These recommendations were developed by the International Olympic Committee (IOC) Medical and Scientific Commission and several International Federations (IF), based on a working group, meetings, field experience, and a Delphi process. The first section presents recommendations for event organisers to monitor environmental conditions before and during the event; to provide sufficient ice, shading, and cooling; and to work with the IF to remove the regulatory and logistical limitations. The second section summarises recommendations that are directly associated with athletes’ behaviours, which include the role and methods for heat-acclimation; the management of hydration; and adaptation to the warm-up and clothing. The third section explains the specific medical management of exertional heat stroke (EHS) from the Field of Play triage to the prehospital management in a dedicated heat deck, complementing the usual medical services. The fourth section provides an example for developing an environmental heat risk analysis for sport competitions across all IFs. In summary, while EHS is one of the leading life-threatening conditions for athletes, it is preventable and treatable with the proper risk mitigation and medical response. The protection of athletes competing in the heat involves the close co-operation of the local organising committee, the national and international federations, the athletes and their entourages, and the medical team.
- Protecting the athlete's health and safety during sport events in the heat requires involvement and collaboration among the local organising committee, the national and international federations, the athletes and their entourages, and the medical team.
- The local organiser should monitor and communicate the environmental conditions before and throughout the event, provide sufficient ice and hydration, and propose adequate heat stress mitigation facilities (e.g. shade, recovery areas).
- The athlete should specifically prepare for the expected environmental conditions (i.e. heat acclimation), manage their health status before the event, and plan their hydration, cooling, warm-up and clothing according to the risks associated with the forecasted environmental conditions.
- Medical providers should receive specific training on exertional heat stroke management including early recognition (e.g. field of play supervision, finish line triage) and diagnosis (including rectal temperature assessment) as well as in the use of rapid on-site whole-body cooling (i.e. cool first, transport second).
- International federations are encouraged to develop specific environmental heat policies with a clear communication pathway on the level of risk and the associated countermeasures (e.g. using a colour-coded 1 to 5 heat stress scale).