With temperatures rising in Paris, Yuri Hosokawa thinks about a race walker who collapsed at the Tokyo Olympics three years ago during a blistering heat wave.
What happened next was a kind of breakthrough.
The athlete’s body reached nearly 108 degrees Fahrenheit — high enough to cause organ damage or even death. But the racer didn’t die, thanks in part to an extreme weather plan drafted with Hosokawa’s help before the games.
The athlete was taken to a tent near the racecourse, called a “Heat Deck,” where he was immersed in ice water for 30 minutes, until his body temperature dropped to 102 degrees.
“He didn’t even have to get hospitalized,” said Hosokawa, a professor of sport sciences at Japan’s Waseda University.
The Tokyo games marked the first time the Olympics treated heat illness on-site with heat decks. They are back for the Paris games and will likely become a stable of sports medicine as athletes compete amid ever-rising temperatures.
“It’s not a conversation that is going away,” said Rebecca Stearns, chief operating officer at the University of Connecticut’s Korey Stringer Institute, which works to prevent heat stroke in athletes and was named after the offensive tackle for the Minnesota Vikings who died of heat stroke in 2001.
Despite their physical conditioning, athletes are at high risk for exertional heat stroke because of the strenuous nature of their activity.
Their bodies are warmed by the ambient temperature of wherever they compete, but also by muscle contractions and exercise. Many sports also require special uniforms or protective equipment that trap heat.
“A lot of the perception around athletes is that they are these high-level, invincible individuals who are at the physiological peak of human anatomy,” Stearns said. “But we see a large number of elite athletes succumb to things like heat stroke.”
So when the International Olympic Committee convened an Adverse Weather Impact Expert Working Group ahead of the Tokyo games, it focused on heat. It identified which sports are at “high risk” from hot temperatures and came up with a plan to respond to illnesses.
“The Olympics did not have a heat policy prior to Tokyo, and we didn’t even have much data to work with,” Hosokawa said. “They had people who did injury surveillance at events, but we didn’t know how much exertional heat stroke to expect at what temperatures, or how much ice we would need.”
The “heat deck” idea was born out of the task force, which determined that safeguards should be used for nearly every outdoor event with at least a medium duration. Some of that was controversial, according to Hosokawa, whose role was to explain to each athletic federation the need for the heat deck.
Some sports were not used to dealing with heat. That included soccer, whose games usually take place in the evenings when temperatures are cooler.
But the women’s final match was initially scheduled to begin at 11 a.m. in Japan, meaning athletes would be playing at the hottest time of day.
“I had to go to FIFA and say, ‘Look, we know you normally don’t see extreme heat symptoms on the pitch during your games, but given this schedule, we need the heat deck,'” Hosokawa said, referring to the international soccer association.
FIFA agreed, though the final match between Canada and Sweden was pushed back to 9 p.m. local time because a heat wave pushed temperatures in Tokyo over 100 degrees.
Convincing Japanese medical officials to use the heat deck system took more time. Experts who specialize in treating exertional heat stroke say that cooling someone down immediately — before transporting them to the hospital — is the best way to save their life. Heat stroke can kill in a matter of minutes.
But the idea of treating an ailing person in place, rather than rushing them to the hospital, is counterintuitive to medical personnel who are accustomed to treating other illnesses. As a result, international athletic guidelines are often not followed outside of sporting events.
“There was a lot of education and translation about how the duration of hyperthermia determines life or death, and we have to cool people before you get to the point of no return and organ failure,” Hosokawa said.
Ultimately, 1 in 100 athletes were found to have suffered some kind of heat-related illness at the Tokyo Olympic and Paralympic Games. Some 24 athletes in the race walk and marathon events became so sick during their events that they could not finish. That no one died is something Hosokawa counts as “a success.”
The Paris Games
After a cool and rainy start to the Olympics in Paris, temperatures climbed to 95 degrees on Tuesday and are expected to reach 90 degrees on Wednesday. The city has suffered from other recent heat waves.
French officials attributed more than 5,000 deaths to heat last summer. One study that looked at heat deaths across Europe found that Paris ranked first.
Athletes didn’t escape unscathed. During the 2023 French Open, which was played at this Olympic’s tennis venue, Roland-Garros, competitors Novak Djokovic and Casper Ruud argued with the game’s umpire over the timing of breaks in the heat.
“Where is the rush, why are you rushing?” Djokovic asked.
French environmental physiology expert Sebastien Racinais chaired the Olympics’ adverse weather group ahead of Tokyo and also helped prepare for the Paris Games.
The Olympics published a pamphlet instructing athletes and their medical teams on how to “optimize performance and reduce the risk of heat illness,” advising that they take at least two weeks to acclimate to Paris weather ahead of the games.
Racinais also shared video of televisions at Roland-Garros stadium displaying heat stress and hydration tips. “Kudos to @Paris2024,” he wrote.
But some athletes are asking the Olympics to do better.
Many Olympians signed onto a report from the British Association for Sustainable Sport this spring calling on organizers to schedule games during cooler times of day, and support athletes who speak up against climate change. It also called on the Olympics to reassess the sponsorships it receives from fossil fuels organizations.
And the report quoted athletes who suffered heat during the Tokyo games.
“At the Tokyo Olympics, it was impossible to hydrate well enough to combat the heat and humidity,” said Marcus Daniell, a New Zealand tennis star who won a bronze medal in men’s doubles. “We sometimes have to play in conditions where an egg can literally be fried on the court.”
Michael Tipton, a lead author of the report, said highlighting an athlete’s experience can help save lives and promote climate action.
“Sporting fans tune into the Olympics for the spectacle, they want to see athletes compete at the top of their game, they want to see world records being broken,” he said. “But that’s not as likely to happen if the athletes have to worry about collapsing in the heat.”
