Translating evidence-based practice to clinical practice in Tokyo 2020: how to diagnose and manage exertional heat stroke

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 assessment of …