Preventing Heat Illness How to Beat the Heat

1. Preventing Heat IllnessHow to Beat the Heat Catherine A. Simonson, MS, ATC, PES PUBH 8165, Environmental Health College of Health Sciences Walden University

2. Learning Objectives • Identify those at high risk for heat illnesses • Utilize techniques to help prevent heat illness • Recognize signs and symptoms of heat illness • Provide basic immediate care • Activate emergency response

3. Who is at Risk? Identify those at high risk for heat illness

4. K-12 Students Student Athletes Students in extra-curricular activities Faculty & Staff Campus visitors Spectators Activity participants Who is at Risk?

5. Who is at Risk? • K-12 Students are HIGH RISK • Sweat less than adults • Poor fitness • Illness • Dehydration • Current or recent history • Nutritional Status (Moss, 2003)

6. Who is at Risk? • StudentAthletes • Increased muscle mass • Equipment intensive sports • Repeated exposure • Previous history • Illness • Medications, Supplements, Drugs (Cleary,2007)

7. Who is at Risk? • Students in extra-curricular activities • ROTC • Uniforms • Required gear- backpacks, weapon, supplies • Band Members • Uniforms • Practice times • Agriculture Club • Working in green houses and outdoors during peak heat

8. Psychological Factors • Students and Student Athletes Fear Failure- • Don’t want to appear weak • Don’t want to let the team/group down • Don’t want to miss the big game, concert, field trip • Don’t want to let teachers and coaches down • Success driven- need this on my college application (Noakes, 2006)

9. Who is at Risk? • Faculty and Staff • Outdoor responsibilities • Coaches • Groundskeepers • Resource Officers • Special activities • Field Trips • Environmental laboratories

10. Who is at risk? • Faculty and Staff • Non-climate controlled work environments • Bus Drivers • Food Service • Laundry Personnel • Maintenance • Custodians

11. Who is at Risk? • Campus Visitors • Spectators • Infants and young children • People aged 65 or older • Those who are physically ill, especially with heart disease or high blood pressure, obesity • People with mental illness • Participants (Carroll, 2002)

12. Teacher School Nurse Administration Bus Driver Resource officer Teacher Aide Certified athletic trainer (ATC) Coach Team Physician EMS School District State Who is Responsible?

13. Techniques to help prevent heat illness

14. What can we do? • Be aware- Watch for warning signs • Stay hydrated and encourage fluid intake • Monitor the weather- know the heat index • Prevention education • Create an educational Heat Illness Information brochure, webpage or video clip • Talk to your family, friends, colleagues about preventing heat illness (CDC, 2004)

15. Teachers • Be aware of temperature and humidity levels. • Modify outdoor activity as needed. • Number of breaks increases along with the temperature • Students should have access to water during outdoor activity. • Identify students at risk and provide direct supervision. • Students with chronic illness, compromised nutritional status, mental illness or obesity. • Every classroom should have an emergency action plan posted. • Practice the plan in real time several times a year. (Casa, Armstrong, Hillman, Montain, Reiff, et al 2000).

16. Administrators • Ensure appropriate medical coverage at school events • Pre-participation examinations • Supervise coaching staff to ensure compliance • Acclimatization, NCHSAA Regulations • Educate school community about heat illness and prevention strategies • Encourage healthy behaviors • Proper nutrition, hydration, adequate sleep (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

17. Coaches • Be aware of temperature and humidity levels. • Change practice length, intensity and equipment use as the levels rise. • Educate student athletes and parents about heat illness • Water should be accessible and remind student athletes to drink frequently. • Emergency Action Plan (EAP) (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

18. Resource Officers • Be aware of temperature and humidity levels. • Collaborate with emergency services • Identify at risk populations for regular observation • Elderly volunteer, chronically ill parent, overweight referee • Review emergency action plan with all faculty, staff, and security personnel (Worfolk, 2000)

19. Heat Safety Guidelines -NOAA National Weather Service

20. Sedgwick County Division of Public Safety

21. Tips for Preventing Heat Illness • Wear lightweight, light-colored, loose-fitting clothing. • Drink more fluids (nonalcoholic), regardless of your activity level. • Don’t wait until you’re thirsty to drink. • Limit outdoor activity to morning and evening hours whenever possible • Try to rest often in shady areas. • Protect yourself from the sun by wearing a wide-brimmed hat • Closely monitor those at high risk for heat illness CDC, 2004

22. Signs and Symptoms of Heat Illness& Basic Immediate Care

23. Types of Heat Illness Dehydration Heat cramps Heat Exhaustion Exertional Heat Stroke Hyponatremia

24. Dizziness Cramps Excessive fatigue Skill impairments DehydrationSigns and Symptoms • Headache • Dry mouth • Thirst • Being irritable or cranky • Bored or disinterested (Casa, Armstrong, Hillman, Montain, Reiff, et al 2000).

25. DehydrationImmediate Care • Move to a cool environment • Provide cool fluids as tolerated • Water • Sports Drinks • Monitor signs and symptoms • Should decrease with time and fluid intake (Casa, Armstrong, Hillman, Montain, Reiff, et al 2000).

