Athletes and Others in Brutal Heat or Cold “And There Are Storms We Cannot Weather...” : Current Sports Medicine Reports

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Pearls and Pitfalls

Athletes and Others in Brutal Heat or Cold
“And There Are Storms We Cannot Weather...”

Eichner, E. Randy MD, FACSM

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Current Sports Medicine Reports: September 2021 - Volume 20 - Issue 9 - p 433-434
doi: 10.1249/JSR.0000000000000882
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Introduction

I write this at the end our third brutal heat wave — across a wide swath of the Pacific Northwest and the Western United States — in just the past month. The first was in mid-June; the second — the deadliest — was at the end of June; and the third began the second week of July. These unseasonable heat waves were caused by a lingering high-pressure system or “heat dome” initially over the United States-Canada border. The heat dome sent temperatures soaring, shattering all-time records. Seattle hit 108°F — 34 degrees above its normal high of 74°F. Portland hit 116°F, its hottest in recorded history. The tiny town of Lytton, British Columbia, hit an alarming 121°F before it was razed by a wildfire. California's Death Valley hit 130°F for only the fifth time in history. Hundreds of heat-related deaths occurred, many of them among the homeless, those with medical issues, or the elderly. More below on athletes and others in the heat. First, I cover a recent tragedy for athletes in the cold.

A Wintry Storm Hits a Mountain Ultramarathon

Elite ultramarathon runner Liang Jing was leading the fourth annual Yellow River Stone Forest 100 k race in late May 2021 when the sudden wintry storm hit. A photograph shows him wearing only shorts and a thin jacket. Liang had won all three previous editions of this 62-mile high-altitude or “mountain” ultramarathon in Gansu province in northwestern China but he was unable to survive the ordeal of the savage storm. It also killed four of the other five front runners and 21 runners in all, or 12% of the 172 runners in the race. Reports say that the main or only cause of death was hypothermia. Maybe we can learn from this horrific disaster in ultramarathon racing.

What Went Wrong

Some say extreme weather was not predicted. Others say the forecast warned of possible sudden rain, hail, and gale-force winds. In any case, 3 h to 4 h into the race, as runners — many lightly clad — were scrambling and clambering along a steep, treacherous shepherd's trail through narrow ravines and over exposed mountain 6500 feet high, they were hit by a savage storm: freezing rain, sleet, hail, and gales that knocked them down and shredded their emergency foil blankets. The area is notorious for wild swings in weather, with mountains to the west and Siberian winds from the north. One runner fell nearly a dozen times before he passed out. A shepherd found him and carried him to safety in a cave that had blankets and a fire. That shepherd, Keming Zhu, is a national hero for saving six runners. About 50 other runners were given shelter in cave dwellings maintained by shepherds.

Many other runners alas were not so lucky. Organizers did not place staff or aid stations along the most rugged trail, where the storm hit, and did not know that this area was a cell phone blind spot. Warm jackets were not compulsory. Many runners were family breadwinners and knew of cash prizes for finishing. It took rescuers, some perhaps poorly trained, hours to reach some victims, who by then were dead from hypothermia. The dead (18 men and 3 women) were all from the lead pack; the storm struck them near the exposed summit of the third checkpoint, about 20 miles into the race. The slower runners, mostly women and way behind the lead pack, missed the worst of the storm and survived.

The tragedy prompted outrage in China. In the aftermath, a top race official committed suicide and about 30 others were detained, fired, or demoted. Granted, many of these errors would be unlikely to occur in ultramarathons in America and elsewhere, but maybe we can learn from this tragedy. It pays to know what can happen, and never to forget that Mother Nature can be unforgiving. Forewarned is forearmed.

Humans in Brutal Heat

Our heat wave in late June killed hundreds of people in ordinarily cool Oregon, Washington, and British Columbia. The deaths — in overheated cars and trailers, in stifling apartments and older homes, in workplaces, in the fields, and in homeless encampments — reflected the danger of sudden extreme heat for days in a row, with little cooling at night. Experts say you can lose up to 2 L of fluid overnight via sweating if the temperature does not drop below 85°F. One man died working in a hot warehouse trailer with only a fan for cooling. Research suggests that in dry heat like this, as opposed to humid heat, fans can increase rectal temperature and so thermal strain (1). So air-conditioning is vital in dire heat waves like this. The city of Sacramento has now opened air-conditioned cooling centers three times by July, whereas last year they opened the centers only three times overall, the third time in September.

