and asked again the consent to stop the CPR. Finally, we relented. Few minutes later, his heart rate monitor went flat. All these happened in front of my wife and me. We lost Remus 48 hours after he collapsed into coma which he has never recovered. His young wife and his eight-year old son took the news very badly.

About Heatstroke:

It usually happen in extreme sports like basketball, football, boxing and marathon.

Heat stroke is a life-threatening medical condition. The person's cooling system, which is controlled by the brain http://www.emedicinehealth.com/script/main/art.asp?articlekey=2516, stops working and the internal body temperature rises to the point where brain damage or damage to other internal organs may result. The body temperature, usually at normal 37 C, goes up during the exertion of effort as result of the increased heart rate. When it reaches 40 C, the person is in danger of getting heatstroke. Above 40 C and mostly at about 42 C, the person can collapse into unconsciousness. If nothing is done within few minutes, he can slip into coma and brain damage may occur. The proven first aid response for heatstroke is cooling the body rapidly in whatever means to the level of below 40 C before bringing him to a hospital. Ice and water is the best way to do this, the same way it is done for a child having high fever who has convulsion.

Another way of understanding heatstroke is comparing it to the performance of car engine. At idling, the engine temp is low and safe. At sustained high speed, engine temperature increases rapidly but because of the cooling system, the heat is continuously dissipated in the radiator and safe temperature level is maintained. But when the water in the radiator is gone, Undissipated heat will rack up the engine temperature and ultimately exceeds the safe limits. At this condition, engine breakdown will occur in minutes starting with broken piston rings, rods, pistons, etc.

With the human body, perspiration cools down the body so hydration by drinking water is essential. Without water, perspiration stops and body temperature goes to critical level and into heatstroke and then organs and brain begin to fail.

Big obvious difference between human body and car engine is that you can always overhaul the engine but you cannot do that on the human body.

Why Heatstroke is More Dangerous in Marathon than in other Extreme Sports?
In basketball, the player exerts extreme effort only in bursts, stopping or slowing down intermittently which slows down heart rate and cools down the body. At timeout, they drink to replenish lost body water hence you always have the waterboy. Heart stroke is rare but ask any PBA player what they do when a player collapse. They don’t move the body but cool them off with water or ice before bringing him to the hospital.

The same is true in football and in many similar sports.

In boxing, in between rounds of three minutes, boxer rests and drinks water. We can only wonder what will happen if the rule of the sport is drastically changed and will only end when one is down and out.

In Marathon, the risk of heatstroke is much higher for the following reasons:
The long distance runner aims for shorter time as a goal and therefore motivated to keep a sustained effort, not unlike cars at high speed in the highway.

Furthermore, the target minimum time set by the organizer adds more to the motivation to run faster. The cut-off time added more pressure to the marginal marathon runner, meaning if you are used to run above the target time, the tendency is to do better time, probably at pace unproven by your body in practice. (Milo Marathon set the target for 21K medal at 2 ½ hours or less. Remus collapsed at near 20th km. with time of 2 hours 10 minutes when his previous record was 2 hours and 27 minutes. ).

The more critical factor is that the hydration management is not in the control of the runner. He has to rely on water availability at the water stations provided and planned by the organizer along the route. ( In this 34th Milo Marathon, several runners including Remus brother, Roy and Remus running buddy asserted that practically there was no water to drink in the last 2~3 kilometers before the finish line, a fatal failure for Remus by the organizer when they changed the route resulting in over-traffic near the finish line. There were record 28,000 runners on that day and the organizers failed to anticipate the complexity of hydration. Milo’s last year marathon participant was well below 10,000 runners.)

The correct life-saving response for heatstroke depends on few knowledgable people who may happen to be around the person. To mitigate this, the organizer deploys ambulances with water & ice for cooling heatstroke victims and is expected to respond within minutes. In addition, marshalls are provided along the route to assess runner situations continuously. (Obviously, the organizer failed again on this aspect because Remus was helped by policemen and his buddy instead. By this time, Remus is probably already brain damaged as evident by his seizure at the hospital. No Milo people knew of Remus case on that day until Roy, his brother, sent an email informing the organizer of the incident in the next morning)

The Sun Factor adds to the danger in Marathon. Running under the heat of the sun in tropical country like ours cannot be underestimated. To minimize the effect of the sunheat, Marathon run is planned to finish in the early morning avoiding the heat at later time. Organizers usually take this into consideration. (Milo organized the 21K to start at 5:30 AM , a departure of common practice of other marathons which started at 5:00 AM. Remus collapsed at about 7:57 AM. Roy who is a better runner than his brother Remus, complained that it was unusually hot that morning even if he was able to finish it earlier in 2 hours 45 minutes )

Clearly, Marathon is an extreme and dangerous sport even to the young, healthy and trained runners. This is not the “fun run” many people confused of.

