Hostname: page-component-54dcc4c588-m259h Total loading time: 0 Render date: 2025-10-02T21:18:40.766Z Has data issue: false hasContentIssue false
  • English
  • Français

Lessons Learned in the Response to Multiple Cases of Exertional Hyperthermia at an Urban Half Marathon

Published online by Cambridge University Press:  30 September 2025

Lindsay V. Walsh ,
Gideon Loevinsohn ,
Nellie Darling ,
Paul D. Biddinger  and
Scott A. Goldberg Open the ORCID record for Scott A. Goldberg [Opens in a new window]
Lindsay V. Walsh
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Brigham and Women’s Hospital, Boston, MA, USA Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
Gideon Loevinsohn
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Brigham and Women’s Hospital, Boston, MA, USA Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
Nellie Darling
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Brigham and Women’s Hospital, Boston, MA, USA Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
Paul D. Biddinger
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
Scott A. Goldberg*
Affiliation:
Brigham and Women’s Hospital, Boston, MA, USA Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
*
Corresponding author: Scott A. Goldberg; Email: sagoldberg@bwh.harvard.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Exertional heat stroke (EHS) occurs when core body temperature exceeds 40°C (104°F) with central nervous system dysfunction and has been identified as a leading cause of morbidity and mortality among endurance athletes. With rapid identification and treatment, survival approaches 100%. This study describes the clinical presentation and course of seven patients transported by emergency medical services from a half marathon with EHS.

Methods

The 2022 Cambridge Half Marathon occurred during unusually warm weather, with a did not finish rate of 2%. Retrospective review was performed of seven patients transported during the race to an urban, level I trauma center with EHS.

Results

Seven patients transported to the study site were included for analysis. All patients treated with cold water immersion at scene were discharged from the emergency department. Three patients without treatment on scene required admission to the intensive care unit. Descriptions of all patients are provided.

Conclusions

Lessons learned from this event include the importance of rapid cooling, the role of event-day communications, the varied impacts on emergency department operations, and the increasing need to anticipate such events outside of traditional warm weather seasons.

Keywords

Hyperthermiaheat strokemass casualty incidentsmarathon runningclimate change

Information

Type
Brief Report
Information
Disaster Medicine and Public Health Preparedness , Volume 19 , 2025 , e285
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Hifumi, T, Kondo, Y, Shimizu, K, Miyake, Y. Heat stroke. J Intensive Care. 2018;6:30. doi:10.1186/s40560-018-0298-4CrossRefGoogle ScholarPubMed
Breslow, RG, Shrestha, S, Feroe, AG, Katz, JN, Troyanos, C, Collins, JE. Medical tent utilization at 10-km road races: Injury, illness, and influencing factors. Med Sci Sports Exerc. Dec 2019;51(12):2451–2457. doi:10.1249/MSS.0000000000002068CrossRefGoogle ScholarPubMed
Sorensen, C, Hess, J. Treatment and prevention of heat-related illness. N Engl J Med. Oct 13 2022;387(15):1404–1413. doi:10.1056/NEJMcp2210623CrossRefGoogle ScholarPubMed
Nowak, AS, Kennelley, GE, Krabak, BJ, Roberts, WO, Tenforde, KM, Tenforde, AS. Endurance athletes and climate change. The Journal of Climate Change and Health. 2022/05/01/ 2022;6:100118. doi:https://doi.org/10.1016/j.joclim.2022.100118CrossRefGoogle Scholar
Weather History for Cambridge, MA. Yankee Publishing Company. June 3, 2024. Updated June 2, 2024. Accessed June 3, 2024. https://www.almanac.com/weather/history/MA/CambridgeGoogle Scholar
Nichols, AW. Heat-related illness in sports and exercise. Curr Rev Musculoskelet Med. Dec 2014;7(4):355–65. doi:10.1007/s12178-014-9240-0CrossRefGoogle ScholarPubMed
Leyk, D, Hoitz, J, Becker, C, Glitz, KJ, Nestler, K, Piekarski, C. Health risks and interventions in exertional heat stress. Dtsch Arztebl Int. Aug 5 2019;116(31-32):537–544. doi:10.3238/arztebl.2019.0537Google ScholarPubMed
DeMartini, JK, Casa, DJ, Belval, LN, et al. Environmental conditions and the occurrence of exertional heat illnesses and exertional heat stroke at the Falmouth Road Race. J Athl Train. Jul-Aug 2014;49(4):478–85. doi:10.4085/1062-6050-49.3.26CrossRefGoogle ScholarPubMed
Stearns, RL, Hosokawa, Y, Belval, LN, et al. Exertional heat stroke survival at the Falmouth Road Race: 180 new cases with expanded analysis. J Athl Train. Mar 1 2024;59(3):304–309. doi:10.4085/1062-6050-0065.23CrossRefGoogle ScholarPubMed
Roberts, WO. A 12-yr profile of medical injury and illness for the Twin Cities Marathon. Med Sci Sports Exerc. Sep 2000;32(9):1549–55. doi:10.1097/00005768-200009000-00004CrossRefGoogle ScholarPubMed
Hosokawa, Y, Adams, WM, Belval, LN, et al. Exertional heat illness incidence and on-site medical team preparedness in warm weather. Int J Biometeorol. Jul 2018;62(7):1147–1153. doi:10.1007/s00484-018-1517-3CrossRefGoogle ScholarPubMed
Sugawara, M, Manabe, Y, Yamasawa, F, Hosokawa, Y. Athlete medical services at the marathon and race walking events during Tokyo 2020 Olympics. Front Sports Act Living. 2022;4:872475. doi:10.3389/fspor.2022.872475CrossRefGoogle ScholarPubMed
McDermott, BP, Casa, DJ, Ganio, MS, et al. Acute whole-body cooling for exercise-induced hyperthermia: a systematic review. J Athl Train. Jan-Feb 2009;44(1):84–93. doi:10.4085/1062-6050-44.1.84CrossRefGoogle ScholarPubMed
Monseau, AJ, Hurlburt, GA, Balcik, BJ, Oppenlander, KE, Chill, NM, Martin, PS. Status of US Emergency Medical Service Protocols regarding pre-transfer cooling for exertional heat stroke. Cureus. Nov 2021;13(11):e19505. doi:10.7759/cureus.19505Google ScholarPubMed
Hosokawa, Y, Nagata, T, Hasegawa, M. Inconsistency in the standard of care-toward evidence-based management of exertional heat stroke. Front Physiol. 2019;10:108. doi:10.3389/fphys.2019.00108CrossRefGoogle ScholarPubMed
Biddinger, PD, Baggish, A, Harrington, L, et al. Be prepared--the Boston Marathon and mass-casualty events. N Engl J Med. May 23 2013;368(21):1958–60. doi:10.1056/NEJMp1305480CrossRefGoogle ScholarPubMed