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Background: The aim of this study was to analyze muscle injuries and their related risk factors during the Athletics events of the 2020 Tokyo Olympic Games including the differences in muscle injury rates between heats and finals., Methods: We included and analyzed in this study muscle injuries diagnosed by either magnetic resonance imaging, ultrasound, or physical examinations by at least two physicians, from Athletics athletes participating at the 2020 Tokyo Olympic Games. Data from electronic medical records, including sex, nationality, event, and the round (heat vs. final) during which the muscle injury occurred and the air temperature in the stadium, measured every five minutes during the competition were extracted., Results: Among the 1631 athletes who competed, a total of 36 athletes (20 males and 16 females) were diagnosed with a muscle injury during the 2020 Tokyo Olympic Games. Among them, 24 occurred during heats (1.47 per 100 athletes) and 12 during finals (2.20 per 100 athletes) (P=0.25). Logistic regression analysis revealed that the geographic region of athletes' origin was a factor associated with muscle injury, with the highest muscle injury rate being in athletes from Africa (odds ratio [OR]=4.74, 95% confidence interval [CI]) = 1.75 to 12.82) and North America (OR=3.02, 95%CI=1.27 to 7.20). For male athletes, competing in finals was a risk factor to sustain a muscle injury (OR=2.55, 95%CI=1.01 to 6.45)., Conclusions: During the 2020 Olympic Games, muscle injury rate was higher in finals than in heats, reaching statistical significance in male athletes.

Objectives: This document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management., Methods: Members of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management., Results: Sports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site., Conclusions: A coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete., Competing Interests: Competing interests: All authors are members of the International Olympic Committee Adverse Weather Impact expert working Group for the Olympic Games Tokyo 2020; not receiving honorarium., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)