At the 2022 New York City Marathon, physician Vibhu Krishna says a confused runner arrived at the finish-line medical tent with a reported oral temperature of 107°F. The tent’s only cold-water immersion tub was already occupied, ice was running low, and monitors and an electrolyte analyzer were in use. Her account is a warning about more than one medical emergency: heat illness can test an event’s capacity to care for runners, so organizers need plans built around forecast conditions and real medical demand.
What Krishna says happened in the finish-line tent
In an essay published by STAT on October 2, 2026, Krishna recounts volunteering in the medical tent at the November 6, 2022, marathon. She identifies herself as a senior resident physician in occupational, environmental and climate medicine at UCSF, with experience in emergency and event medicine.
At roughly three and a half hours into the race, she says, the finish tent filled. A middle-aged man—whom she calls John, a pseudonym—had collapsed at the finish line and was confused. Krishna says his reported oral temperature was 107°F and that she escalated the case as heat stroke. The immersion tub was occupied by another delirious runner; ice was dwindling, the electrolyte analyzer was backlogged, and all vital-sign monitors were in use. Krishna reports that the runner survived and credits volunteers with finding more ice.
This is Krishna’s retrospective account, not an independently reviewed patient record or a count of all medical encounters at the race. It nevertheless shows how a single heat emergency can collide with limited cooling and monitoring capacity in a crowded tent.
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Why heat preparation is an event-planning problem
Exertional heat illness is associated with high ambient temperature and relative humidity. Exertional heat stroke is a medical emergency that calls for prompt diagnosis and treatment. At a large race, responding to it depends not only on an individual clinician’s decisions, but also on whether cooling equipment, ice, water, staff and monitoring are available when patients arrive.
Peer-reviewed medical reporting from the Tokyo 2020 Olympic marathon and race walks offers a useful example of planned cooling—not a risk estimate for a city marathon. In that elite competition, 48 of the 50 athletes transferred to the medical station had signs and symptoms of exertional heat illness. Two cases of exertional heat stroke and three cases of severe heat exhaustion were treated with whole-body cold-water immersion. The report says the cooled athletes recovered without complications.
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| Evidence | What it describes | What it does not establish |
|---|---|---|
| Krishna’s 2022 NYC account, published in 2026 | One finish-line tent’s reported patient and resource conditions | How often heat illness occurred across the race or the total medical workload |
| Tokyo Olympic event-medical report, published in 2022 | 48 of 50 medical-station admissions had signs and symptoms of exertional heat illness; five athletes received whole-body immersion cooling | The expected rate or number of cases at a mass-participation marathon |
For the Tokyo athletes who received immersion cooling, the report gives an average of 14 ± 9.4 minutes to cool rectal temperature below 39°C, with a range of 6–30 minutes. That finding underscores why a cooling method needs adequate water and ice and a staffed medical protocol. The Tokyo races were moved to Sapporo, organizers still encountered unusual heat, and the women’s marathon start was moved an hour earlier the day before. Those elite-event conditions and procedures are a comparator, not a template that can be transferred without adaptation.
Use forecast heat index to scale precautions
NYC Health advises outdoor-event organizers to monitor forecast heat index and prepare protective measures when it reaches 85°F. Its recommendations increase with the forecast. They are general guidance for outdoor events; race organizers still need to apply them to event conditions, permitting requirements and medical expertise.
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| 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 use pauses; and do not encourage personal-best efforts. |
| 105°F and above | Reschedule the event or move it indoors. |
The point of a threshold is to prompt decisions before a tent fills, not to treat the number as a guarantee that conditions below it are safe. Organizers can translate the guidance into a weather-response plan: identify who monitors forecasts, who can change the start or course plan, how runners and staff will receive updates, and how medical capacity will be adjusted as conditions worsen.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.NYRR has medical operations; the question is how to keep them responsive
New York Road Runners describes coordinated medical coverage involving NYRR, EMS providers, medical volunteers and city agencies. Its health-and-safety information describes medical tents at the start, every mile, after the Verrazzano Bridge and in the post-finish area. The issue raised by Krishna is not that the marathon lacks a medical operation; it is whether event planning can anticipate weather-linked demand and adapt resources accordingly.
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Krishna proposes that NYRR, with participant permission, analyze and report de-identified medical-tent encounters alongside weather and race data. Such analysis could help organizers forecast demand and assess whether interventions are working. NYRR’s public description of its medical coverage does not establish whether it currently publishes this kind of linked dataset.
As Krishna puts it, “Goodwill is not a safety system — but evidence could be.” Volunteers’ effort mattered in her account, but systematic data could help an organizer decide where to place cooling resources, how much ice and staffing to stage, and when weather should trigger operational changes. Those decisions should be evaluated against actual event conditions and medical encounters, while protecting participants’ privacy.
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Runners have a role, but responsibility is shared
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, Dr. Matt Friedman advised runners to moderate their effort in heat rather than pursue a personal record. That is race-day guidance, not individualized medical advice.
Runner choices cannot substitute for an organizer’s heat plan. People with chronic conditions, some mental-health or cognitive conditions, pregnancy, older adults and very young children, people taking certain medications, those affected by alcohol or drugs, and people with limited mobility may need particular precautions, according to NYC Health. Clear messaging and accessible water and cooling measures matter because participants do not all face the same risks or have the same ability to respond.
City heat figures are context, not marathon statistics
NYC Health’s 2026 report estimates approximately 490 heat-exacerbated deaths per year on average in New York City during 2014–2023. It reports an average of seven direct heat-stress deaths annually for 2016–2025; the 2025 figures were provisional as of the report’s March 2026 cutoff. These citywide figures describe the broader public-health burden of heat. They are not counts of marathon deaths, race-day illness or NYC Marathon medical encounters.
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