Heat Illnesses Risks and Procedures Policy for Heat Illnesses in Athletics This power point will discuss the three heat illnesses seen in athletics. It will explain the signs, symptoms and how to treat each heat illness. The discussion will show heat protocol and heat index to help better understand the temperatures that go with each individual heat illness. It will show what protocols should be in place to avoid causing serious injury or possible death to athletes suffering heat illnesses.

Heat Illnesses in Athletics Third leading cause of deaths in Athletics On average 3 deaths per year (E. Randy Eichner) (2014) 35 deaths in the last 10 years. Most deaths have occurred in the sport of football. Heat illnesses are the third leading cause of deaths in athletics. In the last 10 years there has been a estimated 35 deaths because of heat related incidents. That is an average of three deaths per year. Most of these deaths have occurred in football. Other sports at risk include cross country running, soccer, track and sports who practice and play in hot environments.

Three Types of Heat Illnesses Heat Cramps (mildest) Heat Exhaustion (most common) Heat Stroke (most dangerous) The Three types of Heat illnesses will be discussed are heat cramps, heat exhaustion and heat stroke.

Heat Cramps - Mildest Muscle Spasms Fatigue Thirst Heat cramps are the mildest out of all three heat illnesses. An athlete suffering from heat cramps usually suffers muscle cramps or spasms in the arms, legs or abdomen during or after exercising. They feel more fatigued or become weak and become very thirsty due to the body becoming dehydrated.

Heat Exhaustion (most Common) Heavy sweating Headaches Dizziness Pale cool moist skin Weakness Nausea Heat exhaustion is the most common heat related illness amongst athletes. When exposed to high temperatures, humidity and dry heat the athlete may show signs of heat exhaustion. Some of the symptoms are heavy sweating, headaches, dizziness, pale cool moist skin, weakness, and nausea.

Heat Stroke Heat Stroke – Most Dangerous (Call 911) Body temperature 104° Fahrenheit or above Irrational behavior Confusion Dry, hot skin Vomiting Seizures Unconsciousness Heat stroke is the most dangerous of all heat illnesses. When a person suffers heat stroke their body is unable to cool itself down, resulting in a fever of 104 or higher. If the body gets to hot the brain cells start to die resulting in the shut down of the brain and heart. Symptoms to look for are irrational behavior, confusion, dry hot skin, vomiting, seizures and unconsciousness.

Majority of heat related illnesses happen in the first few days of practice. Body is not acclimated to the temperature Poor fitness Overweight/obesity Over dressed, to much equipment Dehydration The majority of heat related illnesses happen in the first few days of practice. Most athletes have been inside air conditioned places and when outside practices start their body is not acclimated to high temperatures outside. Athletes who are in poor shape, overweight or obese have a higher risk of experiencing a heat illness. Athletes wearing full uniform and have not been acclimated will heat up faster and their body will have a harder time cooling itself down. Young adults in general do not drink enough water throughout the day causing them to become dehydrated. Athletes that are already dehydrated before going into practice will not be able to sweat enough to cool their body down and will be more likely to suffer a heat illness.

Prevention Moderate workouts Phase in period for equipment/uniform Proper hydration before and after practices Regular hydration breaks Pre-cooling before practice Nutrition They are ways to prevent heat illnesses from occurring. Begining the pre-season/season with shorter less intense practice, eliminate double practice days in high heat and humidity and move practices to early morning or late evenings helps start the season in good standings. It is important to emphasize instruction over conditioning at the beginning to help athletes get acclimated to the heat before adding harder more complex practices. Use a heat index chart to adjust practice intensity and activities. Start athletes off with minimal equipment/uniform and as their body becomes acclimated to the temperature add equipment/uniform a little at a time. Make sure athletes understand the importance of hydration before and after practices. Adjust hydration breaks into activities around every 15-20 minutes. ( M., Koester) Watch athletes that show a decrease in weight. Weighing an athlete before and after practice helps show how much body fluid they are losing each practice. For every pound lost they should drink ”16 ozs of fluid for each kilogram of fluid lost (1 kg = 2.2 lbs.)”. (California Interscholastic Federation) Pre-cooling before practice with wet towels and or splashing water over head, neck, face helps cool the body before practice. Athletes can also eat sensible food with high water content to help keep the body hydrated and it also gives the body the nutrients it needs.

