Prevention and Management of Heat-Related Illness Among Spectators and Staff During the Olympic Games -- Atlanta, July 6-23, 1996

To help ensure the health and safety of athletes, staff, and spectators at the 1996 Summer Olympic Games in Atlanta during July 19-August 5, the Atlanta Committee for the Olympic Games (ACOG) Medical Services; CDC; the Division of Public Health, Georgia Department of Human Resources (GDPH); and other local, state, and federal public health agencies designed and implemented two public health surveillance systems. This report summarizes provisional data from the ACOG health information system about spectators and staff treated by physicians at venue medical-assistance sites from July 6 (when the Olympic Village opened) through July 23; based on these data, heat-related illnesses have been the most commonly reported preventable health problem. This report also presents heat-related data from the GDPH medical-encounter surveillance system designed to monitor health events outside the Olympic venues. ACOG Health Information System

The ACOG system monitors the approximately 100 medical-assistance sites at the venues (1). In Atlanta, the daily temperatures during July 6-23 ranged from 66 F to 95 F (19 C-35 C); in addition, an estimated 2.2 million persons are attending the games. During July 6-23, a total of 2912 spectators and staff were treated by physicians at medical-assistance sites. Of these, 372 (12.8%) persons were treated for heat-related conditions, including heat cramps/dehydration, heat syncope, and heatstroke; 10 persons were transported to hospitals for treatment.

Heat-related illnesses have been reported both from competition and noncompetition venues. Most (193 {51.9%}) of the 372 persons with heat-related illness were treated from noon to 4 p.m. However, 54 (50.5%) of 107 medical encounters treated by physicians at one evening event attended by an estimated 135,000 persons were heat-related. GDPH Sentinel Hospital System

GDPH initiated sentinel medical-encounter surveillance for selected conditions of public health importance, including heat-related encounters, from eight hospital emergency departments (EDs); four hospitals are located in the Atlanta metropolitan area, and four are located in other venue areas.

During July 7-23, a total of 156 persons presented to GDPH sentinel hospital EDs with heat-related conditions, accounting for approximately 2% of ED visits for the selected conditions under surveillance; 15 persons required hospital admission. The proportion of heat-related encounters increased steadily, peaking at 4.2% of visits in both Atlanta and other areas on July 20, the first full day of the Olympic Games. Eighty percent of visits were for persons aged 10-64 years, and 14% were for persons aged greater than or equal to 65 years. Approximately 14% of heat-related encounters in metropolitan Atlanta and 6% of such encounters in other venues occurred among persons who reside outside Georgia.

Reported by: E Martin, J Cantwell, MD, Atlanta Committee for the Olympic Games, Atlanta; D Blumenthal, MD, Fulton County Health Dept, Atlanta; P Wiesner, MD, DeKalb County Board of Health, Decatur; SH King, MD, Chatham and Effingham county health depts, Savannah; KE Toomey, MD, State Epidemiologist, P Meehan, MD, Div of Public Health, Georgia Dept of Human Resources. Office of the Director, Public Health Practice Program Office; Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Div of Prevention Research and Analytic Methods (proposed), Div of Public Health Surveillance and Informatics (proposed), and Morbidity and Mortality Weekly Report Activity, Office of Scientific Communications (proposed), Office of the Director, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: The findings in this report from the ACOG health information system document only heat-related illnesses among spectators and staff treated by physicians inside the Olympic venues. In addition, GDPH data document heat-related illnesses among persons seeking care at hospital EDs. This report does not include information about persons treated by paramedical personnel only.

Based on anticipated high temperatures and humidity, continued crowding, and the provisional data in this report, GDPH, CDC, and other agencies recommend that spectators and staff at the Olympic events and at other summertime sporting events take precautions to prevent heat-related illness (2). These precautions include wearing loose-fitting, light-colored clothing; wearing a protective hat; increasing intake of nonalcoholic beverages; maximizing time spent in an air-conditioned environment; and spending time in shaded areas both inside and outside the venues. Spectators, staff, and others should take these precautions whenever they expect to spend time outside (e.g., en route to or from events), regardless of whether the event itself is indoors or outdoors. Employers and supervisors should consider these precautions when devising work schedules and rest periods for paid and volunteer staff.

GDPH implemented a comprehensive approach to prevent heat-related morbidity statewide during the Olympics, including modifying environmental health regulations to require the availability of free water at events with greater than 50 attendees and undertaking an aggressive media and public information campaign. In addition, local government agencies and volunteer organizations cooperated to establish facilities to provide water, protective hats, and sunscreen. For example, on July 22, an estimated 11,000 cups of water, 5400 hats, and 13,000 sunscreen packages were distributed in downtown Atlanta (P. Meehan, GDPH, personal communication, 1996). In addition, ACOG and public health officials have used the medical surveillance data to redeploy free drinking water provided by GDPH to areas with large numbers of heat-related illnesses. ACOG also has used these data to evaluate and plan medical services.

Adverse health outcomes associated with high environmental temperatures include heat cramps, heat syncope, heat exhaustion, and heatstroke (3). Heatstroke (i.e., core body temperature greater than or equal to 105 F {greater than or equal to 40.4 C}), the most serious of these conditions, is characterized by rapid progression of lethargy, confusion, and unconsciousness; it can be fatal despite medical care directed at lowering body temperature. Heat exhaustion is a milder syndrome that occurs after sustained exposure to hot temperatures and results from dehydration and electrolyte imbalance; manifestations include headache, nausea, vomiting, dizziness, weakness, or fatigue, and treatment is supportive. Heat syncope and heat cramps usually are related to physical exertion during hot weather; persons with loss of consciousness resulting from heat syncope should be treated by placement in a recumbent position and replacement of fluids and electrolytes. During sporting events, such as the Olympics, spectators and staff should obtain medical assistance if, after self-treatment, heat-related symptoms persist or if fainting occurs.

The 1996 Olympics is a mass gathering that has posed complex challenges for ensuring the public health and medical safety needs of its participants. During the 17 days of the Olympics, an estimated 2.2 million persons from geographically diverse areas will be gathered in a confined area under subtropical environmental conditions. To address the health and safety needs, ACOG and local, state, and federal public health agencies collaborated closely to develop a public health surveillance system, unprecedented in timeliness and scope, that also can serve as a model for future scheduled special events.

References

1. CDC. Public health surveillance during the XVII Central American and Caribbean Games -- Puerto Rico, 1993. MMWR 1996;45:581-4.

2. Kilbourne EM. Diseases associated with the physical environment: illness due to thermal extremes. In: Last JM, ed. Public health and preventive medicine. 12th ed. Norwalk, Connecticut: Appleton-Century-Crofts, 1986:703-14.

3. CDC. Heat-wave-related mortality -- Milwaukee, Wisconsin, July 1995. MMWR 1996;45:505-7.

   
   

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