The Tokyo 2020 Olympics faced challenges due to extreme heat conditions, prompting the relocation of race walk and marathon events to Sapporo. Despite expectations of milder heat, Sapporo experienced record-high temperatures during the Games. The decision to move events aimed to reduce exertional heat illness risks, yet heatwaves persisted. Held in Sapporo from August 5th to 8th, 2021, five events saw varying percentages of athletes not finishing due to exertional heat-related issues.

Epidemiological data underscore the association between high ambient temperature and exertional heat illness incidence rates. The relocation to Sapporo aimed to mitigate these risks, but unexpected heat levels challenged event organizers. Athlete medical services in Sapporo had to swiftly implement additional measures to address the heightened exertional heat risk. For instance, the women’s marathon start time was adjusted to combat the intense heat conditions.

The incidence of exertional heat illness was notably high among athletes in the race walk and marathon events during the Tokyo 2020 Olympics. Athletes who required medical attention were transferred to the athlete medical station for treatment. The majority of these athletes exhibited signs of exertional heat illness, with heat exhaustion being the most common condition observed. The incidence rates of exertional heat illness per 1,000 finishers were particularly elevated in the men’s 50 km race walk and marathons.

Efforts to cool athletes diagnosed with exertional heat stroke and severe heat exhaustion were successful through whole-body cold water immersion. Athletes were effectively cooled, with their rectal temperatures dropping below critical levels within an average time frame. The standardized prehospital management procedures implemented by trained medical volunteers proved crucial in addressing exertional heat emergencies.

In conclusion, the Tokyo 2020 Olympics highlighted the importance of proactive measures to mitigate exertional heat illness risks in endurance events. Future elite endurance event organizers are advised to consider early start times and contingency plans for extreme heat events. Implementing standardized prehospital management for exertional heat emergencies can optimize athlete safety and treatment outcomes.

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