Just steps away from the finish line at the Beach to Beacon 10K in Cape Elizabeth, a large tent is transformed into a makeshift emergency room. But this one is equipped differently than what you see in a hospital. It's lined with two rows of big, black, plastic tubs — the kind used for horse troughs — filled with water.
These are ice baths to cool down runners who get heat stroke.
And as nurse Lynn Landry goes over treatment protocols with medical volunteers, she warns that heat stroke patients can be belligerent.
"As we said, these people are combative," she tells them. "They will spit. They will kick. They will bite. They will head butt. They think they're being attacked."
Summertime in Maine can bring welcome sunshine and warmth. But under certain conditions, hot and humid weather can cause problems for the body: anything from minor muscle cramps and skin rashes to more serious issues like dizziness, vomiting, and seizures.
Heat stroke can develop when the body's core temperature rises to 104 degrees or higher. And while hot weather is one cause, so is physical exertion. So even though this is an unusually mild August morning, medical tent team leader Shelly Weinstein says it's still something volunteers need to be on the lookout for.
"What people have to remember is you can have people with heat stroke even as cool as 60 degrees because they're pushing really hard, and so their muscles are actually heating up," says Weinstein. "It's kind of like a roast in the oven. It's cooking from the inside."
And it's life-threatening, says Mylan Cohen. He's a cardiologist at MaineHealth and medical director of the Beach to Beacon.
"The human body was only really designed to operate within a certain temperature range, and when it gets super cold or super hot, things don't work right. Just to put it very simply," Cohen says.
The brain, heart, and other organs can shut down. Cohen says early treatment is key. That's where the ice baths come in.
"OK, alright, ice brigade!" Landry calls out to the medical volunteers. They line up outside the tent to grab bags of ice from a truck and drop two next to each tub.
As runners cross the finish line, nurse Arline Waecker and other medical volunteers look for anyone who shows symptoms of heat illness.
"Well, you look at the face, and the face tells all," Waecker says. "And if they're not comprehending, and they're not really standing, they're ready to pass out, they're vomiting."
They're then escorted inside the medical tent, where volunteers check their core temperature. Chris Troyanos, who is medical services coordinator for the Beach to Beacon as well as the Boston Marathon, says there's only one tried and true method.
"Having a thermometer that's going to go in the rectum, that's the only way to do it," he says.
But that doesn't always go over well with runners who are suffering cognitive symptoms from heat stroke.
"Yeah, so they couldn't get a temperature reading for me pre-going into the ice bath, because I was extremely combative with medical staff," says Dan Brett, who got heat stroke running Beach to Beacon two years ago.
"First four miles was great," Brett says. "Last two miles is when I started to kind of get in trouble."
Looking back, Brett thinks wearing compression shorts and over-the-ear headphones contributed to his body overheating. He had also recently recovered from COVID-19. But at the time, Brett figured he was just pushing hard. After he crossed the finish line, he passed out.
"I woke up in medical tent," he says. "I was in the ice bath, and I was kind of blacking in and out at that point. But sort of one of the few things I remember is asking if I was going to die."
When Brett ultimately agreed to have his temperature taken, it was nearly 108 degrees. He was so sick he had to be transported to a hospital.
"It can definitely happen at any age," Brett says. "Even people who think they're in their 20s, fit, whatever, absolutely can happen."
Brett fully recovered and he raced in this year's Beach to Beacon. And while he avoided a trip to the medical tent, others weren't as lucky.
"He looks pale," says emergency medicine physician John Jardine of Massachusetts as he watches other volunteers help a distressed runner onto a cot. "He looks a little disoriented."
The runner's core temperature is 105 degrees — and climbing.
"107!" the volunteers call out.
"He's up to 107," Jardine confirms.
The man needs to get into an ice bath. Volunteers lift him and place him into a tub.
"Here we go, it's going to be cold," they tell him.
The runner instantly breathes a sigh of relief. Volunteers dip cups into the icy water and pour it over him.
After soaking for several minutes, Jim Gensheimer's core temperature cools and he feels much better.
"I mean, I knew I was going to end up pushing myself to, like, an uncomfortable place, like more so with my legs," he says. "Did not expect that I'd be close to a heat stroke."
While the volunteers here get practice treating athletes, medical services director Chris Troyanos says it's valuable experience that can be applied to the general public.
"And that really can make a difference because, as you know, you're going to see a lot more of these issues outside of athletics with climate change," he says.
So far this year, more than 300 people have been treated in Maine emergency rooms for heat-related illnesses.
This story was reported as part of a collaboration between the Portland Press Herald and Maine Public.