Treatment Heat Cramps/Heat Exhaustion Recognize early signs of distress Cool down the body Shade Air conditioner Remove excess clothing/equipment Give fluids if athlete is not nauseated/vomiting Recognizing the early signs of distress will help with treatment of heat cramps and heat exhaustion. When signs appear it is important to cool down the body so they can return to practice. Have the athletes find some shade to sit under. Remove all excess clothing/equipment and have them drink fluids to rehydrate the body, give fluids only if they are not nauseated or vomiting. Keep a eye on them to make sure they do not return to practice before their body has a proper chance to cool down.

ACTIVATE EMERGENCY MEDICAL TREATMENT (911) Treatment Heat Stroke DO NOT DELAY FIRST AID ACTIVATE EMERGENCY MEDICAL TREATMENT (911) Cool as quickly as possible Move athlete to shade or air conditioning Remove excess clothing/uniform Emerge in a ice bath with Ice bags, cold towels Use ice bags on groin and armpits and cool wet towels on body Rehydrate if possible Treatment of heat stroke is a serious matter. Do not delay first aid treatment and activate emergency medical treatment (911). Fast action is vital to treating heat stroke. Move the athlete out of the sun into shade or air conditioning. If the athletes has excess clothes or added uniform remove it so the body can cool down faster. If an ice bath or tub is available submerge the athlete. If one is not available lie the athlete down and apply ice to the main arteries which are the groin and armpits. If the athlete is not suffering nausea or vomiting give them fluids to rehydrate. The faster the body temperature goes down the faster they move out of the danger zone. Athlete will need to be cleared by a doctor before they are able to return to practice.

Heat Illness Protocol Beginning of season Training session for coaches, staff, athletic trainers, athletes and parents. http://nfhslearn.com/ free course on heat illness prevention Emergency Protocol Emergency Action Plan Emergency Personnel Emergency Communication/first responder Emergency Equipment Revisit training sessions and emergency plan yearly. At the beginning of each season coaches, staff, athletic trainers, athletes and parents should go through heat related illness training. With training sessions they should all know and understand the emergency protocols and know where all equipment is in case of an emergency. This information should be revisited yearly.

Heat Index AMA Webmaster. (2016) National weather heat index chart that can be used to decide activities that will work around daily heat index temperatures. AMA Webmaster. (2016)

Heat Index Protocol 80°F (27°C) to 89° F (32°C) may cause fatigue. 90°F (32°C) to 103° F (39°C) may cause heat cramps or heat. exhaustion 103°F (39°C) to 124° (49°C) may cause heat cramps, heat exhaustion and possible heat stroke. 125°F (50°C) or higher may cause heat stroke AMA Webmaster. (2016) Direct exposure to sun can increase the risk for heat related illnesses on days when heat index is high. Coaches need to be aware of temperature situation at their own individual sites. Most android phones have a temperature app which makes it easier to check before and during practice for temperature and humidity for individual times of the day.

References AMA Webmaster. (2016, June 7). National Weather Service Weather Forecast Office. Retrieved from http://www.srh.noaa.gov/ama/?n=heatindex Brady, E. (2011, August 15). Heat-related illness still deadly problem for athletes - USATODAY.com. Retrieved from http://usatoday30.usatoday.com/sports/2011-08-15-heat-stroke-still-causing- death-in-athletes_n.htm California Interscholastic Federation. (n.d.). Retrieved from http://www.cifstate.org/sports-medicine/heat_illness/index Eichner, E. R. (2014). SSE #86: Heat Stroke in Sports: Causes, Prevention and Treatment. Retrieved from http://www.gssiweb.org/Article/sse-86-heat-stroke- in-sports-causes-prevention-and-treatment Koester, M. (n.d.). Interscholastic Education, Made Easy. Retrieved from http://nfhslearn.com/self_courses/3963884/heat_illness_prevention Toporek, B. (2011, August 8). Academy of Pediatrics Issues New Heat Guidelines for Student-Athletes. Retrieved from http://blogs.edweek.org/edweek/schooled_in_sports/2011/08/academy_of_pedia trics_releases_new_heat_guidelines_for_athletes.html

Question and Answer Section