The following article was written by George Sheehan in his book, “Running To Win”. I purposely wanted this article to be reposted in this blog in order to remind and emphasize to the runners about the danger of heatstroke in running. Many have died due to heatstroke and it is upon the individual runner to take extra precaution on this. On the other hand, it also encouraged that Race Organizers should employ Medical Teams which are trained to deal with heatstroke and better yet, if they are trained as runners also as this article would show that “immediate response and ON-SITE treatment” of heatstroke will make difference on the survival of a victim.

The following is the article as copied from the book. Enjoy reading it. (Note: BDM 102/151 runners should take note on this article)

Heat Can Kill

Despite all we have learned in recent years about heatstroke, runners continue to die from the destruction it wreaks on the human body. These deaths are due to two factors: first, the failure to take the necessary precautions to avoid heatstroke; and second, incorrect management when it occurs.

Precautions against heatstroke are the responsibility of the runner. The protocol to prepare for heat stress, especially encountered in competition, is well established. It includes training in hot weather, carbo-loading, hydrating with fluids, and running at an appropriate pace. During the race, water should be taken at regular intervals as well as splashed or sprayed over the body.

When I run, I wear a painter’s cap in which I place a bag of ice cubes, and I continually soak the cap with water. I never pass a water station without stopping to drink two full glasses and pour one over my head. Wherever there is a hose, I run through the spray, and I carry a cup in the hope that I can fill it with water. And I purposely run 15 to 30 seconds per mile slower than my usual time.

These practices have become so common among runners that the number of heat injuries sustained in races declines each year. Nevertheless, there are always some runners who push too hard, don’t take time to stop for water, or cut corners in other ways. These are mainly highly motivated recreational runners or newcomers to the sport, not veterans. And they are the ones who collapse with heatstroke. Typical symptoms include dry skin, dizziness, headache, thirst, nausea, muscular cramps, and elevated body temperature.

Heatstroke can be a catastrophe, but it need not be. Despite the seriousness of the situation—it’s potentially fatal—correct medical care can and will save the day. And by correct care, I mean the type provided by disaster teams at two of the biggest races in the world run in high heat stress conditions—the Sydney City-to-Surf Race in Australia and the Atlanta Peachtree Run in Georgia, held in July.

While we continue to see random reports of people succumbing to heatstroke, the Sydney medical team has supervised 200,000 runners without a death from heatstroke. In a nine-year period, only two patients were even hospitalized.

There is good reason for this—immediate treatment. Dr. Rowland Richards thinks his Sydney group has arrived at the correct way to treat heatstroke and the correct place to do it: at the race site. Getting a heatstroke victim to a hospital wastes precious time, risking delay in diagnosis and treatment. John R. Sutton, M.D., professor of medicine at the McMaster University in Hamilton, Ontario, Canada, agrees: “Hospitalization may be the very worst approach, especially with subjects whose vital organs are cooking at 107 to 109 degrees Fahrenheit.

That, in a nutshell, is the problem. Fatal heat injury is the result of prolonged exposure to high temperatures. The Sydney physicians are able to reduce initial core body temperatures, taken rectally, of 107 to 109 degrees Fahrenheit down to 100 degrees Fahrenheit in as little as 50 minutes, on the average. This is achieved by applying instant cold packs over the neck, armpits, and groin, along with rapid intravenous rehydration, in every runner with a core temperature of over 100 degrees Fahrenheit. If low blood sugar is suspected, 50 cc’s of 50% glucose is given intravenously. “Failure to follow this routine,” says Dr. Richards, “could result in serious consequences, including death.”

Fortunately, in the one instance in which a heatstroke victim was not given this therapy (a misdirected ambulance was 40 minutes late, then took him to the hospital), the runner did survive.

The Atlanta medical team works on much the same principle. Again, the emphasis is on cooling. Joe Wilson, M.D., the physician in charge, stresses the urgency of bringing down the temperature as quickly as possible. Often this is all that need to be done. Within 30 minutes, patients are usually alert, no longer nauseated, and able to take fluids. If not, intravenous fluids are started. And as in Sydney, no runner has ever died from heatstroke at the Atlanta race.

After reading Dr. Richards and talking with Dr. Wilson, I realized that preventive measures are important, but nowhere near as important as adhering to a tried-and-true protocol aimed at rapidly reducing core body temperature. A heatstroke is a heatstroke. A runner can do everything right and still push himself or herself into a heatstroke as severe as one incurred by an untrained, unacclimatized beginner. At that point, the runner’s life may depend on on-the-spot treatment by an experienced disaster team.

“What is required,” says Dr. Sutton, “is an immediate diagnosis, followed by rapid cooling at the site of the race. Each moment’s delay may worsen the outcome. It is no longer acceptable to have some amateur “ad hoc” arrangement.”

The facts bear that statement out. When we have amateurs running in hot-weather races, we should not have amateurs treating them.

Even the presence of the best professional  on-site disaster team should not keep you from doing your homework, however.