The organizer has clear life-and-death responsibility to make sure that the conditions the runner will run under item 3, 4 and 5 above are done properly. Obviously they did not do their job properly in the 34th Milo Marathon. In my opinion, being the father of Remus, Milo Marathon Organizer have failed my son. It is their incompetence and negligence in their duty that results in the death of Remus …an unneccesary death.

About Remus:
At the time of his death, he was an IT project manager of Hewlett-Packard (HP) responsible in computerizing big companies like Unilab, Coke, etc. including installation of hardwares (servers, etc.) and software system. He used to worked for Intel for 10 years before he moved to HP 3 years ago. He graduated in Computer Engineering. He left a housewife, Takako and two children, Raphael, 8 years old and Therese, 4 years old. Raphael is enrolled at La Salle Greenhills. He played basketball with his brothers regularly on weekends. He has been running since his high school days in Lourdes School of Mandaluyong. He has run many 10Ks and two 21Ks before these, the “Freedom Run” in June 13 and “Nature Valley” in May 20 only this year. He has no history nor complaint of illness and he lived clean.

My Questions for the Marathon Organizer:
How many died in the 34th Milo Marathon last July 4? Is it true that there was another runner at 42K who collapsed at 33 km and later died?

How many runner collapsed in that marathon due to heatstroke who later survived but now are no longer the same person as before due to partial brain injury? At Ospital ng Maynila, we saw a 2nd runner brought in unconscious and woke up later but he can no longer recognize his family. Do the Organizers knew this? What happened to him. Are their more?

Is it true that another 36 year-old runner, Fidel Camson, who ran the 42K 31st Milo Marathon in November 2007 collapsed near the finish line, brought to the Ospital ng Maynila and died later of undetermined cause? If true, what did they do avoid a repeat which apparently did not happen in this 34th Milo Marathon? If true, why do they still keep the Marathon organizer for 10 years until now?

Do they keep tally of deaths in the 34 years of Milo Marathon? Do they study the statistics and establish how many died of heatstroke, the preventable one?

What is the corporate culture of the Organizers regarding its respect of the value of life? Upon knowing the death of my son Remus, A Senior Vice President of one of the organizing team, who head its Beverages Business Unit went to see me and among other things, he told me that the Marathon is continuously improved and but sometimes “lapses occur and they will learn from these lapses”. Lapse is defined as  a ‘mistake’. People learn from ‘error’, a deviation from being correct but a ‘mistake’ is caused by a fault: the fault could be misjudgment or carelessness.  We learn from ‘error’ but we take action on ‘mistake’ and more drastic action when people die of this ‘mistake’. So death in my son’s case is a mere  learning process for this person? Is this the culture that pervades in their Organization? or only in him?

Is the measly “humanitarian” offer to help the family shoulder medical & funeral expense to the family had become an SOP too often? Was it their expectation that as appreciation of this help, the family will keep quiet about the whole thing? Do they really think that the waiver signed by the runners protect them from being liable? Do they know that this waiver won’t apply if negligence of their duty as organizer can be established?

What did the Organizers do, if any, to keep the news of Remus death from appearing in the media even after one week? Not one news item of his death appeared in the newspaper, TV or radio. Could the news of “ HP Manager Died of HeatStroke during the Milo Marathon” not interest the public? Were they afraid that the bigger news is when the subline “Father charged Milo Marathon Organizer of Incompetence and Negligence” which may damage the public image of the company?

The answers to these questions will help enlightened the public whether Milo Marathon is safe or not for the runner. To the runners, their parents, wives and relatives…they all better asked these questions before the runners decide to run in Milo Marathon.

Last Words from Remus Father:
I am not condemning the sport but the organizer who failed to make sure runners will not die of heatstroke, when the risks can be grossly minimized with proper route planning, hydration management and quick medical response. I am condemning the contribution of the apparent culture of the sponsor of diminished value of human life as indicative of its senior executive’s attitude that my son’s death is a result of lapses. My hope is something good will come out of his death and as result of improved organizing of the marathon run, few lives will be saved from heatstroke. My other hope is to get justice and for the Organizing Team to answer for his untimely death. I am working on it.

Rudy Fuentes, Father of Remus