26. Heat CrampsSigns and Symptoms • Intense pain not associated with pulling or straining a muscle • Persistent muscle contractions that continue during and after exercise • Usually occur later in an activity, in conjunction with muscle fatigue and after fluid and electrolyte imbalances have reached a critical level. (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

27. Heat CrampsImmediate Care • Reestablish normal hydration • Provide Cool Water • Light stretching, relaxation and massage of the involved muscle • Be proactive- especially in those with a history of heat cramps. • Encourage proper nutrition and hydration. (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

28. Heat ExhaustionSigns and Symptoms • Difficult or impossible to keep participating • Loss of coordination, dizziness or fainting • Dehydration • Profuse sweating or pale skin • Headache, nausea, vomiting or diarrhea • Stomach/intestinal cramps or persistent muscle cramps (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

29. Heat ExhaustionImmediateCare • Move to shaded or air-conditioned area. • Remove excess clothing and equipment. • Have student lie comfortably with legs propped above heart level. • Activate EMS for transport to an emergency facility if rapid improvement is not noted with prescribed treatment. (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

30. Exertional Heat StrokeSigns and Symptoms • Confusion, irrational behavior, emotional instability • Seizures • Nausea, vomiting or diarrhea • Headache, dizziness or weakness • Hot and wet or dry skin • Dehydration • Combativeness (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

31. Exertional Heat StrokeImmediate Care • Medical Emergency- Activate EMS!! • Aggressive and immediate whole-body cooling • Where medical coverage allows- • Cool first- • Transport second • Without treatment, damage to vital organ systems can be fatal. (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

32. Hyponatremia (low blood-sodium levels) • Too Much Water? • Rare condition • Usually associated with endurance events > 4 hours • In severe cases: • altered consciousness, confusion, coma, convulsions, altered cognitive functioning, cerebral and/or pulmonary edema. (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

33. HyponatremiaSigns and Symptoms • Increasing headache • nausea, vomiting (often repetitive) • Swelling of extremities (hands and feet) • irregular diet (e.g., inadequate sodium intake) • urine with low specific gravity following exercise • lethargy/apathy • Agitation (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

34. HyponatremiaImmediate Care • If you suspect hyponatremia and blood sodium levels cannot be determined onsite: • Hold off on rehydrating athlete as this may worsen condition • Transport immediately to a medical facility. (Binkley, Beckett, Casa, Kleiner, & Plummer, 2002)

35. Emergency Response

36. Emergency Planning • Identify stakeholders • Who is involved • What is their role • Identify resources • Utilize appropriate personnel • Local collaboaration • Revisit and revise annually

37. Emergency Communication • Clear lines of communication • Logistics • Regular review of response protocol • Who, What, When, Where • Chain of command

38. Conclusion • Can you identify the signs and symptoms of heat illness? • Can you identify techniques to prevent heat illness? • Can you identify those at high risk for heat illnesses? • Can you provide basic immediate care? • Can you effectively activate emergency response? • Questions?

39. References Binkley, H., Beckett, J., Casa, D., Kleiner, D., Plummer, P. (2002). National Athletic Trainers' Association position statement: Exertional heat illnesses. Journal of Athletic Training, 37(3), 329-343.  Retrieved May 1st, 2009, from Research Library database. (Document ID: 210650411). Casa, D., Armstrong, L., Hillman, S., Montain, S., Reiff, R., Rich, B., Roberts, W., Stone, J. (2000). National Athletic Trainers’ Association position statement: Fluid Replacement for Athletes. Journal of Athletic Training 35 (2):212–224. Cleary, M. (2007). Predisposing Risk Factors on Susceptibility to Exertional Heat Illness: Clinical Decision-Making Considerations. Journal of Sport Rehabilitation, 16(3), 204-214. Retrieved May 1st, 2009, from Academic Search Premier database. Carroll, P. (2002). The heat is on: protecting your patients from nature's silent killer. Home Healthcare Nurse, 20(6), 376-386. Retrieved May 1st, 2009, from CINAHL Plus with Full Text database.

40. References cont… Centers for Disease Control and Prevention: Tips for preventing heat related illness (2004). Retrieved May 1st, 2009 from www.bt.cdc.gov/disasters/extremeheat Moss, R. (2003). Injury prevention & performance enhancement. Preventing heat illness: beyond the basics. Athletic Therapy Today, 8(4), 33-35. Retrieved May 1st, 2009, from CINAHL Plus with Full Text database. Noakes, T. (2006). Exercise in the heat: old ideas, new dogmas. International SportMed Journal, 7(1), 58-74. Retrieved May 1st, 2009, from CINAHL Plus with Full Text database. NOAA National Weather Service Heat Index retrieved May 1st, from:www.nws.noaa.gov/om/heat/images/CHART05.JPG Sedgwick County Division of Public Safety Hot weather safety tips retrieved May 1st from: www.sedgwickcounty.org/ems/hot_weather.html

41. References cont… Wexler., R.  (2002). Evaluation and treatment of heat-related illnesses. American Family Physician, 65(11), 2307-14.  Retrieved May 1st, 2009, from Research Library database. (Document ID: 126427151). Worfolk, J. (2000). Heat waves: their impact on the health of elders. Geriatric Nursing, 21(2), 70-77. Retrieved May 1st, 2009, from CINAHL Plus with Full Text database.

42. Sources for Further Reading “Fluid Replacement for Athletes” Position Statement –  http://www.nata.org/publicinformation/files/fluidreplacement.pdf -- which presents recommendations on how to optimize fluid replacement practices of athletes. “Inter-Association Task Force on Exertional Heat Illnesses” Consensus Statement -- http://www.nata.org/publicinformation/files/heatillnessconsensusstatement.pdf -- which offers guidelines on how to increase safety and performance for individuals engaged in physical activities, especially in warm and hot environments. A parent and coaches guide based on the consensus statement can be found at: http://www.nata.org/publicinformation/files/parentandcoachesguide.pdf Centers for Disease Control and Prevention http://www.bt.cdc.gov/disasters/extremeheat/