A 22-year-old man was taken to hospital after suffering a heart attack as he neared the finish line during Birmingham's first half marathon.
West Midlands Ambulance Service, which joined with St John Ambulance volunteers to assist at the event, said more than 40 other runners were treated for injuries and dehydration during the race.
Nearly 9,000 people took part in the event and around 50,000 spectators lined the route from the Alexandra Stadium in Perry Barr to the finish line in Broad Street.
An ambulance service spokeswoman said: "Over 40 runners were treated by crews for complaints ranging from dehydration and muscle injuries to one patient who had sustained a fractured leg.
"Ambulance crews also treated a 22-year-old man who collapsed just before the finish line. He was immediately assisted by an off-duty paramedic who was watching the race and found him to be in cardiac arrest."
Cardiopulmonary resuscitation was immediately commenced and the man was then stabilised before being taken to City Hospital.
