Heat injuries are a serious issue, particularly for athletes.
Let’s look at some key facts:
- “There’s no excuse for any number of heat stroke deaths, since they are all preventable with the proper precautions.” (Ref)
- “The most important factor in the treatment of EHS [exertional heat stroke] is the timeliness of rapid cooling, preferably performed on site by whatever means available.” (Ref)
- Acclimate to the heat over a two-week period. Note: being acclimated does not mean being conditioned (fit for playing sports). Conditioning is a separate process that takes months.
- The athlete must be weighed at the beginning and end of each day of training. Greater than a 2% bodyweight loss is significant, and each pound lost must be replaced by 16-24 ounces of water.
- Pay attention to urine color. Deep yellow to brown indicates probable dehydration.
- Trouble signs of heat illness include nausea, incoherence, fatigue, weakness, vomiting, cramps, weak rapid pulse, flushed appearance, visual disturbances and unsteadiness.
- Create an athlete buddy system to report any suspected heat issues.
- An ice bath and ice packs must be field side.
- The organization must have a heat plan for revising practices/games based on the use of a Wet Bulb Globe Thermometer (preferred) or the Heat Index.
- All stakeholders please be familiar with the National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses.
The sad case of Jordan McNair, the Maryland offensive lineman who died of heatstroke over the summer, has put a spotlight on playing and practicing in the heat.
What does a parent, coach and administrator need to know to properly manage a heat illness and prevent them? “The identification of symptoms related to heat injury is crucial. Once symptoms have been identified, treatment is relatively straightforward” (Ref).
In heat illness, there are two major issues—dehydration and increased body heat or hyperthermia. They may occur together or independently.
What Is Dehydration?
“Dehydration is a condition that occurs when the loss of body fluids exceeds the amount of fluids taken in and disrupts the balance of minerals in body fluids.” Greater than a 2% bodyweight loss can impair performance (Ref) and lead to dangerous health consequences.
A recommended way to monitor hydration is called the WUT method (Ref).
- W = Weight. Did I gain or lose weight? Maintain a day-to-day stable body weight by weighing yourself first thing every morning.
- U = Urine. Is my morning urine dark yellow? A reduced daily urine frequency and darkening of urine color in a sample taken during the first urination of the morning may be an indication of dehydration.
- T = Thirst. Am I thirsty? The absence of thirst does not indicate the absence of dehydration. However, the presence of thirst is an indication of dehydration and the need to drink. Therefore, if thirst is present, combine that with urine or body weight information to be more certain.
What is Hyperthermia?
Hyperthermia is when the body’s core temperature rises. A body core temperature greater than 104 degrees Fahrenheit is considered heat stroke or what the medical literature calls exertional heat stroke. This is a medical emergency.
Contrary to popular belief, heat illnesses do not necessarily exist on a continuum. You do not need to have heat cramps or faint before you have heat exhaustion or heat stroke.
Heat illnesses consist of:
- Heat Cramps
- Heat Rash
- Heat Syncope (fainting)
- Heat Exhaustion
- Heat Stroke
A cramp is an involuntary contraction of a muscle. The original theory (1904) was that these cramps were caused by dehydration and electrolyte imbalance due to exercise. A new theory (1997) proposed that training leading to muscular overload and then fatigue caused the cramp. Which theory is correct? We are not quite sure, so both issues must be addressed when treating heat cramps.
Heat Rash is caused by blockage of the sweat ducts, which results in the leakage of eccrine sweat into the epidermis or dermis. Small, pinkish pimples are usually found on body areas covered by clothing. These pimples can develop within minutes or hours after the stimulation of sweating and typically resolve within one hour of cooling down. Individuals with heat rash are at particularly high risk for heat exhaustion during exertion in hot weather, because their ability to dissipate heat by means of sweat evaporation is impaired.
Heat fainting usually occurs in “unfit or heat-unacclimatized persons who stand/exercise for a long period of time in the heat or during sudden changes in posture in the heat.” (Ref)
Heat exhaustion is the inability to exercise effectively. Signs and symptoms include an elevated body temperature (greater than 104 degrees Fahrenheit), dehydration, profuse sweating, loss of coordination, dizziness, fainting, GI/muscle cramps, headache, nausea/vomiting, diarrhea and weakness.
The most important skill for a parent, coach or administrator is observation. Look for the “trouble signs” of heat illness: “nausea, incoherence, fatigue, weakness, vomiting, cramps, weak rapid pulse, flushed appearance, visual disturbances, and unsteadiness.” An important point is that an athlete with heat stroke may be sweating profusely. (Ref)
There is no excuse for lack of preparedness for heat illnesses. Here are three sets of guidelines and consensus statements that go into great detail:
1. Get a thorough sports physical. Answer the questions in Table 2 of this document.
2. Get acclimated to the heat. Spend at least two weeks outside performing physical activity BEFORE the first sports practice.
3. Get fit. How long does it take to get fit? How out of shape is the athlete? It can take several months to develop a good sports fitness baseline.
4. Weigh yourself twice per day. If you see more than 2 percent bodyweight loss, report this to the organization and make sure you rehydrate properly. In other words, stay hydrated all the time.
1. Make sure your athlete gets a thorough sports physical.
2. Understand heat illnesses and what your athlete must do to prepare.
3. Check with the organization to make sure there is a complete emergency action plan in place, that the coaches are trained, and that an ice tub is field-side. If not, are you going to allow your athlete to participate with this organization?
4. Weigh your athlete twice per day. If you see a more than 2 percent bodyweight loss, report this to the organization and make sure your athlete rehydrates properly.
1. Take the NFHS Heat Illness Prevention Course. You say it is not required? Take it anyway. It’s free and it is just that important.
2. Make sure you have an ice and an ice tub field-side.
3. Pay attention to your athletes.
4. Monitor the heat using either a Wet Bulb Globe Thermometer or the Heat Index.
1. Preparticipation physicals for athletes
2. NFHS Heat Illness Prevention course for all coaches
3. Ice tubs on the sidelines
4. A heat plan for practice/game revisions based on Wet Bulb Globe Thermometer (preferable) or Heat Index readings.
5. Athletic Trainer at games and practices is the best case scenario.
6. A safety system designed to educate coaches and parents as well as document and communicate on-field injuries with an oversight plan for administrators. TeamSafeSports.
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