Navigating implementation barriers: a holistic approach to improving exertional heat stroke management.

Objectives: To assess the shift in medical volunteers' perception and practice surrounding exertional heat stroke (EHS) prehospital management after the Tokyo 2020 Olympic Games. Methods: An online survey was sent to medical volunteers assigned to work at high EHS risk events during the Tokyo 2020 Olympic Games. Surveys were sent at the time of initial training, immediately after the Games, and one year after the Games. The survey investigated medical volunteers' perceptions and practices regarding the assessment of rectal temperature and the use of whole-body cold water immersion (CWI) as prehospital management of EHS. In addition, an open-ended question was prepared to examine barriers and facilitators of their chosen perception and/or behaviour. Results: The lack of knowledge about rectal temperature assessment improved over time, but the actual implementation did not. Meanwhile, increased utilisation of CWI was observed 1 year after the Games. The lack of equipment, apprehension towards rectal temperature assessment, the perception of difficulty getting patient consent, concerns for hypothermic overshoot and the number of required medical providers were raised as barriers to implementation. Conclusion: Some improvements were observed in perception and practice; however, further organisational and financial support is warranted for a broader skill transfer and implementation.