Exertional Heat Stroke Survival at the Falmouth Road Race: 180 New Cases With Expanded Analysis

Abstract

Context: Falmouth Road Race experiences high a number of exertional heat stroke (EHS) cases. Objective: The purpose of this paper was to extend previous analyses of EHS cases at the Falmouth Road Race by assessing or describing 1) EHS and heat exhaustion (HE) incidence rates, 2) EHS outcomes as they relate to survival, 3) the impact of the environment on these outcomes and 4) how this impacts medical provider planning and preparedness. Design: A descriptive epidemiological study utilizing eight years (2012–2019) of Falmouth Road Race medical tent records. Anonymous EHS and HE medical records were obtained for analyses. Meteorological data were collected and analyzed to evaluate the impact of environmental conditions on heat illness incidence (EHI=EHS + HE). Setting: Falmouth Road Race. Patients: EHS or HE patients admitted to the medical tent. Main Outcome Measures: EHS treatment and outcomes (i.e., cooling time, survival, discharge outcome), number of HE patients, WGBT for each race. Results: 180 EHS and 239 HE cases were identified. EHS and HE had an overall incidence rate of 2.07 and 2.76 per 1,000 participants, respectively. EHI incidence rate was 4.83 per 1,000 participants. Of the 180 EHS cases, 100% survived and 20% were transported to the emergency department. WBGT was strongly correlated with EHS incidence (r2=0.904, p=0.026) and EHI incidence (r2=0.912, p=0.023). Conclusions: This is the second-largest civilian database of EHS cases ever reported; however, when combined with the previous dataset of EHS survivors from this race, it amounts to 454 EHS cases resulting in 100% survival. WBGT remains a strong predictor of EHS and EHI cases. These findings support that a wide range of ages and sexes can be treated with CWI with 100% survival from EHS.