In an opinion piece for STAT, Dr. Vibhu Krishna, a senior resident in occupational and environmental medicine at UCSF, describes volunteering at the 2022 New York City Marathon, where unseasonably high temperatures filled the finish-line medical tent. One patient, called John, had collapsed with an oral temperature of 107°F and was initially placed in the moderate-severity zone before being upgraded to critical care. The tent had limited ice, a single cold-water immersion tub, and a backlogged electrolyte analyzer, forcing staff to ration monitors.
Krishna argues that such scenes are becoming predictable as endurance events grow and global temperatures rise. He notes that the same year, 16 participants at the Brooklyn Half Marathon were hospitalized, and at this year's Los Angeles Marathon, nearly 1,000 runners accepted an early medal option amid heat risk while the race recorded 652 incidents of injury or illness. Some events have already adapted, such as Grandma's Marathon and Twin Cities Marathon, but Krishna says the lack of standardized medical data across races prevents organizers from learning what works.
The author calls for a shared evidence base that links race data, climate conditions, and medical outcomes. Without it, he writes, goodwill from volunteers is not a safety system, and large-scale races in a warming world will remain dangerously unprepared.