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Translating evidence-based practice to clinical practice in Tokyo 2020: how to diagnose and manage exertional heat stroke
  1. Yuri Hosokawa1,
  2. Douglas J Casa2,
  3. Sebastien Racinais3
  1. 1 Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
  2. 2 Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
  3. 3 Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Dr Yuri Hosokawa, Faculty of Sport Sciences, Waseda University, Tokorozawa 2-579-15, Japan; yurihosokawa{at}

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Elite athletes competing at high-intensity in the hot and humid ambient conditions of the upcoming Games of the XXXII Olympiad (Tokyo 2020) are likely to reach elevated core temperature ( ≈ 41.5°C) as previously reported in elite competitions in the heat and the risk of exertional heat stroke (EHS) is heightened.1 EHS is a medical condition defined as an internal body temperature exceeding 40.5°C with central nervous system dysfunction (eg, disorientation, aggressiveness, hysteria, delirium, altered consciousness, irrational behaviour).2 3

Survival and sequela from EHS depend on the duration of hyperthermia.4 In 2020, evidence-based consensus suggests whole-body cooling until 39°C within the first 30 min of collapse as the critical requirement to maximise patient outcome.2 3 5 Whole-body cold water immersion (CWI) was associated with 100% survival rate in 274 runners diagnosed with EHS over the 18 years of patients treated at the New Balance Falmouth Road Race, with average cooling rate of 0.22°C min–1.5 In a different study, CWI using circulated water controlled at 2°C demonstrated an average cooling rate of 0.35°C min–1.6

To achieve the clinical target, medical providers at Tokyo 2020 must:

  1. provide on-site …

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  • Contributors All authors contributed to the conception of the work. YH contributed to the acquisition, analysis and interpretation of data presented in the manuscript. All authors contributed in drafting or revising the manuscript and approval of final version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests YH, DJC and SR have a potential COI as members of the IOC Adverse Weather Impact expert working Group for the Olympic Games Tokyo 2020; not receiving honorarium.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.