Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes

Hosokawa, Yuri; Adami, Paolo Emilio; Stephenson, Ben T.; Blauwet, Cheri; Bermon, Stéphane; Webborn, Nick; Racinais, Sébastien; Derman, Wayne; Goosey‐Tolfrey, Victoria L.

doi:10.1136/bjsports-2021-104786

Cited by 16 publications

(17 citation statements)

References 45 publications

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“…Each of these life-threatenning conditions has their own internationally agreed management protocols that should be integrated into the mandatory training for all FoP medical teams. However, while most team physicians are well aware of the management of cardiac174 and concussion175 issues in athletes, several are not familiar with the specific prehospital management of EHS for athletes61 and para-athletes 155. Thus, specific training is warranted for medical personnel covering events in hot ambient conditions.…”

Section: Discussionmentioning

confidence: 99%

“…However, while most team physicians are well aware of the management of cardiac 174 and concussion 175 issues in athletes, several are not familiar with the specific prehospital management of EHS for athletes 61 and para-athletes. 155 Thus, specific training is warranted for medical personnel covering events in hot ambient conditions. The appropriate management of EHS (ie, algorithm and facilities) allow improved recovery and survival.…”

Section: Discussionmentioning

confidence: 99%

“…The reader is referred to the recently published evidence-based guidelines on EHS management developed for the Olympic 61 and Paralympic 155 Games. This section complements those guidelines by presenting some applied perspectives for their implementation.…”

Section: Section 3: Medical Service and Management Considerationsmentioning

confidence: 99%

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

et al. 2022

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This document presents the recommendations developed by the IOC Medical and Scientific Commission and several international federations (IF) on the protection of athletes competing in the heat. It is based on a working group, meetings, field experience and a Delphi process. The first section presents recommendations for event organisers to monitor environmental conditions before and during an event; to provide sufficient ice, shading and cooling; and to work with the IF to remove regulatory and logistical limitations. The second section summarises recommendations that are directly associated with athletes’ behaviours, which include the role and methods for heat acclimation; the management of hydration; and adaptation to the warm-up and clothing. The third section explains the specific medical management of exertional heat stroke (EHS) from the field of play triage to the prehospital management in a dedicated heat deck, complementing the usual medical services. The fourth section provides an example for developing an environmental heat risk analysis for sport competitions across all IFs. In summary, while EHS is one of the leading life-threatening conditions for athletes, it is preventable and treatable with the proper risk mitigation and medical response. The protection of athletes competing in the heat involves the close cooperation of the local organising committee, the national and international federations, the athletes and their entourages and the medical team.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…46 However, the logistical (e.g. transferring athletes in and out of an immersion tank) and physiological concerns related to hypothermic overshoot 47 and/or triggering autonomic dysreflexia in SCI above T6 48 limit its practical application in certain SCI subpopulations. Confounding results were present for the use of ice slurry as a pre-cooling method, 45,49 which is surprising given 6.8 g•kg −1 has been effective at lowering body temperature in AB individuals.…”

Section: Discussionmentioning

confidence: 99%

The effect of pre-cooling or per-cooling in athletes with a spinal cord injury: A systematic review and meta-analysis

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Stephenson

et al. 2022

Journal of Science and Medicine in Sport

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“…25 26 Procedures that were implemented specifically for the Paralympic population included upskilling local medical providers' awareness on the effect of heat in athletes with certain impairment types and accommodation of team medical staff within the heat decks. 27 The first week of the Tokyo Paralympic Games were held under extreme weather conditions with WBGTs between 30°C and 35°C and humidity ranging from 72% to 84%. 28 According to the position stand of the American College of Sports Medicine, exercise under these conditions should be limited or cancelled.…”

Section: The Incidence Of Heat Illness At the Tokyo 2020 Gamesmentioning

confidence: 99%

Incidence and burden of illness at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days

et al. 2022

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ObjectiveTo describe the incidence and burden of illness at the Tokyo 2020 Paralympic Games, which was organised with strict COVID-19 countermeasures.MethodsDaily illnesses were recorded via the web-based injury and illness surveillance system (teams with their own medical staff; n=81), and local polyclinic services (teams without their own medical staff; n=81). Illness proportion, incidence and burden were reported for all illnesses and in subgroups by sex, age, competition period, sports and physiological system.Results4403 athletes (1853 female and 2550 male) from 162 countries were monitored for the 15-day period of the Tokyo Paralympic Games (66 045 athlete days). The overall incidence of illnesses per 1000 athlete days was 4.2 (95% CI 3.8 to 4.8; 280 illnesses). The highest incidences were in wheelchair tennis (7.1), shooting (6.1) and the new sport of badminton (5.9). A higher incidence was observed in female compared with male athletes (5.1 vs 3.6; p=0.005), as well as during the precompetition versus competition period (7.0 vs 3.5; p<0.0001). Dermatological and respiratory illnesses had the highest incidence (1.1 and 0.8, respectively). Illness burden was 4.9 days per 1000 athlete days and 23% of illnesses resulted in time loss from training/competition>1 day.ConclusionThe incidence of illness at the Tokyo 2020 Paralympic Games was the lowest yet to be recorded in either the summer or winter Paralympic Games. Dermatological and respiratory illnesses were the most common, with the burden of respiratory illness being the highest, largely due to time loss associated with COVID-19 cases. Infection countermeasures appeared successful in reducing respiratory and overall illness, suggesting implementation in future Paralympic Games may mitigate illness risk.

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Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes

Cited by 16 publications

References 45 publications

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

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

The effect of pre-cooling or per-cooling in athletes with a spinal cord injury: A systematic review and meta-analysis

Incidence and burden of illness at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days

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