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AI-DRAFTED — PHYSICIAN REVIEW IN PROGRESSThe citation for this entry was checked against Crossref and PubMed, but its summary and interpretation were drafted by an AI model from the published abstract and have not yet been individually read by a physician. Read the linked source before relying on this operationally.
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Lessons Learned in the Response to Multiple Cases of Exertional Hyperthermia at an Urban Half Marathon[1]

Walsh LV, Loevinsohn G, Darling N, Biddinger PD, Goldberg SA · 2025 · Disaster Med Public Health Prep

Summary

Retrospective case series of seven runners transported by EMS with exertional heat stroke (EHS - core temperature above 40 degrees C / 104 F with central-nervous-system dysfunction) from the 2022 Cambridge Half Marathon, which ran during unusually warm weather with a 2% did-not-finish rate, to an urban level I trauma centre. The clinical split is the finding: every patient who received cold water immersion at the scene was discharged from the emergency department, whereas the three patients who were not treated on scene required admission to the intensive care unit. The authors frame the lessons as the importance of rapid on-site cooling, the role of event-day communications, the varied downstream impact on ED operations, and the increasing need to anticipate heat events outside the traditional warm-weather season. They note that with rapid identification and treatment EHS survival approaches 100%.

So what

The cleanest small natural experiment for the "cool first, transport second" doctrine an event medical plan can cite: on-scene cold water immersion mapped to ED discharge, while the absence of it mapped to ICU admission, in the same race on the same day. It is a disposition-power argument in miniature - the on-site capability (an ice-immersion tub and the staff to use it) is what changes the outcome and the destination, not the transport. Three operational riders travel with it: event-day communications (warn runners and staff when conditions turn), the ED-operations ripple (a warm-day race pushes a burst of critical patients into one hospital), and season creep (EHS now appears in shoulder-season races, so cooling capability cannot be reserved for July). Caveat: seven patients, retrospective, single race - cite for the on-site-cooling / disposition mechanism and the season-creep warning, not for incidence.

Key findings

  • 2022 Cambridge Half Marathon, unusually warm; DNF rate 2%; 7 EHS patients transported to a level I trauma centre
  • EHS defined as core temp >40 C (104 F) + CNS dysfunction; with rapid Rx survival ~100%
  • ALL patients given on-scene cold water immersion were discharged from the ED
  • The 3 patients NOT treated on scene required ICU admission
  • Lessons: rapid on-site cooling, event-day communications, ED-operations impact, anticipate EHS outside warm-weather season

Read the paper