Exertional heat stroke, which the leading cause of sudden death, and also 100% avoidable

Heat: A Letter from VP of Medicine and Community

This summer has already presented us with unprecedented heat across the country, and I wanted to share some precautions that should be taken to help keep everyone safe.

Exertional heat stroke is one of the leading causes of sudden death in sport. Exertional heat stroke (EHS) is a medical emergency defined as life-threatening hyperthermia (core body temperature >104°F) combined with central nervous system dysfunction (e.g. irrational behavior, irritability, emotional instability, altered consciousness, collapse, coma, dizziness, etc.)  While this is an alarming fact, it is 100% preventable and 100% treatable.  The best way to keep your participants safe this summer is to prevent a situation where exertional heat stroke can happen.

Here are a few tips to help prevent exertional heat stroke during your summer programming:

> Assess the Wet Bulb Globe Temperature: When making activity decisions regarding participation in the heat, it is important to assess more than just air temperature.  The air temperature, heat index and “feels like” measurements are not accurate enough to truly assess the situation. The athletic trainer you are working with can help you monitor wet bulb globe temperature. The wet bulb globe temperature takes into account air temperature, relative humidity, wind speed and solar radiation. These four factors paint a more accurate picture of how effectively the body can keep itself cool.

> Modify Your Activity: Once you have the WGBT, you can consult the chart linked here for activity recommendations. Best practice dictates that if the WBGT reaches certain levels, you should modify or cancel participation that day.  Be creative when taking steps to mitigate risk. Can you move from the turf to grass? Can you find a shadier side of the field? Can you run non-contact drills to allow your participants to take off their equipment? Can you provide longer breaks to allow equipment laden players to take off their equipment to cool off and then put them back on to play?

> Communicate: Remind parents and players that it will be hot that day and therefore they should bring plenty of cold water with them. Also, remind them that you will be providing several longer breaks so that the players can cool themselves down during the day. You should also coordinate your plan with your athletic trainer.  Athletic trainers are specialists when it comes to exertional heat illnesses. Make sure you and your athletic trainer have all of the supplies you need to save a life if needed.

> Life-Saving Equipment: A patient is diagnosed with exertional heat stroke (EHS) when their core body temperature is above 104°F.  Best practice for assessing core body temperature is using a rectal thermistor.  Contact your athletic trainer in the days leading up to your event helps to ensure proper equipment availability. Letting the AT know what you will have on hand allows them to properly prepare what to bring. In the event of EHS, the gold standard for treatment is COOL then TRANSPORT.  Be sure to call 911 and assist your athletic trainer with anything they need.

In order for your athletic trainer to effectively cool the participant, they will need plenty of water, ice and a vessel large enough to totally immerse the patient’s body. We have attached a handout here that shows what a heat tent set-up may look like. Vessels can range from large rubbermaid stock tanks to inflatable baby pools or even a simple 10’ x 10’ tarp. Take into consideration the size of your participants when purchasing a cooling vessel.

The treatment goal is to decrease the person’s core body temperature as fast as possible by submerging them in ice water. That means you and your athletic trainer will need enough ice to ensure the water is very cold (36°F – 50°F).  Once the patient’s temperature has dropped it is okay to transport them to the closest hospital for further evaluation.

On the blog you will find some resources explaining the wet bulb globe temperature, heat tent set up, as well as recommendations for modifications that can be made to help ensure the health and safety of participants, employees and staff.

Thank you for your continued support and commitment to designing and maintaining safe environments for all!

K. Ellis F. Mair, EdM, ATC
VP of Medicine and Community

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