Carolyn Baker, clad in a neon pink top and matching sunglasses, smiled as she ran the Falmouth Road Race on the shore of Cape Cod, looking around for friends as she neared the end of a race shesa国际传媒檇 completed more than a dozen times before.
Suddenly, Baker collapsed, as her exertion on a sunny August day sent her internal temperature soaring. As medical volunteers rushed to her aid by plunging her into a tub filled with ice water, they measured it at nearly 107 degrees (41.6 Celsius).
For family members, the first sign of trouble was when their tracking app showed Baker moving backward on the course sa国际传媒� as she was taken to the medical tent. Her husband, catching up with friends after finishing earlier, blurted sa国际传媒淥h my god,sa国际传媒� after his daughter called to alert him, then rushed to the tent.
The heatstroke that felled Baker last year is a deadly , and climate change is worsening the risk. In the continental U.S., the frequency of dangerously hot days .
Exertional heatstroke happens during exercise when the body cansa国际传媒檛 properly cool, and triggering a central nervous system problem such as fainting or blacking out. It can be effectively treated by rapidly cooling a victim, but lots of races lack the resources or expertise to do it. And many runners, in a culture that esteems grit and suffering, may ignore conditions that put them at risk.
Muscles can break down, releasing proteins that damage kidneys. The lining of the digestive system may weaken and leak bacteria. Brain cells may die. It can damage organs and, ultimately, kill.
The Falmouth race is a magnet for heatstroke. At 7 miles, itsa国际传媒檚 long enough to give the body time to heat up dangerously and short enough that many runners are pushing hard. And with more than 11,000 runners, odds are good that some havensa国际传媒檛 trained to acclimate to hot weather, or show up dehydrated. And some runners are simply more vulnerable.
But if you are going to have heatstroke, you could do it in a worse place than Falmouth. They have enough people, equipment and experience to handle lots of cases. And medical director John Jardine has documented nearly 500 cases of heatstroke in more than two decades sa国际传媒� so many the race has attracted researchers.
The problem is lots of races donsa国际传媒檛 have the equipment or expertise to offer the right lifesaving care, said Douglas Casa, director of the University of Connecticutsa国际传媒檚 Korey Stringer Institute, named for the Minnesota Vikings lineman who died of heatstroke in training camp in 2001.
sa国际传媒淭hink of the local 5K races,sa国际传媒� Casa said. sa国际传媒淭hey might have an ambulance there or they might have a nurse or medic or somebody there, but they donsa国际传媒檛 have a whole medical tent set up to be able to deal with heatstroke.sa国际传媒�
Keeping runners alive
Getting victims into a tub of ice water is the best way to quickly cool them. And it needs to happen fast, with quick diagnoses to treat runners on the spot. Medical staff need rectal thermometers to gauge temperature when skin can be deceptively cool.
sa国际传媒淚 cansa国际传媒檛 guarantee everything that is going to happen in the future,sa国际传媒� Casa said. sa国际传媒淏ut based on over 3,000 cases wesa国际传媒檝e tracked, if someonesa国际传媒檚 temp gets under 104 within 30 minutes of the presentation of heatstroke, no one has ever died.sa国际传媒�
He said there isnsa国际传媒檛 good data on how many races do it right. From his decades of experience, very few do, although generally he said care is better now than when he started. Casa suggested governing bodies for racing should publish heat-related recommendations for safety.
Race directors must organize complex events for runners of all ability. Some are big races with lots of resources; others are small local affairs with a shoestring budget. Security, organizing workers and volunteers, tracking runners and medical care all must be assembled and paid for, said Dave McGillivray, who helps direct the Boston Marathon and also advises other race directors.
Runners bear responsibility, too. He recalls grabbing a mic at the 2012 Boston Marathon when it was , telling runners they needed to take it easy. Itsa国际传媒檚 a hard message for runners who have trained months to meet goals.
sa国际传媒淲e cannot fit all of you in our medical tents,sa国际传媒� he remembered saying. More than 2,000 people needed treatment that day; roughly 200 went to the hospital.
sa国际传媒淚t was a lot of carnage out there,sa国际传媒� McGillivray said. sa国际传媒淏ut, you know, no one passed, people went home, and we dodged the proverbial bullet. Not every race can say that. If you donsa国际传媒檛 have the resources, then you shouldnsa国际传媒檛 be firing the gun.sa国际传媒�
Two athletessa国际传媒� stories
Evan Hauptmann, a multi-sport athlete in high school, decided to run Falmouth at 17. He wanted to finish in under an hour and felt fine until a big hill late in the race made him light-headed. By then he could see the finish line and his competitive nature kicked in.
