As we move into the hottest weather of the year and with fall sports starting soon, heat illnesses become an important topic. As with any illness or injury, there are three important steps for dealing with these: Prevention, recognition, and treatment.

Prevention

There are several recommendations and steps athletic trainers take to help reduce the risk of suffering from a heat illness. Some of these start days and hours before the event, and others are at the time of the event. One of the keys to heat illness prevention is hydration, and adequate hydration actually starts several days before the event and even continues throughout the night after the event.

As a rule, the average athlete should consume one-half to two-thirds of his or her body weight in ounces of water per day, with part of that being an electrolyte drink. So, if you weigh 150 pounds, you should be drinking 75 to 100 ounces of water per day. Additionally, you should consume an extra 16 to 24 ounces of water for every pound of weight you lose during that event. So, if you weigh 150 pounds before the event and after the event you weigh 148 pounds, you will need to consume an additional 32 to 48 ounces of water or electrolyte drink to make up for the fluids you sweated out during the event.

Another key to heat illness prevention is taking proper rest breaks and wearing the right gear during the event. Missouri State High School Activities Association (MSHSAA) has an approved set of guidelines to aid in this decision-making process and that document will be linked below. It is important to note that that these guidelines are based on the wet bulb globe temperature and not heat index. The wet bulb globe thermometer is a very site-specific tool that collectively assesses outside temperature, humidity, wind speed, cloud cover, and other factors, which is the reason it is the gold standard. We are fortunate in that all the schools Freeman Health System services have a wet bulb thermometer that provides live updates throughout the events, so adjustments can be made to gear, rest breaks, and so on as needed.

Recognition

In the event of a heat illness emergency, prompt recognition is key. The three most common types of heat illness include heat cramps, heat exhaustion, and heat stroke. Heat cramps are caused by excessive sweating or electrolyte loss and can occur during or after the activity. 

Heat exhaustion occurs when the body is unable to cool itself effectively. Common symptoms include excessive sweating, headache, nausea or vomiting, dizziness or fainting, pale, flushed or red skin, and goose bumps might also be visible while in hot weather.

Heat stroke is a life-threatening condition that occurs when the body temperature reaches 104 degrees or higher and is unable to regulate its own temperature. Common symptoms include dizziness, fainting or loss of consciousness, little or no sweating, hot and dry skin, headache, nausea or vomiting, and seizures.

Treatment

Quickly recognizing a heat illness is important, because the sooner you recognize, the sooner you can treat it, and the odds of a positive outcome increase drastically. In all three cases, treatment involves moving the patient to a cooler area, rehydration and cooling the body as quickly as possible. 

If the patient is suffering from heat cramps, you will want to move him or her to a cooler area, give them water and/or an electrolyte drink and lightly stretch the involved area. You might also place a cold towel or bag of ice around their neck, under their armpits and/or in their groin.

While heat exhaustion and a heat stroke are different levels of heat illness, treatment should be very similar, because heat exhaustion can quickly turn into a heat stroke. First and foremost, the emergency action plan (EAP) should be activated, and 911 should be called. From there, the patient needs moved to a cooler area and rapid cooling of the body needs to take place. Cold water immersion is the gold standard, but this can also be achieved by adding cold towels or ice around the neck, under the arm pits, in their groin and over their torso. Towels or ice bags might need to be replaced frequently due to the body warming them to an ineffective temperature. Rehydration is also key - if the patient is conscious, they should be taking small, frequent sips of fluids to avoid nausea or vomiting. Once first responders arrive, IV treatment is the best way to quickly rehydrate the patient. 

Conclusion

In a perfect world, the goal is to prevent heat illnesses from ever taking place. Unfortunately, these things happen from time to time. In the case of a heat illness, time is key, the sooner you can recognize the emergency, the sooner you are able to treat and help the patient. The symptoms and treatments listed above are just some you might encounter when faced with a heat illness. Freeman Health System athletic trainers outreach at local schools and are extremely knowledgeable and experienced, and do a fantastic job of, not only, preventing heat illness, but quickly responding to it and treating it when emergencies arise.

MSHSAA Wet Bulb Globe Temperature Guidelines

https://www.mshsaa.org/resources/pdf/WBGTGuidelines.pdf