The 2017 Montreal Half-Marathon was held on September 24th despite a record-breaking, out-of-season heatwave. The Urgences-santé Corporation (USC), Quebec’s largest emergency medical service (EMS), was tasked with coordinating and delivering prehospital response for over 15,000 runners at a time when the province’s paramedics were on strike.

USC’s mission was to ensure runner safety under extreme conditions with limited staffing. In conjunction with the event’s medical teams, we implemented a new approach that oriented patients to the event’s clinic with the aim of limiting ambulance transports off-site and thus optimizing resources by promoting a “treat and release” principle.

Emergency response was organized around the event’s clinic, which offered a level of care comparable to proximate emergency departments, including mass-cooling capacities. This capacity allowed us to modify provincial protocols, and thus prioritize treating patients on-site instead of transporting them to a hospital. Consequently, the prehospital response on the course could be assured with only 15 ambulances (staffed by managers) and a single team deployed at the event’s clinic, acting as transport officers. Heatstroke identification protocols were reinforced for the safety of the runners and spectators.

A total of 1,071 participants received medical attention, including 24 who were treated for a heat-related incident. On the course, 32 were evaluated by paramedics and 20 were transported to the event’s clinic. Only 7 patients were transferred from the clinic to a hospital, of which only one was for a heat-related incident. No deaths resulted from the race.

By anticipating and preparing for the extreme heat, the coordinated prehospital response safely reduced off-site transports, minimizing treatment delays for patients, and maximizing the use of on-site resources. We attribute this success to a strong collaboration with the race organizers, the presence of an on-site clinic, and an increase in prehospital resources.