To make it worse, drought and heat are partners in crime. Droughts are more likely or more extreme when temperatures soar. Also, a drought-stricken landscape augments the heat. When the ground absorbs sunlight, some of that energy turns soil moisture into water vapor, drawing heat away from the surface. Dry soil means less solar energy used to evaporate water and more solar energy to heat the ground and air.

Consider also that many climate scientists agree that human-caused climate change is already affecting heat waves. Global warming — by an average of nearly 2°F over the past century — has caused heat waves to be hotter, larger, longer, and more frequent. So, the distant past is no longer a reliable guide to the near future. The worst may be yet to come.

Implications for Elite Athletes

The U.S. Olympic track and field trials were held in Eugene, Oregon, during the second and deadliest heat wave. Overall, the athletes fared better than I feared they might. However, heptahlete Taliyah Brooks, then in fourth place, fainted in the extreme heat on Sunday, June 27, as she warmed up for the javelin. After being carted off the field in a wheelchair and getting medical treatment, Brooks withdrew from competition. The temperature on Sunday soared to 108°F, and it was said to be 150°F on the field. At that point, mid-afternoon Sunday, the trials were shut down and spectators were asked to leave. About 5 h later, Sunday evening, the trials resumed, with the temperature reading 99°F.

Athletes in the Ironman Triathlon at Coeur d' Alene, Idaho, also felt the heat but in general, they fared well or at least coped well. The start time was moved to 5 a.m., and there were tons of ice at aid stations, along with misting stations and chilled towels. Savvy competitors doused themselves regularly with ice water. The fastest and most fit competitors seemed to fare best, maybe in part because they spent less time boiling in the sun and went home before the temperature hit 100°F at 5 p.m. The slower competitors had a longer and more grueling duel in the sun. Up to 600 (maybe 28%) dropped out, more than usual for that race, but no catastrophe occurred.

Less Elite Athletes Driven Hard in the Heat

What about young football or soccer players driven hard in the heat? By and large, they seem not to fare as well as elite Olympians or top triathletes. To wit, fatal exertional heatstroke (EHS). Not all EHS can be prevented; however, EHS should never be fatal in high school football or soccer. Yet I am sad to report that, although the numbers are small, the trend is troubling.

Seven players died in high school football activities in 2020. None died from trauma. At least three (and maybe four) died from EHS, as reported by the National Center for Catastrophic Sport Injury Research, and as I mentioned earlier (2,3). This is a troubling — and I hope not foreboding — uptick from three high school football EHS deaths in the prior 2 years combined.

Does the trend continue? During one of our recent dire heat waves, at a high school in North Las Vegas, a 13-year-old football player collapsed near the end of a 2-h evening “practice” on a day when the top temperature was 106°F, and it was still 93°F when they took the field. We await the official cause of death, but heat was likely a factor.

Ditto soccer. Four days before the young football player died in the Las Vegas heat, a 16-year-old soccer player collapsed and died after a 2-hour soccer practice on a hot, humid evening in Ohio. He also collapsed a year ago, but survived; it was attributed to “dehydration.” We now await the cause of his death. In August 2020, a 17-year-old soccer player collapsed during practice in Chino, CA; the ambient temperature was 111°F. The official cause of his death was EHS. In these troubling times, what's next?

These are our children, dying in the sun. Where are the adults?

The author declares no conflict of interest and does not have any financial disclosures.

References

1. Morris NB, English T, Hospers L, et al. The effects of electric fan use under differing resting heat index conditions: a clinical trial. Ann. Int. Med. 2019; 171:675–7.
2. Kucera KL, Klossner D, Colgate B, Cantu RC. Annual survey of football injury research, 1931–2020. NCCSIR. [cited 2021 July 16]. Available from: http://nccsir.unc.edu/reports/.
3. Eichner ER. Updates on heat stroke, carbon monoxide, and muscle cramping. Curr. Sports Med. Rep. 2020; 19:446–7.
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