Heat Exhaustion and Heat Stroke: Avoiding, recognizing and treating heat related emergencies.

During a football team’s 2-hour practice in late August, the coach has defense running sprints without rest breaks for the last 20 minutes of practice. One of the players suddenly falls to the ground. He has extremely hot skin, is sweating, and appears disoriented. What would you do?

This scenario can happen at any outdoor practice or event, whether it’s high school athletics, or band practice.  It is important to avoid heat related emergencies, as well as recognize when one is happening. 

Avoiding Heat Related Emergencies

Although heat related emergencies still happen when precautions are taken, here are some ways to minimize the severity or frequency by which they occur:

  • Schedule practices or the outdoor portion of the practice to occur outside of the hottest hours of the day 
  • Wear light colored, loose fitting, and breathable clothing whenever possible
  • Take breaks, preferably indoors or in shade. 
  • Stay hydrated- hydration should not only occur during practice, but around the clock to prevent dehydration during times of high heat. Drinking excessive amounts of fluids during practices can cause nausea and vomiting. 
  • Encourage members to avoid caffeinated beverages as they can work against the hydration effects of water. 
  • Encourage or require the use of sunscreen, and don’t forget to leave time for reapplication. 
  • Pace activity- do not begin with the hardest drill.
  • Make use of the buddy system to watch for signs of heat exhaustion and stroke. 

Heat Exhaustion

Heat exhaustion occurs when the body is unable to properly cool itself, and it’s temperature becomes elevated. Dehydration combined with prolonged physical activity and high temperatures are the most common causes of heat exhaustion. Here are the signs that heat exhaustion is occuring:

  • Cool, moist skin
  • Nausea, vomiting
  • Excessive sweating
  • Headache
  • Dizziness, lightheadedness
  • Weakness
  • Muscle cramping
  • Elevated or weak heart rate
  • Fainting

Although initially not a medical emergency, if not promptly treated heat exhaustion can escalate into a life-threatening situation. 

  1. Remove the person from the heat. Somewhere indoors with air-conditioning is preferred, but if not available, minimally out of the sun in the shade. 
  2. Provide the patient with plenty of cool water or fluids such as sports drinks, and remind them to sip not chug. 
  3. Use ice packs wrapped in paper towels or a cold compress on the back of the neck, under the armpits, the back of the knees, and groin in order to bring down the patient’s body temperature. 
  4. If the condition does not improve within an hour or worsens, emergency care should be sought. 
  5. IMPORTANT: The patient should not return to the activity for the remainder of the day. Doing so could shock the body and lead to heat stroke.

Heat Stroke

If not recognized or treated properly, heat exhaustion can become heat stroke. Heat stroke is a life-threatening emergency that causes deaths every year. The symptoms of a heat stroke include:

  • Red, hot, and dry skin
  • Elevated skin temperatures (103° or higher)
  • Dizziness, confusion, fainting
  • Seizing 

If a heat stroke is recognized, 911 must be called immediately. While waiting for EMS to arrive, these steps can be taken in order to prevent the condition from worsening: 

  1.  Remove the person from the heat. Somewhere indoors with air-conditioning is preferred, but if not available, minimally out of the sun in the shade. 
  2. Provide the patient with water. 
  3. Use ice packs wrapped in paper towels or a cold compress on the back of the neck, under the armpits, the back of the knees, and groin in order to bring down the patient’s body temperature. 
  4. Monitor the patient until EMS arrives.

Additional Heat Related Illnesses

Heat cramps can be recognized by painful cramping or muscle spasms, most often in the abdomen, legs, or arms. If heat cramps occur, rest in a cool area, hydrate, and wait a few hours before returning to the activity. If the cramps persist, seek medical attention.

Heat rash is caused by heat and moisture, and can be recognized by clusters of pink or reddish bumps, usually found on the neck or upper chest, or in folds of skin. If heat rash occurs, move to a drier and less humid environment, and keep the affected area as dry as possible. 

Sources: OSHA, Mayo Clinic, CDC, National Athletic Trainers Association (NATA)

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