1. The Dangers of Environmental Conditions- Heat Illness
Presented by: Krista Andereck, MS, ATC, LAT
Manhattan High School -

2. Dangers of Lightning
Lightning is a giant spark of electricity in the atmosphere between clouds, the air, or the ground.
Lightning can occur between opposite charges within the thunderstorm cloud (intra- cloud lightning) or between opposite charges in the cloud and on the ground (cloud-to- ground lightning).
To properly use the “flash-to-bang” method, count the number of seconds between the time you see the lightning and hear the accompanying thunder. Divide the number of seconds by five to determine how many miles away the lightning is occurring.
30 minute time clock is started when the first strike is indicated and reset for every strike spotted within that time frame.
Move to a closed in building or overhang when lightning is close enough and clear the area of spectators and the other teams. Lightning is very dangerous

3. What is Heat Illness?
Heat illness is the effect that the thermal environment has on a person’s ability to maintain a normal body temperature. Physical work generates heat in the body which must be lost to the environment through sweating and evaporation. A hot or humid environment makes this more difficult and this can affect both mental and physical performance. Inability to get rid of body heat adequately may result in heat illness

4. Exercise Associated Muscle Cramps (EAMC)
Commonly know as heat cramps but inappropriate terms because they are not directly related to elevated body temperature.
Sudden and sometimes progressively noticeable involuntary, painful contractions of skeletal muscles during or after exercise.
Signs and symptoms include- tics, twitching, stiffness, contractures
Cause is not fully known but contributing factors include- dehydration, electrolyte imbalance, fatigue and any combination of these.

5. Heat Syncope (orthostatic dizziness)
Often occurs in unfit or unacclimatized persons who stand for long periods or change posture suddenly in the heat.
Usually happens in the first 5 days of heat unacclimatized persons (preseason).
Heat Syncope is often attributed to dehydration, venous pooling, reduced cardiac filling or low blood pressure

6. Heat Exhaustion
The inability to effectively exercise in the heat, secondary to combination of factors such as cardiovascular insufficiency, hypotension (low blood pressure), central fatigue.
Condition is manifested by an elevated core body temperature and associated with a high rate of skin blood flow, heavy sweating and dehydration.
Most frequently occurs in hot or humid conditions (or both combined- we do live in Kansas)
Heat exhaustion can happen in normal conditions during intense practices or exercise

7. Exertional Heat Stroke- VERY SERIOUS
Exertional heat stroke is an elevated core temperature (usually >40°C [105°F]) associated with signs of organ system failure due to hyperthermia.
Early signs- headaches, dizziness, nausea
First sign is CNS dysfunction- collapse, aggressiveness, irritability, confusion, seizures or altered consciousness
Major medical emergency
Best indication (Gold Standard) of body temperature taken by rectal temperature, no other form of temperature taken is valid or reliable.

8. Heat related deaths
90% of heat illness injuries occur during practice time
From there were 61 players who died due to a heat illness
46 high school
11 college
2 professional
2 youth sports

9. Prevention Conduct thorough PPE Acclimatize athletes over 7-14 days
Progressively increase activity, intensity, duration, and equipment
Greatest risk in first 3 weeks of preseason
Educate yourself and staff members- coaches, athletes, parents, Athletic Trainers (if applicable) or other healthcare professionals
Instruct athletes to be hydrating throughout the day not just a practice
Hydration throughout entire practice- water, Gatorade, powerade
Instruct to properly eat nutritious foods to help with sodium loss

11. Prevention cont.
Have an EAP in place and practiced by all involved before each season
Have cold tubs and ice towels available during hotter humid days to immerse or soak persons with suspected heat illness.
Athletes are encouraged to get at least 7 hours of sleep, eat a balanced diet, hydrate BEFORE, during and after participation.
Rest breaks should be implemented every minutes for extra hydration during hotter days

13. Non environmental Risk Factors
Heat Acclimatization
Exercise intensity
Overzealousness
Poor Physical condition
Increased body mass
Dehydration
Illnesses
History of EHI
Medications
Electrolyte imbalance

14. Recognition
EAMC- visible cramping, localized pain, dehydration, thirst, sweating, fatigue
Heat Syncope- brief episode of fainting associated with dizziness, tunnel vision, pale or sweaty skin, decreased pulse rate while standing in heat.
Exertional Heat Exhaustion- excessive fatigue, faints or collapses w/ minor cognitive changes, altered mental status, hallucinations, confusion, disorientation, weakness, dizziness, headaches, vomiting, low blood pressure, impaired muscle coordination
Exertional Heat Stroke- CNS dysfunction- confusion, dizziness, loss of balance, disorientation, staggering, irritability, irrational or unusual behavior, aggressiveness, collapse, loss of consciousness and coma, core body temp greater than 104

15. Treatment
EAMC- rest and passive static stretching, icing, ice massage, fluid replacement
Heat Syncope- move athlete to shaded or cool building and monitor vital signs, elevate legs above the heart, replace fluids slowly and cool the skin.
Exertional Heat Exhaustion- remove excess clothing and equipment, move to shaded or cool area, ice towels or fans to further cooling, monitor vital signs, place on back with legs elevated above the heart, replace fluids slowly.
Exertional Heat Stroke- LOWER CORE BODY TEMPURATURE within 30 minutes of collapse or episode, remove excess clothing and equipment, cold water immersion (ice tubs/tanks) full body water should be about 59 degrees, remove from immersion when body temp reaches 102, activate EMS

16. Tips
Ice towels on site during hot days, small cooler with ice and water covering towels (can be reused)
Have a large tank in shaded area with water in it and ice bags ready to throw in
Know your student- athletes to be able to recognize signs and symptoms

18. Return to Play (RTP)
EAMC/ Heat Syncope- monitor conditions until signs and symptoms no longer present
Heat Exhaustion- same day return is not recommended
Heat Stroke- patients who are cooled effectively and sent home the same day, may return to activities within a month. Patients will need to be fully cleared by a physician who has experience dealing with heat illnesses. If treatment is delayed, patients can see residual complications from months to years and may not return to sport.
Must complete a 7-21 day rest period, normal blood work, physician clearance then they may begin gradual return to play with supervision by a medical professional.

19. Which is better?
Grass?
Turf??

20. Grass vs. Turf fields
Turf- can be played on in all weather, easier maintenance
Grass- not playable in all weather, must be mowed, watered, painted
Temperature
Grass- usually lower than the air temperature but not always
Turf- can be up to degree hotter or more than the air temperature.

21. 71 degrees hotter on the day they took this. Imagine Kansas!

23. QUESTIONS????? ?

24. References http://www.kshsaa.org/Public/PDF/Lightning.pdf
NATA Position Statement: Exertional Heat Illness
Korey Stringer Institute- 5 Pillars of Exertional Heat Stroke Prevention
Surviving-EHS.pdf
KSHSAA