Incidence and factor analysis for the heat-related illness on the Tokyo 2020 Olympic and Paralympic Games.

Introduction: Among the 43 venues of Tokyo 2020 Olympic Games (OG) and 33 venues of Paralympic Games (PG) were held, the heat island effect was highly expected to cause heat-related illnesses in the outdoor venues with maximum temperatures exceeding 35°C. However, the actual number of heat-related illness cases during the competition was lower than that was initially expected, and it was unclear under what conditions or environment-related heat illnesses occurred among athletes. Object: To clarify the cause and factors contributing to the occurrence of heat-related illness among athletes participating in the Tokyo 2020 Olympic and Paralympic Games. Method: This retrospective descriptive study included 15 820 athletes from 206 countries. From 21 July 2021 to 8 August 2021 for the Olympics, and from 24 August 2021 to 5 September 2021 for the Paralympics. The number of heat-related illness cases at each venue, the incidence rate for each event, gender, home continent, as well as the type of competition, environmental factors (such as venue, time, location and wet-bulb globe temperature (WBGT)), treatment factor and the type of competition were analysed. Results: More number of heat-related illnesses among athletes occurred at the OG (n=110, 76.3%) than at the PG (n=36, 23.7%). A total of 100 cases (100%) at the OG and 31 cases (86.1%) at the PG occurred at the outdoors venues. In the OG, a total of 50 cases (57.9%) occurred during the competition of marathon running and race walking at Sapporo Odori Park. Six of those, were diagnosed with exertional heat illness and treated with cold water immersion (CWI) at OG and one case at PG. Another 20 cases occurred in athletics (track and field) competitions at Tokyo National Olympic Stadium. In total, 10 cases (10.0%) were diagnosed with severe heat illness in the OG and 3 cases (8.3%) in the PG. Ten cases were transferred to outside medical facilities for further treatment, but no case has been hospitalised due to severe condition. In the factor analysis, venue zone, outdoor game, high WBGT (<28°C) and endurance sports have been found to have a higher risk of moderate and severe heat-related illness (p<0.05). The incidence rate and severity could be attenuated by proper heat-related illness treatment (CWI, ice towel, cold IV transfusion and oral hydration) reduced the severity of the illness, providing summer hot environment sports. Conclusion: The Tokyo 2020 Olympic and Paralympic summer games were held. Contrary to expectations, we calculated that about 1 in 100 Olympic athletes suffered heat-related illness. We believe this was due to the risk reduction of heat-related illness, such as adequate prevention and proper treatment. Our experience in avoiding heat-related illness will provide valuable data for future Olympic summer Games.

Lots of luck on thin ice from Tokyo to Paris: Following the track of the preparedness and results of Emergency Medical Services and Disaster Medical Response during 2020 Tokyo Olympic and Paralympic Games from the Perspective of Academic Consortium (AC2020) of Japan and Medical Advisory Board of Tokyo Metropolitan Government

