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Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020
  1. Yuri Hosokawa1,
  2. Sebastien Racinais2,
  3. Takao Akama1,
  4. David Zideman3,
  5. Richard Budgett4,
  6. Douglas J Casa5,
  7. Stéphane Bermon6,7,
  8. Andrew J Grundstein8,
  9. Yannis P Pitsiladis9,
  10. Wolfgang Schobersberger10,
  11. Fumihiro Yamasawa11
  1. 1Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
  2. 2Research and Scientific Support Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  3. 3Medical and Scientific Commission Games Group, International Olympic Committee, Lausanne, Switzerland
  4. 4Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
  5. 5Korey Stringer Institiute, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
  6. 6Health and Science Department, World Athletics, Monaco
  7. 7LAMHESS, Université Côte d'Azur, Nice, France
  8. 8Department of Geography, University of Georgia, Athens, Georgia, USA
  9. 9Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
  10. 10Insitute for Sports Medicine, Alpine Medicine and Health Tourism, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall, Austria
  11. 11Marubeni Health Promotion Center, Marubeni Corporation, Chuo-ku, Japan
  1. Correspondence to Dr Yuri Hosokawa, Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan; yurihosokawa{at}


Objectives This document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management.

Methods Members of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management.

Results Sports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site.

Conclusions A coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

  • exertional heat stress
  • thermoregulation
  • consensus statement
  • heat

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • Contributors YH contributed to the conception of the work. 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 All authors are members of the International Olympic Committee Adverse Weather Impact expert working Group for the Olympic Games Tokyo 2020; not receiving honorarium.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.