Recognition and treatment of exertional heat illness at a marathon race

Exertional heat illness is rarely encountered by individual EMS providers but can be common in certain settings and events. The notion that significantly altered mental status must accompany elevated core temperature in heat illness may delay recognition and treatment. We report on a series of marathon and half-marathon runners who suffered exertional heat illness during a marathon race in relatively mild conditions. Altered mental status was not uniformly present. All patients were treated in the finish line medical tent and responded well to cooling. More than half were discharged from the medical tent without being transported to the hospital. This case series demonstrates that many runners respond to early identification and treatment of exertional heat illness. Significant preparation is required by the medical providers to handle the rapid influx of patients at the conclusion of the event.