Last year, Amy was excited to be back in running shape. After having a baby the year before, she had trained all summer for the Beach to Beacon race. She was ready for a great race, a fast time, and to feel like she had regained her fitness.

The morning of the race was unusually warm. After training in the cool, wet weather of the last summer, Amy thought she was prepared for a hot race. She wore a hat, a light outfit, and she drank plenty of water before the start.

Amy was an experienced runner and she began the race feeling great. Before long, she checked her watch and saw that she was on pace for a personal record. But at Mile 5, her race began to go badly.

Her running partner began to notice Amy struggling and encouraged her to keep her rhythm up. Amy worked hard for the next mile, but by the turn into Fort Williams Park, she was staggering all over the road. She stumbled and fell as she passed over an uneven section of pavement. She ignored her friend’s concern, got up again and headed for the finish.

Amy had barely made it over the finish line when she collapsed. She was carried to the medical tent. By that point she couldn’t remember the day, the date, or even her own name. She lay on a cot, listless and close to unconsciousness.

Amy was suffering from exertional heatstroke. Her core temperature was measured at over 106 degrees. At that temperature, the body’s cells literally cook themselves. Athletes, even those as young and fit as Amy, can suffer irreversible liver, kidney and circulatory failure in minutes. Many sustain brain damage that is permanent.

Every summer, athletes around America die of exertional heatstroke. It can come on quickly, and it often strikes the young and fit. Military personnel, tradespeople, and especially athletes are at risk.

One of the greatest tragedies is that heatstroke is entirely preventable. The National Oceanic and Atmospheric Administration provides a heat index chart on its website. The heat index takes into account temperature and humidity and can help event organizers and athletes decide when it is too hot to compete.

Getting adjusted to the heat by exercising in hot weather is also key in preventing heatstroke. As we spend time working out under hot conditions, our bodies become more efficient in sweating and maintaining a constant, safe temperature. It probably takes a minimum of 10 days for us to fully acclimatize.

One common pitfall of athletes is to assume that staying well-hydrated will prevent heatstroke. While it is true that we may become a little bit warmer while exercising if we are dehydrated, there is no evidence that drinking fluids will prevent heatstroke.

One key concept concerns exertion level. If they pay attention to their bodies, athletes are actually very good at preventing heatstroke. They speed up when their core is cooler, and slow down to cool off when their core temperature rises.

Problems arise when athletes push themselves too hard by ignoring the signs that they are getting in trouble. Instead of pacing themselves, they can strive for faster splits, or to keep up with a fitter competitor. Before long, these racers end up in the medical tent with their lives in danger.

Fortunately for Amy, the Beach to Beacon provides a large, well-equipped medical area staffed by volunteers trained to recognize heatstroke. Even before her core temperature was measured, Amy was placed in a tub of icy water. As the bath cooled her, she began to regain her composure. Miraculously, 20 minutes later she walked out of the tent looking for a post-race bagel.

In two weeks Amy will be back in Cape Elizabeth at the race. This time she has a different approach. She worked with her doctor to test herself carefully before running again in the heat, because heatstroke can recur if athletes return to the heat too quickly. She has been running on hot days to get ready. She knows about the heat index and checks out the weather forecast before each race. And finally, Amy has a race plan that allows her to slow down if things don’t feel right.

All Maine athletes, and especially parents of our younger athletes, can take a page from Amy’s book. Keep yourself and your loved ones safe from heatstroke, because those of us working in medical tents this summer know that the best race is one in which there are no emergencies.


Dr. James Glazer is a sports medicine physician for Coastal Orthopedics and Sports Medicine in Freeport. He serves as a consultant for the Portland Pirates and the U.S. Ski Team.