The Heat Is On – In the hottest months of the year, coaches need to watch for any signs of heat illness.

August will be here in a few weeks, and for most areas that means the hottest weather of the year. The high heat and humidity combined with the most intense football practices of the year mean that coaches need to be extra alert for any signs of players who might be suffering heat-related illnesses.

Football players, perhaps more than any other athletes, are vulnerable to a variety of serious medical conditions arising from outdoor physical activity in intense heat. It is tragic but true that, every year, athletes die from heat-related illnesses. Especially since, with greater awareness of the symptoms of and treatment for heat ailments, these deaths are entirely preventable.

To provide coaches with clear-cut steps that they can take to minimize risks for their players while practicing in the heat and to learn more about the various types of heat illnesses and how to deal with them, AFM turned to the experts at the National Athletic Trainers’ Association (NATA) and the Korey Stringer Institute, named after the Minnesota Viking OT who died of complications from heat stroke in 2001.
   

“We can’t completely prevent heat illness, but the following tips can help in any instance of physical activity in the heat,” said athletic trainer Brendon McDermott, PhD, ATC, with the University of Tennessee at Chattanooga and member of the KSI Medical and Science Advisory Board. “The goal is to avoid potential consequences through education of athletes, coaches, parents and health care providers about what can be done to prevent and treat exertional heat illnesses.”

Perhaps the best advice for football coaches at the onset of August practices is to take it slow and allow players to gradually get acclimated to the heat. “Heat-acclimatization is the number one controllable factor that can help prevent heat illness,” according to McDermott. “Gradually introducing equipment and heat exposure over a 10-day period is the best way to facilitate heat-acclimatization in football players.”

In addition, McDermott stressed the importance of adequate rest breaks. “Providing rest breaks during and allowing adequate recovery (at least 4 hours) between practices is advantageous to football players in helping prevent heat illness and getting the most out of them during activity. Removing helmets and pads during conditioning-specific activity allows greater heat dissipation, and can help prevent heat illness as well.”

As a service to coaches and athletes, the NATA has provided the following guidelines to help reduce the occurrence of heat-related illnesses and descriptions of the various types of illnesses and suggestions about dealing with them. They will help you keep your players safe.
 
Tips to Reduce Onset of Heat Illness

To guard against heat illnesses, NATA and KSI recommend following these easy steps:

1. Gradually increase activity in terms of intensity and duration in the heat. This prepares your body for more intense, longer duration exercise in warm conditions, and helps prevent injury and heat illness. This is known as heat acclimatization.
  
2. Intersperse periods of rest during activity and assure adequate rest between exercises. Rest breaks are an important defense against heat illness, and proper sleeping habits decrease your risk as well.
  
3. Begin outdoor activities only after you’re properly hydrated. Drink water or sports drinks throughout physical activity in the heat. Make sure fluid is easily accessible in ample quantities during rest breaks and during exercise when possible.
  
4. A darker urine color is a quick indicator of dehydration. Your urine should look more like lemonade (hydrated) than apple juice (dehydrated).
  
5. Exercise during cooler portions of the day (early morning or late evening), if possible.
  
6. Do not participate in intense exercise if you show signs of an existing illness (i.e., fever, diarrhea, extreme fatigue, etc.). These can decrease your body’s exercise heat tolerance and increase your risk of a heat illness. If you are suddenly not feeling well during exercise in the heat, back off on exercise intensity or duration (i.e., walk instead of run, cut the session short, etc.)
  
7. Athletic events should employ an athletic trainer for coverage to assure proper medical supervision, recognition and treatment of possible injuries and heat illness.
 
8. Acclimatize to warm weather activities over a 14-day period. The goal is to increase exercise heat tolerance and enhance the ability to exercise safely and effectively in warm and hot conditions.

