When you enter a race, you expect a physical challenge, but not a life-threatening episode of heat stroke. When this happened to one Cape Town Marathon runner, the Mediclinic Events team were thankfully on hand with the immediate, expert assistance needed to save his life.

Having trained extensively, Brett Hannington felt confident going into his first full marathon after multiple half-marathon events. Despite a brief pause due to a slight calf muscle pull and a cold two weeks before race day, he says he was in the best shape he’d ever been.

Brett is a regular runner and had felt in great shape before the marathon.

Problems later in the race

But around 30km into the marathon, Brett started feeling tired. At 35km, soon after his running partner had taken two anti-inflammatories, he took two as well. “About 2km later I started feeling a bit dizzy,” he recalls. The two began walking, only running when Brett felt able to.  

With 2km to go they decided to run for 1km, during which time Brett failed to see a very visible “no stopping” sign. Then, with 400m to go, he felt very dizzy but focused on getting over the finish line. “That’s literally the last memory that I have of the race,” he says. 

I knew I was in trouble, but I didn't know what had happened. Scarily, it felt like everything was out of my hands, I could actually feel my body shutting down.

Immediate, expert care  

Brett had been caught as he collapsed. His eyes were open, but he appeared very confused. Placed on a golf cart and then a stretcher, he was rushed to the medical tent on site into the care of the expert Mediclinic Special Events Team – made up of specialists in sports, exercise, and emergency medicine. 

“My next memory was coming around in the medical tent for a few seconds, feeling freezing as they’d placed me in an inflatable ice bath,” says Brett. “I knew I was in trouble, but I didn’t know what had happened. Scarily, it felt like everything was out of my hands, I could actually feel my body shutting down.” 

Dr Darren Green, Events Chief Medical Officer of Mediclinic Corporate Events, explains: “Brett had severe heat stroke, was in an altered mental state and his core body temperature was around 42°C. He needed to be actively cooled through ice water immersion. We also packed cold towels with ice in all crevices, in the groin, under the armpits, under the feet, and behind the neck.”  

Heat stroke patients do not present with a fever, Dr Green adds, but rather the body loses its ability to thermoregulate – in other words, to regulate temperature during any form of exercise or endurance event. In heat stroke, your body’s compensatory mechanisms run out and it can’t cool itself.

“Your core body temperature then rises above 40°C, affecting multiple internal organs and systems, including your kidneys, nervous, cardiac and gastrointestinal systems, and your level of consciousness,” adds Dr Green.

“If you don’t cool patients down within a certain rapid time period and reverse the core body temperature, permanent cell damage starts developing. Luckily, we managed to stabilise Brett and get his body temperature down quickly.” 

In so doing, Dr Green and the Mediclinic Events team saved Brett’s life. “They acted immediately and were perfectly prepared with everything that they needed to bring my temperature down,” Brett says. “They were amazing.” 

Brett is thankful to have recovered and determined to make the most of life.

Recovery and a new outlook 

Once stabilised, Brett was rushed to hospital by ER24 and spent a night in ICU and another in the general ward. He was walking a day after his ordeal but felt fatigued for about two weeks. “I was very short of energy for the first 10 days but recovered quite quickly afterwards,” he recalls. 

Brett says he’s now grateful for each day. While he has always prioritised his family, he’s now maximising their time together. “I’m more eager to make things happen, to make time count, to travel as a family, I’m just taking more opportunities.” 

Expert advice on pre-race conditioning

“Your pre-race conditioning is vital,” says Dr Green. “If you train at a certain intensity in certain conditions, your body can better adapt to those temperatures [thermoregulate],” he advises.  

“In addition to that, remaining hydrated and keeping the water in balance with electrolytes is key. The vital organs involved in body cooling are your brain and kidneys – which specifically maintain the fluid-electrolyte balance. During exercise, if that balance is off, the muscles, which  depend on certain electrolytes, cannot function.”  

Dr Green also cautions against pushing through pain and says you need to listen to your body’s warning signs. By taking anti-inflammatories during the race, Brett was unknowingly endangering his. 

Taking medication like anti-inflammatories can decrease blood supply to the kidneys and cause kidney damage,” Dr Green explains. “This affects your ability to regulate the fluid electrolyte balance, which leads to heatstroke.” 

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