Management of Exertional Heat IllnessSigns and symptoms for coaches, parents, and staff

Shawn HanlonFriday, April 21, 2023

Just FYI• Use extreme caution in

hot, humid weather• Athletes can suffer from

heat illness or even DEATH

• Watch for signs of Dehydration

• Recognize who is more susceptible than others

• Wet bulb globe scale flag conditionsGreen: 80-84.9° Yellow:85-87.9°Red:88-89.9°Black:90°+

• This flag will be hung outside the ATF by 2pm

Just FYI

Hydration• Instruct your athletes to be well hydrated

24 hours prior to activity• 17-24 fluid ounces 3-4 hours before

exercise• 7-10 fluid ounces 15 minutes before

exercise• Small amounts throughout

the day

Drink me 15 minutes before

exercise!

Determining Hydration• Urine color is a good indicator• Light yellow= well hydrated• Dark yellow-brown= dehydrated• Body weight under normal conditions

compared to post-exercise– When 1-2% of BW is lost to sweat, athletes

begin to feel thirsty

Fluid Replacement• Sports drinks are better than water • Allow unlimited, easy access to fluids• Flavored drinks will stimulate thirst and increase

fluid intake (compared to water)

• Fluid intake should be as much as possible during exercise, but should not exceed the amount of fluid loss

• For vigorous activity lasting longer than 1 hour, adding sodium (0.3-0.7g per 8oz. Water) and carbohydrates(14g

per 8oz. Water) to drinks

Susceptible Individual Characteristics• Consider body type

– Those with more muscle mass are more prone to heat illness

• Overweight individuals• Previous history of heat

illness• Poor fitness level• Young or elderly

Acclimatization Process

Days 1-5 Only one practice per day

Days 1 and 2 Helmets only

Days 3 and 4 Helmets and shoulder pads only

Day 5 Full Pads

After Day 5 May begin two-a-days every other day

*Based on two hour practices

Heat Illness Prevention

Recognizing Heat Stress• Symptoms:

– muscle twitching– Cramps– Muscle spasms

Treatment of Heat Stress• Get them into air conditioning if possible• Intake large amounts of fluids• Ice massage for muscle cramps• Stretching• Ice bag across the neck/shoulders

Recognizing Heat Exhaustion• Symptoms:

– Excessive thirst– Seeming slowed down– Dry mouth– Temperature 102°-104°– Weakness– Fatigue

Treatment of Heat Exhaustion• Get them out of the sun and into a cool

room• Encourage them to drink as much as

possible • Sponge with cool water• Ice bags under armpits, groin, and on back

of neck• Cold tank emersion

Recognizing Heat Stroke• Headache or decreased mental acuity• Vomiting/diarrehea• Flushed skin• Increased heart rate (160-180)• Core temperature 104°+• Feels like they are burning up• COULD LEAD TO PERMANENT BRAIN

DAMAGE

Treatment of Heat Stroke• LIFE-THREATENING EMERGENCY

activate EMS• Ice bath emersion in the meantime• Sponge with cool water and fan if ice bath

is not available• Have them try to drink fluids• Must lower their body temperature as soon

as possible

Exertional Rhabdomyolysis• Sudden muscle catabolism (breaking down)

and degeneration• Can occur in healthy athletes during intense

exercise in extreme climates• Gradual onset of muscle weakness,

swelling, pain• Can progress to renal failure or even death

Pre-season Checklist• Review CPR skills• Review the emergency action plan (EAP)• Encourage your athletes to start hydrating

the night before practice• Have unlimited fluids readily available• DO NOT take away water as punishment

Hanlon’s Recommendations• Educate yourself and others• Don’t panic, take a breath and act• NATA Position Statement on

exertional heat illness• NATA Position Statement on

Fluid Replacement• When in doubt, ship them out

Hanlon’s Recommendations

NATA recommendations for Heat Illness Prevention

Ensure appropriate medical care

Conduct pre-participation physicals to identify susceptible individuals

Acclimatize athletes over 10 to 14 days

Educate athletes and coaches regarding prevention, recognition, and treatment of heat illnesses

Educate athletes to balance fluid intake with sweat and urine loss

Encourage 6-8 hours of sleep

Monitor environmental conditions and develop guidelines for altering practices

Provide an adequate supply of water or sports drinks

Weigh high-risk athletes before and after practices

Minimize the equipment worn on hot days

Minimize warmup on hot days

Have appropriate emergency equipment available (ice, cold bath, water, thermometer)

Arnheim’s Principles of Athletic Training, 2009

Heat Illness Prevention Video

Questions?