just touching on that you've done a lot of work around that subject for the brighton marathon and looking at that exertional collapse what have you learned as a research group from your studies

the main kind of challenge we had to begin with was trying to understand what normal looked like because when you finish a marathon and you're unwell your physiology is obviously quite abnormal and you know your heart rate's high your blood pressure's potentially a bit low or even a bit high your cool temperature's high you do some biochemistry and you'll have pretty abnormal biochemistry and and it's hard to interpret that when you don't know what the normal distribution looks like So the first question we sought to answer was what a normal troponin rise is when you run a marathon.

Because we were seeing a lot of elevated troponins in unwell runners.

So we did a nice study where we looked at pre and post troponin levels in a cohort of healthy runners and compared that to runners who had collapsed at the finish line and saw that actually there wasn't a significant difference.

So there was a raise, not an unsignificant raise.

I think medium baseline was around four.

This was troponin T, high sensitivity troponin T.

Just going back to your event medic hat on, for those of us who don't work in the world of event medicine, what's going through your head when you see a runner collapse?