With the World Cup now in full swing, many doctors warn that the risks of extreme heat extend far beyond the action on the field – especially at certain venues, potentially affecting millions of fans and thousands of workers.

Summer always brings the heat, but the places that pose the greatest risk might surprise you. In the United States, experts are keeping an eye on stadiums in three host cities: Miami, Kansas City and Philadelphia.

Some US host cities with hotter climates – Atlanta, Houston and Dallas – have air-conditioned indoor stadiums, which may afford fans and workers some protection. But Miami, Kansas City and Philadelphia are home to open-air stadiums, which means they have the potential to expose fans to “very high heat” and “very high humidity,” said Dr. Fabian Arous, a sports medicine physician at Children’s Health Andrews Institute for Orthopedics and Sports Medicine with a FIFA diploma in football medicine.

No matter where fans are, experts caution that they should be mindful of the heat while attending outdoor events, including before and after matches.

“There are two things we worry about: heat exhaustion and, more severely, heat stroke,” Arous said.

“I would put all my red flags up for the city of Miami as my biggest place of worry,” said Dr. Douglas Casa, board of trustees distinguished professor at the University of Connecticut and chief executive officer of the Korey Stringer Institute, where he studies the impacts of heat and hydration on athletes, military members and laborers.

Casa added that spectators and workers are at a higher risk of heat-related illnesses than the athletes themselves.

Players have access to medical teams, cooling breaks, elite training and carefully monitored conditions, but many of the people who make the World Cup possible — including the spectators, security guards, concession stand staff and construction workers — may spend hours in the heat and not have the same relief, especially in outdoor stadiums.

The last men’s FIFA World Cup, held in Qatar in 2022, was mired in controversy as concerns were raised that migrant laborers were working in life-threatening heat and humidity leading up to the tournament.

That event was held in November and December, and seven of the eight stadiums were covered and temperature-controlled. But this summer in the United States, Canada and Mexico, most of the World Cup matches will be held in outdoor venues.

“This could be the hottest World Cup in history,” Casa said.

Preparing for heat risks ahead

As part of this year’s World Cup schedule, Miami is home to seven matches, while Kansas City and Philadelphia both have six.

As Ivory Coast defeated Ecuador 1-0 in Philadelphia on Sunday, there was a slight increase in heat-related complaints among fans being treated at medical facilities in the stadium, and “the temperatures were well above 90,” said Dr. Kathleen Faccio, an emergency medicine physician at Jefferson Abington Hospital. She also practices event medicine and is collaborating with FIFA’s medical team at Philadelphia’s World Cup matches.

“The majority of people were presenting with some mild heat-related illnesses, mild heat exhaustion,” she said. There are two medical areas in the stadium that are staffed with physicians and accessible to fans. Faccio’s colleagues worked at the facilities Sunday, and she is scheduled to work there during Monday’s match.

“Heat exhaustion specifically, which is the most common presentation that we see, can be a myriad of symptoms that includes headache, nausea, fatigue, abdominal cramping, leg cramps,” Faccio said, adding that she and her colleagues are gearing up for the next several matches and will ensure they have IV fluids among the medical supplies on site.

“There’s going to be a lot of excitement, and a lot of families maybe tailgating in the parking lots,” she said. “I do anticipate that even before the game starts, that we’ll have some patients.”

At Miami Stadium, Jackson Health System worked with FIFA to set up medical areas for spectators who may need care, said Dr. Hany Atallah, Jackson Memorial Hospital’s chief medical officer.

“Heat is certainly on our concern list,” Atallah said.

“We’re making sure we have the right supplies available. If someone does need some IV fluids or other care, that we have those things available,” he said. “At the same time, we obviously have the backup of our EMS colleagues and have a transportation plan to get people to a hospital, should their medical condition necessitate that transfer.”

Miami is considered the hottest of the World Cup outdoor venues on average this summer.

Miami is considered the hottest of the World Cup outdoor venues on average this summer.

During Monday’s World Cup match in Miami this week, which ended in a draw between Uruguay and Saudi Arabia, the heat index rose above 100 degrees Fahrenheit, said Dr. Jose Llach, regional medical director of emergency care centers with Baptist Health South Florida.

“It’s only going to get hotter here in Miami, because July is a hotter month compared to June,” he said, adding that he expects the heat risks to rise as the World Cup continues. “Some of the games are more competitive games as the tournament goes along, so what happens is that’s going to be more fans in the stadiums, leading to a warmer environment, making it more dangerous for the community and the fan base.”

Those attending World Cup matches aren’t the only ones at risk from the extreme heat. Watch parties and FIFA-sponsored Fan Festivals are being hosted in cities across the country.

Evan Young was among the fans already feeling the rising temperatures at these events. It was a warm summer night in Decatur, Georgia, where he spent hours in the heat leading up to the US-Paraguay match’s 9 p.m. kickoff on Friday.

“We got here at like 6 p.m.,” Young, 31, said at the Decatur WatchFest outside Atlanta. “It’s been pretty hot. I think it was 92 degrees when we left the house.”

