Original research
Exertional heat fatalities in Australian sport and recreation

https://doi.org/10.1016/j.jsams.2021.04.007Get rights and content

Abstract

Objectives

To describe the number and case characteristics of sport and recreation-related exertional heat deaths in Australia and summarise recommendations derived from case narratives.

Design

Descriptive, population-based, retrospective cohort study.

Methods

Cases were identified using the National Coronial Information System (NCIS) through multiple search strategies comprising queries, keywords and cause of death codes. Cases were included where there was evidence that the deceased was actively engaged in sport or recreation and exertional heat illness was causal or contributory to the death. Data extraction were performed independently, in duplicate, to ensure accuracy. Descriptive statistics are used to report deceased's socio-demographic characteristics, incident characteristics, type of sport/recreational activity and time sequence of events. Content analysis is used to summarise recommendations.

Results

Thirty-eight deaths (males n = 29, 74%; median age = 40 years, range 8–77) were identified during the study period (2001 to 2018), with 22 recommendations for five cases. Two cases occurred during organised sport and 36 during active recreation, of which 27 were in hiking. Eleven (29%) individuals were international visitors. There were 22 recommendations across 5 cases presented, with a focus on education and training.

Conclusions

Exertional heat deaths in outdoor recreation in Australia were far more prevalent than cases in organised sport. The largest proportion of deaths occurred in hiking with two populations featuring: males aged 15–45 years and international visitors. Considering the incident characteristics and time sequence of events, measures such as early recognition of symptoms, provision of first aid and timely access to emergency medical care are important to prevent fatalities.

Section snippets

Practical implications

  • Two distinct populations who had a fatal heat related death were identified — males aged 15–45 years and international visitors. Any safety and awareness information that is developed must be relevant and accessible to these populations.

  • Most fatalities occurred during hiking on days of high temperature and high humidity. Clear and simple messaging of ‘hiking on days of extreme heat is strongly discouraged’ should be promoted.

  • Delays in accessing medical care contributed to many fatalities.

Background

The 2019–2020 Australian Summer of high temperatures, bushfires and smoke significantly impacted participation in sport and recreation across the country.1 These events raised concern that as extreme temperatures become more common, safe participation in outdoor sport and recreation will become increasingly challenging.2 Existing evidence has shown that an increased number of hospital admissions are reported during heat waves in Australia.3 Most of these cases are attributed to the classic form

Methods

A population-based retrospective cohort study was performed to examine all cases of exertional heat-related deaths in sport and recreation notified to Australian Coroners from 1 January 2001 to 31 December 2018. This study was approved by the Justice Human Research Ethics Committee CF/19/24669 and Western Australia Coronial Ethics Committee.

The primary data source for this study was the National Coronial Information System (NCIS). The NCIS is an internet-based data repository of all deaths

Results

There were 38 exertional heat-related deaths in Australia related to active sport or recreation identified. Cases were most frequently male (n = 29, 74%) and ages ranged from 8 to 77 years (median 40 years) (Table 1). At least one case was recorded for residents from all States/Territories, the majority residing in Western Australia (WA) (n = 7), New South Wales (NSW) (n = 5) and Queensland (QLD) (n = 5). Most deaths occurred in recreation (n = 36, 95%), including 27 hiking deaths. Two deaths

Discussion

This is the first study to present national population-based data on heat-related deaths linked to sport and recreation activity in Australia. The results confirm that while such deaths are rare, they occur with enough regularity to warrant renewed attention toward their prevention. Three key findings of our study are highlighted: population targets; hiking in the heat; and sign/symptom awareness. Firstly, we found two distinct populations at risk. One is young-to-middle aged men, between the

Conclusion

The heat and extreme conditions in Australia are generally respected and there are several ways in which awareness of extreme days are promoted to reduce morbidity and mortality. Despite this, there were 38 preventable deaths identified in this series. Most cases were participating in outdoor recreation, such as hiking, on a day of high temperature. Specific consideration of how to reach young-to-middle aged men and international visitors with safety messaging is critical. Messaging must

Funding information

Funding was received from the Victorian State Government for conduct of the project from which this study is derived.

Declaration of interest

Author LVF is an Associate Editor with the Journal of Science and Medicine in Sport. There are no other conflicts of interest declared.

Confirmation of ethical compliance

This study was approved by the Justice Human Research Ethics Committee CF/19/24669 and Western Australia Coronial Ethics Committee.

Acknowledgements

We acknowledge the Department of Justice and Community Safety (source organisation of the data), and the National Coronial Information System (database source).

References (24)

  • S. McLean et al.

    Applying a systems thinking lens to injury causation in the outdoors: evidence collected during 3 years of the understanding and preventing led outdoor accidents data system

    Inj Prev

    (2021)
  • P.J. Gamage et al.

    Document analysis of exertional heat illness policies and guidelines published by sports organisations in Victoria, Australia

    BMJ Open Sport Exerc Med

    (2020)
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