Summary Introduction The 2020 Tokyo Olympic and Paralympic Games (2020 Tokyo Olympics) was held in Japan during the pandemic of new coronavirus infection (COVID-19) in 2021. Preparedness In 2016, the Academic Consortium consisting of 29 major medical associations (AC2020) was launched and undertook medical risk assessment, issuing statements, and disseminating manuals/guidelines, training materials through its website. Administratively, Tokyo Organizing Committee of the Olympic and Paralympic Games (TOC) was responsible for preparations inside the venue, while Tokyo Metropolitan Government (TMG) was responsible for preparations on the last mile and around the venue. In response to the AC2020 recommendation, the TOC and TMG has set up the subcommittee for reviewing emergency and disaster medical systems for the games. Finally, the 2020 Tokyo Olympics gave up accepting spectators from abroad and limited domestic spectators. The multi-organizational training was not systematically performed until just prior to the event due to the delay in deciding on the form of this big event. Results A total of 779,820 people participated during the entire period. The 316 patients were seen at hospitals including 53 COVID- 19 cases, and the patient presentation rate (PPR) was 2.4/1000. The COVID-19 cases in Japan increased as the games approached, and a major wave peak of the epidemic was observed during the games. Conclusion If MCI had occurred during the games, the current medical care system would not have been able to cope with such situation. We were walking on thin ice, but fortunately, we didn’t step out and drown in the water. Résumé Introduction Les Jeux Olympiques et Paralympiques de Tokyo 2020 (Jeux Olympiques de Tokyo 2020) ont eu lieu au Japon pendant la pandémie COVID-19 en 2021. Préparation En 2016, le Consortium Académique composé de 29 grandes associations médicales (AC2020) a été lancé et a entrepris une évaluation des risques médicaux, publié des mises aux points et diffusé des manuels/directives, du matériel de formation via son site Web. Sur le plan administratif, le comité d’organisation des Jeux olympiques et paralympiques de Tokyo (TOC) était responsable des préparatifs à l’intérieur du site, tandis que le gouvernement métropolitain de Tokyo (TMG) était responsable des préparatifs sur le dernier kilomètre et autour du site. En réponse à la recommandation AC2020, le COT et le TMG ont mis en place le sous-comité chargé d’examiner les dispositifs prévisionnels de secours pour les urgences et en cas de catastrophe pour les jeux. Enfin, les Jeux Olympiques de Tokyo 2020 ont renoncé à recevoir des spectateurs étrangers et ont limité les spectateurs nationaux. La formation multi-organisationnelle n’a été systématiquement effectuée que juste avant l’événement en raison du retard dans la décision sur la forme de ce grand événement. Résultats Au total, 779820 personnes ont participé pendant toute la période. Les 316 patients ont été vus dans les hôpitaux dont 53 cas de COVID-19, et le taux de présentation des patients (PPR) était de 2,4/1000. Les cas de COVID-19 au Japon ont augmenté à l’approche des jeux, et un pic de vague majeur de l’épidémie a été observé pendant les jeux. Conclusion Si un afflux de victimes s’était produit pendant les jeux, le système de soins médicaux actuel n’aurait pas été en mesure de faire face à une telle situation. Nous marchions sur de la glace mince, mais heureusement, nous n’avons pas dérapé et ne nous sommes pas noyés dans l’eau.

Evaluation of the physiological changes in prehospital health-care providers influenced by environmental factors in the summer of 2020 during the COVID-19 pandemic.

AIM: Wearing personal protective equipment (PPE) is essential to prevent infection transmission, but the risk of heatstroke increases with wearing PPE in a humid and hot environment. Therefore, we aimed to examine how environmental parameters change the body physiology in a hot environment during the coronavirus disease (COVID-19) pandemic. METHODS: This was a retrospective cohort study extracted from the MEDIC Japan heatstroke prevention database, which was recorded between 1 August and 7 September, 2020. Its database is a registry collection from seven healthy health-care providers. Subjects recorded their own vital signs (forehead and tympanic temperature, blood pressure, pulse rate, and oxygen saturation) and environmental factors (type of weather, wet-bulb globe temperature [WBGT], air temperature, humidity, and location) every hour during their working shift. RESULTS: From 323 records, a weak positive but statistically significant correlation was observed between WBGT and pulse rate (correlation coefficient [95% confidence interval], r = 0.34 [0.23, 0.45]) and between WBGT and core body temperature. Forehead temperature had a stronger correlation than tympanic temperature (forehead, r = 0.33 [0.21, 0.43]; tympanic, r = 0.17 [0.05, 0.28]), which also showed a larger effect (forehead, η2 = 0.08; tympanic, η2 = 0.05). The effect size of oxygen saturation measured outdoors was large (η2 = 0.30). Forehead temperature increased abruptly at 28°C WBGT and at 33°C air temperature. CONCLUSION: A hot environment significantly affected forehead temperature, and the daytime imposed a high risk of heatstroke. To avoid heatstroke, environmental parameters are important to note as outdoor environments had a large effect on vital sign changes depending on the time of day.

Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020).

Mass gatherings are events characterized by "the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community." Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health-care system, it can provide the opportunity for long-term benefits of public health-care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID-19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.