He visited the WatchFest event’s cooling station, equipped with misting fans, at least four times that night.

Achraf Hakimi of Morocco pours water over himself to cool down in the heat. Fans and players alike are encouraged to stay hydrated during World Cup matches.

Achraf Hakimi of Morocco pours water over himself to cool down in the heat

Recognizing the signs

Host cities in the United States are monitoring forecasts to determine when soaring temperatures could pose public health threats this summer, said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials. For instance, Houston is expecting heat indices approaching 105 degrees Fahrenheit during the tournament, she said.

Extreme heat remains the leading weather-related cause of death in the United States.

“It’s sometimes overlooked as an active public health surveillance area, but extreme heat and the effect that it has on people during these events is right up the lane of our local health departments, and they are looking at what risks may be presented by heat as well as air quality,” Freeman said.

And while teams monitor the health of their players, public health departments monitor the health of communities.

“So the public health role would be to make sure that there are appropriate cooling tents and facilities and proper emergency partnerships in place that can address both people that might be overcome by heat but also making sure we prevent them from being overcome by heat,” Freeman said.

There is a spectrum of heat-related illnesses that can have varying effects, said Dr. Jonathan Bar, an emergency physician and director of emergency preparedness at Penn Medicine in Philadelphia.

“In the mild forms of it, you might get heat rash. This occurs when sweat clogs your skin pores, and that goes away with getting cool and gentle exfoliation,” Bar said.

“Heat cramps are kind of the next level up, where that’s usually due to electrolyte issues, and so staying hydrated is really important for that,” he said. “You can get heat edema – moving up the spectrum – that’s where your legs might swell a little bit, and generally that goes away with getting into a cooler area and compression.”

Bar added that “heat exhaustion and heat stroke are on the more severe end” of the spectrum. Symptoms of heat exhaustion can include headache, nausea, dizziness, heavy sweating and elevated body temperature.

According to the Mayo Clinic, treatment options for heat exhaustion and heat stroke include lowering body temperature quickly by cooling your skin with ice packs or immersion in cold water.

“What really differentiates heat exhaustion from heat stroke is involvement of the central nervous system,” Bar said, as symptoms of heat stroke include confusion, loss of consciousness or seizures. “It’s important to recognize it quickly, because these are life-threatening medical emergencies.”

How to pack and prepare

Whether attending a World Cup match or a watch party, there are items that you can bring with you to reduce your risk of a heat-related illness. And of course, it’s important to check whether the stadium or venue has specific bag requirements.

Water bottle

After facing pressure in the media and the soccer community, FIFA changed its policy to ban ticketholders from bringing some kinds of water bottles into stadiums. Fans in the US and Canada are now permitted to bring in one “soft, plastic, 20 ounces (590ml), factory sealed disposable water bottle into any FIFA World Cup 2026 match.” But “fans will not be permitted reusable water bottles due to safety and security reasons.”

Anyone attending a World Cup match should bring one water bottle per person and “drink that water up when you get in and then use the refilling stations or the bathrooms to replace the water,” Casa said.

Cape Verde goalkeeper Vozinha takes a drink. Fans in the US and Canada are also allowed to bring in one water bottle per person

Cape Verde goalkeeper Vozinha takes a drink. Fans in the US and Canada are also allowed to bring in one water bottle per person

Sun protection

Remember to not only pack sunscreen but apply it generously and often. It’s recommended to apply sunscreen at least 20 minutes before you’re exposed to the sun. Then reapply at least every two hours.

“Preventing sunburn with sunscreen is really important,” Bar said.

Hats, sunglasses and loose-fitting SPF clothing also can help reduce sun exposure while keeping you cool. Consider packing a wide-brimmed hat to cover your head, neck and face, Casa said.

During the opening match of the World Cup last week, some Mexico fans were seen tossing sombreros in delight as their team defeated the Republic of South Africa 2-0, but the hats might come in handy for the rest of the tournament.

Fan and towels

There are dozens of cooling products soccer lovers can use to stay cool, such as portable fans and hand towels that can be moistened with water.

If you soak a small hand towel under cold water, use it to cool yourself off, Llach said.

“Just soak it with some water in the bathroom, and put it on your neck when you’re watching the game, and that goes a long way,” he said, adding that it can help reduce the risk of heat-related emergencies.

Medication awareness

Older adults are advised to pack any medications that you usually take around the time the match is happening, Faccio said.

“There are a lot of World Cup fans who are over 65, and we sometimes fail to remember the timing of medication is really important for this specific population. If you come to the game at 4 or 5 o’clock and you may not be able to leave, by the time you get home, like 11 or 12, you’re missing that anti-hypertensive medication or that medication for Parkinson’s,” she said. “That can be really detrimental.”

Additionally, Bar cautioned that certain medications and heat can interact, potentially putting you at greater risk of heat-related illness. Those medications can include antihistamines, beta-blockers, diuretics, anti-psychotics and stimulants such as ADHD medications or SSRIs.

It’s important to talk with your doctor if you will be spending an extended period of time outdoors while taking any medications that may have heat interactions. (CNN)

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