For many programs throughout the country, August represents the beginning of another promising season for young athletes. However, as temperatures continue to rise in many regions, so does the chance of heat-related illnesses that can vary in severity from heat cramps to heat stroke, which can be fatal. While not always preventable, even in the fairest of climates, exertional heat stroke can be 100% survivable. This includes prompt recognition and immediate cooling of the individual to a safe temperature within the first 30 minutes following collapse.
It is important that parents and athletes are informed and ask the right questions to reduce the risk of heat-related illness.
- Does the team follow heat acclimatization guidelines? All athletes need to become accustomed to exercising in the heat. Heat acclimatization involves phasing in activity (duration and intensity) over seven to 14 days to help the body physically adapt to better cope with heat stress.
- Does the team monitor environmental conditions? A medical professional, such as an athletic trainer, should monitor heat-stress conditions with equipment such as a Wet-Bulb Globe Temperature (WBGT) device, which measures ambient temperature, relative humidity, wind speed and radiation from the sun. WBGT readings may warrant immediate adjustments to the team’s practice such as changing work-to-rest ratios, increasing water breaks, modification to equipment (i.e. removing excess clothing), change in length and/or intensity of activity and moving practice times to a cooler part of the day.
- How do I know if my athlete is properly hydrating? Water should be freely available during any sports activities. However, hydration shouldn’t end there, make sure your student hydrates adequately before, during and after activity. If an athlete goes to practice dehydrated, they are already putting themselves at risk for heat-related issues. Tracking urine color can be a good indication of hydration. Pale yellow usually indicates proper hydration.
In addition, all schools or teams should have protocols for the prevention and treatment of exertional heat stroke. Anyone providing sports-related oversight should be familiar with them. Here are lifesaving measures that the school should have in place:
- Emergency action plan (EAP). Appropriate personnel (medical staff, coaching staff and athletic administrators) should be familiar with the EAP for exertional heat illnesses and be prepared to immediately activate the plan if an emergency occurs.
- Cold-water immersion (CWI) tub onsite. Once exertional heat stroke is suspected, decreasing the athlete’s core body temperature to a normal range via cold-water immersion within the first 30 minutes after collapse is critical. A cold-water immersion tub should be onsite and filled with water prior to the start of activity. Ideally this would be located in the shade or under a medical tent.
- Medical personnel readily available. Having an athletic trainer or other appropriate medical personnel onsite and available to respond to emergency situations, such as an exertional heat stroke, will ensure timely recognition of the condition and initiation of treatment. The risk of long-term or permanent complications, and even death, is directly related to the number of minutes an individual remains hyperthermic. The presence of an on-site medical professional will ensure proper emergency measures are in place and that an athlete with EHS is cooled promptly and effectively.
Below are different signs and symptoms of the spectrum of heat illnesses.
- Heat cramps: Characterized by painful muscle spasms, sweating, dehydration, increased thirst and fatigue.
- Heat syncope: Fainting in hot environments, usually during the initial days of heat exposure. Other symptoms may include dizziness, light-headedness, weakness, pale or sweaty skin and weak pulse.
- Heat exhaustion: The inability to continue exercise or physical activity in the heat. Signs and symptoms include headache, dizziness, light-headedness, fainting, fatigue, nausea and/or vomiting and weakness.
- Exertional heat stroke: An emergency condition characterized by extreme hyperthermia (body temperature above 104°F/40°C taken with a rectal thermometer) and central nervous system dysfunction (e.g. altered consciousness, combativeness, seizures, confusion, emotional instability, irrational behavior, decreased mental acuity). Other signs and symptoms include nausea, vomiting, or diarrhea, headache, dizziness, or weakness, increased heart rate, decreased blood pressure and dehydration.
Visit National Athletic Trainers’ Association (NATA) for additional information and resources available on hydration, preventing heat illness and exertional heat stroke.