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Marathons need plans that match medical capacity to the heat expected on race day—not just advice telling runners to slow down. In a 2026 essay, physician Vibhu Krishna recounts treating a confused runner with a reported oral temperature of 107°F in the 2022 New York City Marathon finish-line medical tent. She describes a tent where the only cold-water immersion tub was already occupied, ice was running low, and monitors were in use. Her account is one clinician’s experience, not a count of how often heat illness occurs at the race. But it illustrates why organizers need weather-triggered plans, adequate cooling and staffing, and evidence about what happens in their medical tents.
What happened in the NYC Marathon finish-line tent
Krishna, a senior resident physician in occupational, environmental and climate medicine at UCSF with emergency and event-medicine experience, says she was volunteering in the finish-line tent on November 6, 2022. At about three and a half hours into the race, she recounts, the tent filled. A middle-aged man—given the pseudonym John in her essay—had collapsed at the finish, was confused, and had a reported oral temperature of 107°F. Krishna says she escalated the case as heat stroke.
In her account, another delirious runner was already in the tent’s sole cold-water immersion tub. Ice was dwindling, an electrolyte analyzer was backlogged, and every vital-sign monitor was in use. Krishna says the runner survived and credits volunteers who obtained more ice. The case details are from her retrospective personal essay; they are not an independently reviewed medical record or a published series of NYC Marathon patient cases.
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The point is not that one incident establishes how common heat stroke is at the marathon. It does not. It shows how a medical station can face competing urgent needs at once, even at a major urban race with a medical operation. Exertional heat stroke is a medical emergency, and the capacity to recognize and treat it promptly has to be planned before the tent fills.
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How organizers can plan for heat before race day
Weather preparation is an event-level safety task as well as an individual runner’s responsibility. NYC Health advises outdoor-event organizers to monitor the forecast heat index and prepare protective measures when it reaches 85°F. Its guidance escalates actions as the index rises. These are general recommendations for outdoor events, not a marathon-specific clinical protocol; organizers must apply them with event conditions, permitting requirements, and medical expertise in mind.
| Forecast heat index | NYC Health recommendations for outdoor events |
|---|---|
| 85–94°F | Provide accessible water; communicate heat-safety information; make water or non-caffeinated sports drinks and food available to replenish electrolytes; and encourage hats and sunscreen. |
| 95–99°F | Increase messaging and warnings about heat illness; provide more free water, breaks, and cooling relief; consider shifting the start time or shortening the event; and enhance medical staffing and crowd monitoring when applicable. |
| 100–104°F | Consider rescheduling or moving indoors; modify activity and pauses; and do not encourage personal-best efforts. |
| 105°F and above | Reschedule the event or move it indoors. |
The threshold is the forecast heat index, not simply the air temperature. The practical value of a graduated plan is that it gives organizers decisions to make before conditions become an emergency: what messages to send, where to add water or cooling relief, whether to increase medical coverage, and when to change the event itself.
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NYRR describes coordinated marathon medical coverage involving the organization, EMS providers, medical volunteers, and city agencies, with medical tents at the start, every mile, after the Verrazzano Bridge, and in the post-finish area. That published description establishes a substantial medical operation; it does not show what resources will be available at every station under every weather condition. Race-day arrangements and emergency contacts can change, so runners and volunteers should check NYRR’s current health-and-safety information for the event they are attending.
What the Tokyo Olympic medical report can—and cannot—tell us
A peer-reviewed report on the Tokyo 2020 Olympic marathon and race walks offers a useful example of why cooling resources need to be planned. The races were moved to Sapporo, where organizers still encountered unusual heat. The women’s marathon start was shifted one hour earlier the day before the race, and medical stations used protocols that included rectal-temperature assessment and cold-water immersion.
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Of 50 athletes transferred to the medical station, 48 showed signs and symptoms of exertional heat illness. Two exertional heat-stroke cases and three cases of severe heat exhaustion were treated with whole-body cold-water immersion. The report says all athletes who received cooling recovered without complications. Among cooled athletes, the reported average time to lower rectal temperature below 39°C was 14 ± 9.4 minutes, with a range of 6–30 minutes. The report emphasizes having enough ice and water for immersion cooling.
These numbers describe elite Olympic athletes in a specific event-medical setting; they are not an estimate of heat-illness risk for ordinary participants in a mass-participation city marathon. They do, however, document that immersion cooling was used for serious exertional heat illness and that its delivery depended on having adequate supplies and medical protocols.
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Why better event data could improve the plan
Krishna’s proposed next step is for NYRR, with participant permission, to analyze and report de-identified medical-tent encounters alongside weather conditions and race data. The goal would be to help organizers forecast resource needs and evaluate whether interventions work. That is a proposal in her essay, not evidence that NYRR currently publishes linked, de-identified encounter data.
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- Anti Freeze Security: You Cannot Risk Freezing Your Medication. The portable medicine cooler is built with high tech features that allow it to safely detect temperature fluctuations, and thanks to the auto shut off / on option, it automatically adjusts the power so internal temperature stays in the safe range of 2°C-10°C (default 6°C) all the time.
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Krishna puts the case for evidence plainly: “Goodwill is not a safety system — but evidence could be.” The distinction matters. Volunteers who find extra ice can make a critical difference, as her account says they did, but organizers should not rely on last-minute improvisation to fill predictable gaps.
What runners can do—and what organizers still owe them
Runners have a role in reducing avoidable risk, but individual choices cannot replace event planning. NYRR advises runners to respect the weather, avoid trying new routines on race day, drink to thirst, and seek medical help for unusual symptoms. In a 2025 NYRR-produced discussion, race medical director Dr. Matt Friedman urged runners to moderate their effort in heat rather than pursue a personal record. That is general race-day guidance, not individualized medical advice.
NYC Health identifies people with chronic conditions; some mental-health or cognitive conditions; pregnancy; older adults and very young children; people taking certain medications; people using alcohol or drugs; and people with limited mobility as groups who may need particular precautions at outdoor events. These considerations support clear communication and accessible water, shade, cooling, and medical help—not assumptions about what any individual runner can safely tolerate.
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A climate-ready race joins runner guidance to organizer decisions: forecast thresholds, timely communications, accessible water and cooling, enough trained medical staff and equipment, and a way to learn from de-identified event data. Krishna’s account makes the stakes tangible; the planning challenge is to make the response systematic rather than improvised.
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