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Heat Illness
Injuries & Conditions You Need to Know About

How to Reduce the Risk of Exertional Heat Stroke at Your School

Amanda Muscatell 29 September 2016 Heat illnesses are a spectrum of illnesses that can occur due to environmental exposure to heat, whether outdoor or indoor. These illnesses can occur with or without physical exertion and include heat cramps, heat syncope, heat exhaustion and the life-threatening exertional heat stroke (EHS). Luckily, EHS is 100% preventable. By implementing the measures below you can significantly reduce your school’s risk of athletes falling victim to exertional heat stroke.
(Above) Schools in areas labeled as “Category 3” Heat Safety Regions by Applied Geography are especially at risk of heat illnesses. Fig.1
(Above) A map depicting regional heat safety thresholds for athletics. Physical activity should be adjusted accordingly based on the region and category. 1

1. Start using the wet bulb global temperature when modifying practices/games.

While the term, “heat index” is the best-known form of measuring “apparent temperature” — that is, the temperature as perceived by humans — it only takes into account the shaded air temperature and humidity, something an outdoor athlete will probably not be doing for long periods of time (sorry baseball!). A much better way to measure the apparent temperature as it relates to athletes is to use the Wet Bulb Global Temperature (WBGT). In contrast to the heat index, the WBGT measures the unshaded air temperature and humidity as well as the level of solar radiation and the wind speed (which affects how quickly your body cools through perspiration evaporating).

2. Get a heat stress tracker.

So how do you read the WBGT? With a heat stress tracker. This device will cost between $100 – $500 and is instrumental in reducing your risk of heat illness. The newer models even have Bluetooth capability so you can set up alerts for all of your coaching staff!

3. Implement heat illness guidelines that include WBGT.

Now that you have a heat stress tracker you will need to work with your school’s sports medicine team to determine heat illness guidelines that include a WBGT scale dictating how specific WBGT readings will impact your practices and games. For example, the Georgia Independent School Association (GISA) heat illness guidelines call for schools to modify outdoor activities when the WBGT reading is between 82 and 86.9 by adding rest breaks and closely monitoring at-risk students. As a result of these measures, GISA saw a 70% decrease in heat illness incidents — no small accomplishment for a state that once led the nation in heat-related deaths among high school-age athletes.

4. Make sure there is a cold water emergent tub at every game and practice.

The key to managing EHS is early recognition and quick treatment by lowering their core body temperature. Since athletes suffering from exertional heat stroke may have a core body temperature of nearly 106 °F, it is crucial to cool the athlete immediately, even before the ambulance arrives. The best way of doing this is to immerse the athlete in a cool water tub. These tubs should be in close proximity to the sidelines of each game or practice and can be any fixture on campus able to function as a large tub (my school uses a 150 gallon agricultural feeding tub). Ideally, the tub will be portable enough to travel with the team to away games. If not, make sure there is a plan in place to communicate with the home team medical staff beforehand in order to ensure that a tub is available.

About the Author

David Csillan, MS, LAT, ATC David Csillan, MS, LAT, ATC has been an athletic trainer at Ewing High School in Ewing Township, New Jersey for the past 26 years. He was a co-author on the NATA Preseason Heat-Acclimatization Guidelines for Secondary School Athletics and contributing author on The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations and NATA Position Statement: Exertional Heat Illnesses.  

1. Grundstein, A., Williams, C., & Phan, M. (2015, January). Regional heat safety thresholds for athletics in the contiguous United States. Applied Geography, 56, 55-60. Retrieved September 21, 2016, from