Management of Exertional Heat Illness

1. Management of Exertional Heat Illness Signs and symptoms for coaches, parents, and staff Shawn Hanlon Wednesday, September 17, 2014

2. 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

3. Just FYI • Wet bulb globe scale flag conditions • Green: 80-84.9° • Yellow:85-87.9° • Red:88-89.9° • Black:90°+ • This flag will be hung outside the ATF by 2pm

4. 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!

5. 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

6. 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

7. 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

8. Acclimatization Process *Based on two hour practices

9. Heat Illness Prevention

10. Recognizing Heat Stress • Symptoms: • muscle twitching • Cramps • Muscle spasms

11. 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

12. Recognizing Heat Exhaustion • Symptoms: • Excessive thirst • Seeming slowed down • Dry mouth • Temperature 102°-104° • Weakness • Fatigue

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. ExerciseIntensityDecreases Hanlon’s Recommendations Temperature Increases

20. Arnheim’s Principles of Athletic Training, 2009

21. Heat Illness Prevention Video

22. Questions?