Climate and health challenges for Paris 2024 Olympics and Paralympics

Mitigating risks from heat

Experiences from previous summer games should help.12 Recent events such as the 2019 World Athletics Championships in Doha, Qatar, and the 2020 summer Olympics in Tokyo, Japan, have raised awareness of heat risks among stakeholders and the general public. An update of the International Olympic Committee (IOC) consensus statement focuses on protecting and maintaining athletes’ health while optimising their performance.1234567

Effective emergency services are important during the planning and execution of such large events since they enable early detection and treatment of heat related illness before transfer to medical facilities. Initial treatments include oral or intravenous rehydration, ice towels, and air blowers for spectators and cold water immersion for athletes. A network of designated hospitals with advanced heat related expertise and capabilities should be identified before the event to help the local healthcare system cope with patient volume. Steps should be taken to ensure that care can be provided in multiple languages as required, and that expertise in country specific insurance, billing, and repatriation procedures is available.

Tokyo 2020 had no spectators because of the covid-19 pandemic, so the incidence of heat related illnesses was low.8 The exposed population will be much larger during the Paris 2024 games. In previous summer Olympics affected by heat, spectators accounted for 4-68 times more heat related illnesses than athletes.910

The Paris organisers are paying close attention to long term weather models and have a contingency plan to adjust schedules, but not locations, in case of extreme heat.11 However, 50 cases of heat related illnesses occurred among athletes at the Tokyo 2020 games despite changes to the location and timing of the marathon and race walking events.8

Safety initiatives to protect spectators, workers, and volunteers include providing shaded areas in queuing lines (with efficient check-in and additional staffing to reduce waiting times), free water dispensers, and sunscreen, fans, caps, and umbrellas. Leaflets on thermoregulation, risk factors for and symptoms of heat illness, and information on hydration and cooling, should be considered, along with a map of local public air conditioned spaces.

An additional concern is the “marathon for all,” which is scheduled for 10 August late in the evening. This will offer 40 000 public participants the chance to experience the official Olympic marathon course or a 10 km race. Coupled with other concerns (for example, the lack of air conditioning in the Olympic village), these events highlight the Paris 2024 organisers’ challenges regarding heat hazards, especially in an unprepared population. Health professionals may struggle to meet the extra demand for care.

Role of public health

The public health system needs to be proactive. Many countries and international federations already have policies for extreme weather or heat (including the UK Health Security Agency, the IOC, and the International Volleyball Federation). France has had a heat watch and warning system to protect the general population since 2004,12 and it will be active during the Paris 2024 games alongside heat policies developed by individual sports federations. However, experiences from Tokyo 2020 highlight that meteorological forecasting must consider all available basic weather variables (instead of wet bulb globe temperature, which is subject to underestimation and misinterpretation13) and provide easily comprehensible reports. Combining local weather metrics with advanced human heat transfer and thermoregulation models and signs and symptoms of heat related illnesses could help fine tune heat contingency plans in real time.14 This would also help stretched emergency departments predict and prepare for periods of high demand.

Clinicians have an important role helping patients and the public recognise, respond to, and prepare for climate related ill health. Climate change and related health problems are, however, often missing from medical curriculums.1516 One exception is the World Athletics’ race emergency medicine course, which includes lectures on exertional heat stroke, skill building activities, and race day observation.17 Specific training in the diagnosis, assessment, treatment, and follow-up of heat related illness should be organised for the clinicians directly or indirectly involved in Paris 2024 as well as for all future generations of healthcare practitioners.36 Heat health surveillance, prevention campaigns, and communication aimed at the general public would help improve the safety of both athletes and the general public during the forthcoming games.18 Without careful and comprehensive preparation supported by the media, any heat events could be more deadly than anticipated.