Heat-related Ailments 

Following is an overview of the heat-related ailments to be aware of when working or playing in the heat:

1. Exertional Heat Stroke is an extremely serious illness that can result in death unless quickly recognized and properly treated. Signs and symptoms include an increase in body temperature (usually above 104-105°F/40-40.5°C at time of collapse); central nervous system dysfunction, such as altered consciousness, seizures, confusion, emotional instability, irrational behavior or decreased mental acuity; nausea, vomiting, or diarrhea; headache, dizziness, or weakness; increased heart rate; decreased blood pressure or fast breathing; dehydration; and combativeness. 

What to do: It’s very important that treatment for exertional heat stroke be both aggressive and immediate, provided adequate medical personnel are on site. Key steps to take when exertional heat stroke is identified include calling 911 to activate the emergency response system. It is critical at that same time to ensure immediate whole-body cooling, preferably through cold-water immersion, begins immediately on-site. No time should be lost with regard to all efforts being focused on the rapid reduction of body temperature (the number of minutes severely hyperthermic will dictate the outcome). If proper medical staff is on-site (physician or athletic trainer) and if cooling via cold water immersion is available on-site then the medical protocol should be cool first (on-site down to under 102oF), then transport second to an emergency room.

2. Heat exhaustion is a moderately serious illness resulting from fluid or sodium loss. Signs and symptoms include loss of coordination; dizziness or fainting; profuse sweating or pale skin; headache, nausea, vomiting or diarrhea; stomach/intestinal cramps or persistent muscle cramps. 

What to do: Heat exhaustion patients should immediately be moved to a cool, shaded environment with feet elevated, and fluids should be replaced. If their condition worsens or does not improve within minutes, heat stroke or another condition should be considered and appropriate treatment should ensue. Those suffering from heat exhaustion should avoid intense activity in the heat until at least the next day. A trip to the physician’s office is also recommended to rule out any underlying conditions that predispose them to heat exhaustion. 

3. Heat cramps are often present in those who perform strenuous exercise in the heat. Conversely, cramps also occur in the absence of warm or hot conditions, which is common in ice hockey players. Signs and symptoms include intense pain (not associated with pulling or straining a muscle) and persistent muscle contractions that continue during and after exercise. 

What to do: People suffering from heat cramps should cease activity, consume high sodium food and be sure to drink to overcome dehydration, preferably with a sports drink, and stretch the affected muscle. They should also be assessed by an athletic trainer to determine if they can return to activity. If cramping progresses in severity or number of muscle groups, patients should be transported to the emergency room for more advanced treatment. The etiology of heat cramps is not completely understood and is likely multi-faceted. Fatigue, especially from a unique or extremely intense activity, along with electrolyte and hydration issues, has been implicated as potential causes. 

4. Hyponatremia is a potentially fatal illness that occurs when a person’s blood sodium levels decrease, either due to over-hydration or inadequate sodium intake, or both. While technically not a heat illness, it often presents itself in similar circumstances and medical complications can result in cerebral and/or pulmonary edema. Signs and symptoms of this illness include excessive fluid consumption before, during and after exercising (weight gain during activity); increasing headache; nausea and vomiting (often repetitive); and swelling of extremities (hands and feet). 

What to do: Hyponatremia cases that involve mental confusion and intense headache should be seen by a physician so proper treatment can be administered. A physician should also be consulted prior to resuming outdoor activity in the heat. Always listen to your body. If you are participating in any fitness routines or general activity in the heat, and you start to feel ill or strange, you should stop immediately and seek medical attention, as needed.

National Athletic Trainers’ Association (NATA)
– Health Care for Life & Sport

Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers’ Association represents and supports 34,000 members of the athletic training profession. Visit: www.nata.org 

The mission of the Korey Stringer Institute is to provide first-rate information, resources, assistance and advocacy for the prevention of sudden death in sport, especially as it relates to exertional heat stroke. The Korey Stringer Institute is housed in the Neag School of Education at the University of Connecticut.
Visit: www.ksi.uconn.edu