Heatstroke Prevention Strategies

Updated August 2005

Heatstroke Prevention Strategies

From the professionals all the way down to Pop Warner, football training camps are in full swing. But so is the summer heat and humidity. Football players of all skill levels are at risk for heat related illness.

Heatstroke is the most dangerous of the heat-related illnesses. If not treated immediately, it can be fatal. The exact cause of heatstroke isn't clear, and unlike heat exhaustion, it strikes suddenly and with little warning. When the body cooling systems fails, the core temperature rises quickly. Signs of heatstroke include a core body temperature above 105°F, hot, dry skin, lack of sweating, a very fast pulse, and mental status changes such as confusion, disorientation and clumsiness.

Athletes generally suffer a slightly different type of heatstroke called exertional heatstroke. In exertional heatstroke, victims continue to sweat, despite the increased core temperature.

It is important to be aware that heatstroke is not limited to athletes. It can also occur while attending an outdoor concert, walking around an outdoor street festival or, for that matter, working in your backyard garden.

Here is our suggested risk management strategy for heatstroke prevention:

	Acclimatize to heat gradually. Early practices, such as during the first seven-10 days, should be shorter and less intense, as should those on abnormally hot or humid days.
	Pay attention to the Humidity Index. The temperature and relative humidity should be taken into account in determining the length of practice sessions. It has been suggested that, if the sum of the temperature and relative humidity are greater than or equal to 160, precautions must be taken. If the sum is greater than 180, practice and/or games should be cancelled.
	Take regular breaks. Adjust the activity level and provide frequent rest periods during hot weather. Rest should be accomplished in shaded areas, helmets taken off, and jerseys loosened or removed. Rest periods should consist of 15 minutes each hour of workout and, if the temperature and humidity are over 160, breaks should occur every 30 minutes.
	Cold water should be available in unlimited quantities to players. Scheduled water breaks should be strictly enforced. A good general rule is 16 ounces of water two hours prior to activity, plus half a water bottle every break, and, for every pound of weight loss, three cups of water after activity. Stay away from caffeine drinks as they dehydrates the body. Avoid carbonated beverages, which can cause bloating and deter you from drinking enough water.
	Avoid salt tablets. Instead, salt should be replaced through electrolyte sports drinks and seasoning of food.
	Measure water loss and replenish fluids. Athletes should be weighed before and after each practice to monitor water loss. A good way to monitor and document weight is in a chart in the bathroom by the scale. Weight loss greater than three percent indicates a substantial risk and five percent a significant danger. Remember to drink water before and after practice to replace fluids.
	Wear proper, breathable clothing for strenuous activities. During practice, athletes should wear cool clothing such as shorts and fishnet jerseys. Sweat-saturated T-shirts should be changed often because they retain heat. Helmets should be used sparingly in hot weather.
	Know your athletes' vulnerabilities. Some are more susceptible to heat illness than others. Identify and observe closely the ones at greatest risk of heat illness, especially those that are poorly conditioned, overweight, and/ or have an acute physical illness (such as cystic fibrosis or diabetes). A player who develops cramps, weakness, fatigue, and nausea is exhibiting signs of heat exhaustion (a precursor to heat stroke) and should be made to rest in the shade and drink fluids to cool off.
	Be alert to the problem. It is imperative that all coaches, parents, and players be on the lookout for the signs of fatigue--lethargy, inattention, stupor, and/or awkwardness. The athlete must be removed immediately from participation, cooled down (blanket the athlete with cool, not cold, damp sheets or towels), and placed in a shaded environment. All too often, symptoms are present, but everyone ignores the signs until catastrophe occurs.

For the youth athlete, parents need to become activists in their practices and games. If water breaks are not occurring, a parent needs to step forward and make them happen. People are dying from this illness, now is not the time to be passive and think that the coaches know more than you do about your child.

Heatstroke First Aid

Heatstroke is a life-threatening condition. Follow these first aid steps:

1.	Call 911 or other emergency medical services.
2.	Move the person into a cool place, out of direct sunlight.
3.	Remove unnecessary clothing and place the person on his or her side to expose as much skin surface to the air as possible.
4.	Cool the person's entire body by sponging or spraying cool (not cold) water and fan the person to lower the person's body temperature.
5.	Apply ice packs to the groin, neck, and armpits, where large blood vessels lie close to the skin surface. Do not immerse the person in an ice bath.
6.	If possible, check the rectal temperature frequently, and try to cool it to 102.3 °F (39.06 °C) or lower as soon as possible. The longer the body is at a high temperature, the more serious the illness and the more possible complications. Temperatures taken by mouth or in the ear are not accurate in this emergency situation.
7.	If breathing stops, start CPR.
8.	Do not give aspirin or acetaminophen to reduce a high body temperature that can occur with heatstroke. These medications may cause problems because of the body's response to heatstroke.
9.	If the person is awake and alert enough to swallow, give the person fluids (32 fl oz to 64 fl oz over 1 to 2 hours) for hydration.