Opinion: I treated heat stroke at the NYC Marathon. Marathons need to prepare for a climate-changed world
An event physician and amateur runner recounts volunteering at the finish-line medical tent of the record-hot New York City Marathon on Nov. 6, 2022. Around the three-and-a-half-hour mark, the tent filled, and unseasonably climbing temperatures visibly affected athletes of all levels. The author was assigned to a row of cots in the moderate-severity zone.
A middle-aged man, called John, collapsed at the finish line and was wheeled into that zone. He could give his name but, when asked where he was, said "Nick's house"; his skin was flushed and his oral temperature was 107°F. He had been mistriaged. The author fetched a senior physician from critical care, and John was upgraded immediately as a heat-stroke patient. They moved him, cut off his soaked singlet, and began cooling him with the tent's last bags of ice.
The tent's only cold-water immersion tub was already occupied by a young woman the author recognized from club running in Central Park; she was likewise overheated and deliriously swatting at the attending physician. The tent's only electrolyte analyzer was backlogged, and every vital-signs monitor was in use, so staff rationed monitors based on who would benefit most. In the middle of Manhattan, flanked by some of the nation's best hospitals, they were practicing resource-limited field medicine. No one died that day, a result the author credits to thousands of volunteers who gave 12 hours of their Sunday, some sprinting to bodegas for more ice—but goodwill, the author argues, is not a safety system.
The author still thinks about John's mistriage, the dearth of supplies, and the mere minutes that could have cost his life, and asks why they were not adequately prepared. It is tempting to dismiss such stories as niche, but as endurance-event popularity and global temperatures rise, these scenes are increasingly predictable. That same year, at the hot, humid Brooklyn Half Marathon, 16 participants were taken to the hospital.
The author acknowledges that events are voluntary and that heat acclimation, pacing, and hydration are participant responsibilities, and does not disagree. But when an event swells to the size of a city—the New York City Marathon had nearly 60,000 finishers last year—climate risk is no longer solely a personal matter; it is a public health matter that can strain local systems. Several races are already adapting with warning flags, earlier start times, date shifts, and outright cancellation. Decades ago, Grandma's Marathon in Minnesota, held every June, quantified and shared the impact of strategies to reduce runner morbidity; after it added a half-marathon option and an additional change not fully described in the excerpt.