Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport

Abstract

The Tokyo 2020 Olympic Games is expected to be among the hottest Games in modern history, increasing the chances for exertional heat stroke (EHS) incidence, especially in non-acclimatised athletes/workers/spectators. The urgent need to recognise EHS symptoms to protect all attendees’ health has considerably accelerated research examining the most effective cooling strategies and the development of wearable cooling technology and real-time temperature monitoring. While these technological advances will aid the early identification of EHS cases, there are several potential ethical considerations for governing bodies and sports organisers. For example, the impact of recently developed cooling wearables on health and performance is unknown. Concerning improving athletic performance in a hot environment, there is uncertainty about this technology’s availability to all athletes. Furthermore, the real potential to obtain real-time core temperature data will oblige medical teams to make crucial decisions around their athletes continuing their competitions or withdraw. Therefore, the aim of this review is (1) to summarise the practical applications of the most novel cooling strategies/technologies for both safety (of athletes, spectators and workers) and performance purposes, and (2) to inform of the opportunities offered by recent technological developments for the early recognition and diagnosis of EHS. These opportunities are presented alongside several ethical dilemmas that require sports governing bodies to react by regulating the validity of recent technologies and their availability to all.

IOC consensus statement on recommendations and regulations for sport events in the heat

“… 9 32 The first real-time monitoring occurred during the 2020 Summer Olympic Games ( figure 4 ). Knowing an athlete’s physiological status however, raises an ethical dilemma, 161 as there is no ethical or legal grounds for making a decision to withdraw an athlete from a race against his or her will. Real-time physiological monitoring may however inform the LOC and/or IF at the organisational level to determine if an event should be altered when participants appear to have difficulties coping with the extreme conditions.…”

Wearable and telemedicine innovations for Olympic events and elite sport

“…Some of the aforementioned sensors (especially those included in the "future" category) lack of validity data, which illustrates the need for a certification system (like CE mark for performance) that regulates the use of wearable sensors during competition according to their validity and availability to all athletes/technical teams. With this rationale in mind, concerted efforts of our research team in collaboration with the International Federation of Sports Medicine (FIMS) have already proceeded in order to establish a Guiding Reference Standard (GRS) for wearable devices 68,69 . The main objective of this GRS is to provide high-quality, external, and non-profit validity testing for wearable technology.…”

“…The effectiveness of a given wearable will be tested and certified, so its validity data will be publicly available. As stated in a recent review developed by our group 69 , this validity and certification process would be necessary so that both the athlete's physical integrity and sports integrity prevail.…”

Potential use of new cooling technologies during Tokyo 2020 Olympics and associated ethical dilemmas

“…The rapid introduction of cooling wearables and the lack of external validity testing hinders the process of selecting the most effective devices. As we recently discussed [7], there is concern that the unregulated use of this technology and without rigorous quality control procedures, poses a threat, be that perceived or real, that athletes could use these technologies to gain an unfair advantage over their competitors if this technology is not available to all before its true effect is fully understood. For example, the current technical regulation of World Athletics, states that athletes are allowed to use "any kind of personal safeguard (e.g., bandage, tape, belt, support, wrist cooler, breathing aid, etc.)…”