Heat illness can range from mild to severe and all athletes are at risk, but it is preventable and survivable when the proper steps are taken.
What is heat illness?
Heat illness occurs when an individual’s core body temperature increases, and the body’s methods to cool down are not sufficient. There are several types of heat illness ranging in severity. The most severe form, exertional heat stroke, can be fatal if not identified and treated promptly. Types of exertional heat illness include muscle cramps, heat syncope, heat exhaustion and exertional heat stroke. Each type of heat illness has different signs and symptoms. It is important to be able to recognize the signs and symptoms for proper treatment.
SIGNS AND SYMPTOMS OF EXERTIONAL HEAT ILLNESS
Exercise Associated Muscle Cramps
- Cramping in all or part of the muscle groups
- Brief episodes of fainting associated with dizziness
- Tunnel vision
- Pale or sweaty skin
- Decreased pulse rate
Exertional Heat Exhaustion
- Excessive fatigue, fainting or collapse
- Altered mental status, confusion, disorientation
- Weakness, dizziness, headache, vomiting
- Rectal temperature less than 105
Exertional Heat Stroke
- Rectal temperature above 105
- Central nervous system dysfunction
- Hot, wet skin
Who is at risk of experiencing heat illness?
There are various factors that make individuals more at risk for experiencing exertional heat illness.
Extrinsic Risk Factors
- Environmental Conditions: heat, humidity and other environmental conditions such as wind speed and radiant heat from the sun. It should be noted that an EHI could occur in seemingly ‘‘normal’’ environmental conditions and, therefore, all appropriate precautions should be taken, especially in the first week of practice
- Barriers to Heat Loss: this includes athletic equipment and robber or plastic suits used for weight loss.
- Yesterday’s Weather: when athletes participate in high WBGT conditions, the risk of EHI increases the following day. Additionally, athletes who sleep in warm conditions are more susceptible due to the cumulative effects of heat exposure.
- Extra Clothing or Equipment
- Not enough breaks
- Pressure to perform from coaches, teammates or parents.
- Not knowing the signs and symptoms
- No emergency action plan or policies and procedures in place to treat EHI.
- No or limited access to water.
- Delay in recognizing and treating the signs and symptoms of EHS.
Intrinsic Risk Factors
- Heat acclimatization: athletes who have not been allowed to acclimatize their body to cope with heat exposure during physical activity are at increased risk.
- Exercise intensity and overzealousness: athletes who are highly competitive and ignore their body’s natural defense mechanism signaling for them to slow down or reduce intensity are at increased risk of EHI.
- Poor physical condition/increased body mass: athletes who are overweight or unfit can develop exertional heat illness in less than 30 minutes of high-intensity exercise.
- Dehydration from excess sweat, not drinking enough water or fluids, sickness, certain medication or substances and alcohol can increase the risk of EHI.
- Illness: individuals who are currently or recently sick may be at increased risk of EHI due to fever, dehydration and use of certain medications.
- Medications and drugs: though taking medication, drugs or other substances doesn’t mean an athlete cannot play, it is important for the AT to be aware as these athletes may be at an increased risk. Medications that may have an adverse affect on an athlete’s ability to regulate their core body temperature include stimulants, antihistamines, anticholinergics, and antipsychotics.
- History of exertional heat illness.
How do you treat heat illness?
Prompt diagnosis and treatment of exertional heat stroke can be the difference in life and death in an athlete. Athletic trainers are the ideal health care professionals to manage heat related illness. Ask if your child’s team is prepared for a heat-related emergency. All schools or teams should have protocols for prevention and treatment of exertional heat stroke, and anyone providing sports-related oversight should be aware of them.
Here are lifesaving measures to have:
- An emergency action plan (EAP) in place. Appropriate personnel (medical staff, coaching staff, athletic administrators) should be familiar with the EAP for exertional heat illnesses and be prepared to activate the plan if an emergency occurs. If an individual’s rectal temperature is 104-105F degrees or higher and exertional heat stroke is suspected, call 911 simultaneously while treating the athlete using cold water immersion. Rectal temperature should be continuously monitored while cooling until the athlete’s temperature has dropped to 102-103F. Once the body temperature has normalized, the athlete should be cared for by emergency medical services providers.
- A cold-water immersion tub onsite. Exertional heat stroke is 100% survivable when the athlete is cooled via cold-water immersion within the first 30 minutes after collapse. A cold-water immersion tub or a substitute, such as a kiddie pool, should be onsite and filled with water prior to the start of activity. Ice should be added to the tub just before immersing the body to ensure the temperature of the water is optimal for cooling. Continuously stir the water and rotate cold, wet towels on any areas of the body that are not submerged in the tub (e.g. head, neck, arms, legs).
- Medical personnel readily available. Athletic trainers are health care professionals trained in the prevention, recognition and treatment of athletic-related injuries, illnesses, and causes of sudden death in sport. 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.
How reduce risk of heat illness?
Exertional heat illness can be prevented. Here are some tips to reduce the risk of heat illness and provide a safer approach for athletes:
- Ensure all athletes have a complete preparticipation physical exam (PPE) before any physical activity begins.
- Follow a gradual heat acclimatization process over a 7 to 14 day period.
- Do not play if sick.
- Stay hydrated – athletes should have free access to fluids at all times.
- Know the signs and symptoms of EHI.
- Ensure parents, coaches and athletes know the signs and symptoms of EHI.
- Onsite medical professional with knowledge of EHI prevention, recognition and treatment.
- Cold water immersion tub or ice towels prepped and available for suspected EHI.
- Be healthy – get at least 7 hours of sleep in a cool environment, eat a balanced diet, stay hydrated.
- Allow for appropriate rest periods that include meals and allow 2 to 3 hours for nutrients and electrolytes from food and drink to be digested and absorbed before the next practice or competition.
- Have a plan and adjust for particularly hot or humid conditions (based on WBGT).
- Identify and more closely monitor athletes with an increased risk of EHI.
- Allow athletes to have enough rest time in cool areas and allow for hydration.
- Athletes should be allowed to remove helmets during rests or breaks.
- Avoid the use of dietary supplements and other substances as they can have a dehydrating effect, increase metabolism or otherwise affect body temperature.