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Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes
  1. Yuri Hosokawa1,
  2. Paolo Emilio Adami2,
  3. Ben Thomas Stephenson3,4,
  4. Cheri Blauwet5,6,
  5. Stephane Bermon2,7,
  6. Nick Webborn6,8,
  7. Sebastien Racinais9,
  8. Wayne Derman10,11,
  9. Victoria L Goosey-Tolfrey3,12
  1. 1Faculty of Sport Sciences, Waseda University, Saitama, Japan
  2. 2Health and Science Department, World Athletics, Monaco
  3. 3Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
  4. 4English Institute of Sport, Loughborough University, Loughborough, UK
  5. 5Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Medical Committee, International Paralympic Committee, Bonn, Germany
  7. 7LAHMESS, Universite Cote d'Azur, Nice, Provence-Alpes-Cote d'Azu, France
  8. 8Centre for Sport and Exercise Science and Medicine (SESAME), School of Sport and Service Management, University of Brighton, Brighton, UK
  9. 9Research Education Centre, ASPETAR - Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  10. 10Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
  11. 11IOC Research Center, University of Stellenbosch, Cape Town, South Africa
  12. 12IOC Research Center, The National Centre for Sports Exercise and Medicine, Loughborough University, Loughborough, UK
  1. Correspondence to Dr Paolo Emilio Adami, Health and Science, World Athletics, Monte Carlo, Monaco, Monaco; paoloemilio.adami{at}


Objectives To adapt key components of exertional heat stroke (EHS) prehospital management proposed by the Intenational Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 so that it is applicable for the Paralympic athletes.

Methods An expert working group representing members with research, clinical and lived sports experience from a Para sports perspective reviewed and revised the IOC consensus document of current best practice regarding the prehospital management of EHS.

Results Similar to Olympic competitions, Paralympic competitions are also scheduled under high environmental heat stress; thus, policies and procedures for EHS prehospital management should also be established and followed. For Olympic athletes, the basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. Although these principles also apply for Paralympic athletes, slight differences related to athlete physiology (eg, autonomic dysfunction) and mechanisms for hands-on management (eg, transferring the collapsed athlete or techniques for whole-body cooling) may require adaptation for care of the Paralympic athlete.

Conclusions Prehospital management of EHS in the Paralympic setting employs the same procedures as for Olympic athletes with some important alterations.

  • disabled persons
  • body temperature regulation
  • hot temperature
  • wheelchair
  • athletes

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, PEA, SB and VLG-T contributed to the conception or design of the work. YH, PEA and VLG-T drafted the manuscript. YH, PEA, BTS, CB, SB, NW, SR, WD and VLG-T critically revised the manuscript. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

  • 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 WD reports grants from IOC Research Centers Grant, other from IPC Travel Support, grants from World Rugby, grants from AXA, grants from Ossur, outside the submitted work.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

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