Soon after finishing, he lost consciousness. His temperature was the highest Jardine has seen at Falmouth sa国际传媒� 112.8 degrees (44.9 Celsius).
sa国际传媒淭hatsa国际传媒檚 crazy,sa国际传媒� said Dr. Sameed Khatana, a professor of medicine at the University of Pennsylvania. sa国际传媒淭hat is not compatible with life.sa国际传媒�
But Hauptmann got immediate care, with a half-hour in the ice bath bringing his temperature down quickly, and he went home that day. Doctors worried about organ damage. Blood tests showed high protein levels from muscle breakdown, but they came down and he avoided lasting injury.
Two weeks later he started playing football again. But hesa国际传媒檚 more aware of heatsa国际传媒檚 danger, and makes sure to stay hydrated and aware of how he is feeling.
sa国际传媒淎s an athlete I cansa国际传媒檛 really let it stop me from competing,sa国际传媒� he said. sa国际传媒淚 kind of just have to learn from it, realize what I did wrong and realize what I can do better in the future to listen to my body.sa国际传媒�
In contrast, theresa国际传媒檚 Zo毛 Wallis, recruited to play college basketball in South Carolina. The summer before her freshman year in 2014, her team was told their mental strength would be tested with a 5-mile run they had to finish within an hour. It was about twice as far as she had ever run.
By the second half, she started feeling hazy, then panicky. Eventually, a teammate on each side held her up. She recalled saying she wanted to stop but being pushed forward.
sa国际传媒淲hat I remember happening was getting a jolt of energy near the end and feeling like I was hitting this runnersa国际传媒檚 high and was going to finish the run strong,sa国际传媒� she said. sa国际传媒淚n reality, what happened is that I completely collapsed, skinned my entire arms, elbows, knees.sa国际传媒�
She was taken to the hospital in a car, laid across the warm laps of teammates. She awoke in the emergency room, disoriented. Her kidneys and liver had failed, she said. She eventually sued the school and receive a settlement.
Wallis said it took about three months to resume practice. But the sport never felt the same. Eventually, she left the team, lost her scholarship and transferred.
sa国际传媒淭he mental aspect of the heatstroke consumed me. I felt so fragile, not only when I was practicing and actually playing my sport, but also just existing. I was just afraid in so many ways,sa国际传媒� she said. Ten years later, shesa国际传媒檚 in a good place, but it took therapy and time.
Keep running, but be smart about it
Racing may slightly increase the chances a runner will suffer a rare event like heatstroke or cardiac arrest, but doctors say itsa国际传媒檚 almost certainly healthier to show up anyway.
sa国际传媒淩unners and athletes are at reduced risk of having not only cardiac arrest, but all forms of heart disease compared to non-runners,sa国际传媒� said Dr. Aaron Baggish, a professor at the Universit茅 de Lausanne and former medical director of the Boston Marathon.
Baker, now 61, had a happy ending.
She regained consciousness in an ice bath that brought her temperature down to a safe level. Her head hurt and she felt weak, but family members eventually helped her stand and she was able to go home. She had no memory of her collapse, and called it sa国际传媒渆eriesa国际传媒� afterward when she came upon a gallery of race pictures online and saw photos that showed her falling to the ground.
One week later, Baker dressed in the same pink top, sunglasses and racing bib to run Falmouthsa国际传媒檚 last mile, striding past the spot where she collapsed. Her husbandsa国际传媒檚 photos show her smiling and flexing at the finish.
sa国际传媒淲e have a big running group of friends and family,sa国际传媒� Baker said. sa国际传媒淓verybody in our group had finished the race except for me. And I was like nah, I need to do it. And I need to know Isa国际传媒檓 going to be OK mentally.sa国际传媒�
This year, she was back at Falmouth again sa国际传媒� and finished safely.
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Michael Phillis, The Associated Press
