Nobody dies at the end.
True, true, most stories about exertional heat stroke are tragic, sad, heartbreaking and make you want to scream; “HOW DOES THIS STILL HAPPEN?!?!?”
After all, exertional heat stroke is a terrible way to die.
Exertional heat stroke is the most severe heat illness. It is characterized by neuropsychiatric impairment and a high core body temperature, typically 40.58°C (105.8°F). This condition is a product of both metabolic heat production and environmental heat load and occurs when the thermoregulatory system becomes overwhelmed due to excessive heat production or inhibited heat loss or both. The first sign is often CNS dysfunction (e.g., collapse, aggressiveness, irritability, confusion, seizures, altered consciousness). EHS can progress to a systemic inflammatory response and multi-organ system failure. The risks of morbidity and mortality increase the longer an individual’s body temperature remains elevated above the critical threshold (40.58°C [105.8°F]).1
And it’s all the more terrible because exertional heat stroke is 100% preventable and 100% survivable if treated in time.
Best practices require rapid cooling of the patient to a temperature less than the threshold for critical cell damage (∼104.5°F) in less than 30 minutes from the time of collapse. For events with medical personnel on-site (e.g., a certified athletic trainer), the appropriate standard is to cool the EHS patient on site.2
But—reminder—this story is not terrible.
This is a happy story about preparation and athletic trainers saving the day.
(And exertional heat stroke.)
It took place on a Saturday—June 22nd, 2019 to be exact—at the NXT Sports’ Rippin’ girls’ lacrosse tournament about an hour south of Tampa in Bradenton, Florida. The wet-bulb globe temperature readout had put the heat just below biblical and by early morning the hot weather protocol was already in effect; shorter games and mandatory water breaks in the middle of each half.
At around 10:30 am, tournament director Rachel Hodge was manning the operations tent when she was approached by a coach seeking help for one of his players.
The player was pale. shaking. disoriented.
She. did. not. look. good.
Rachel reacted instantly.
But really, Rachel had started reacting months earlier…
Before the beginning of their summer lacrosse tournament season, NXT Sports had conducted a mandatory, all-staff exertional heat stroke emergency training.
Led by NXT’s Director of Participant Safety, Ian McGinnis—himself an Athletic Trainer—the staff drilled and studied.
They learned the warning signs of exertional heat stroke, how to set up and stock an exertional heat stroke station (tent, tub, ice and water) and prepare for critical life-or-death moments.
Moments exactly like the one Rachel was facing.
Rachel radioed the on-site Athletic Trainer, Hannah Wohltmann, and rushed the player to the tournament’s exertional heat stroke station. While Hannah scrambled to get the station, Rachel submerged the player into the pool as other staff members poured in ice and agitated the water.
When Hannah got there, she directed Rachel to call 911 to get an ambulance rolling. With the player already in the pool, Hannah rigged up some towels for privacy, then prepared and inserted a rectal thermometer.
Suffice to say, the day was probably not going the way this young athlete had envisioned.
“On top of being seriously sick from the heat and then with the rectal thermometer, I knew she was freaked out by the whole situation.” -Hannah
To treat the ‘freaking out’—along with the exertional heat stroke—Hannah was direct and calm.
You just overheated a little. So, we’re cooling you off.
The ice bath was starting to work.
This is not a big deal. Happens to the best of us…
Her internal body temperature was coming down rapidly.
You’re gonna make it, kid.
Once her temperature fell below 102°F, everyone was able to breathe again.
With disaster and heartbreak averted, the player emerged from the tub and dried off as EMS arrived to transport her to a hospital for a full evaluation. (She was even able to make a joke or two about what had just happened, her teenage psyche made stronger from the experience.) After the doctors at the hospital checked her out, it was relayed back to the team that the she didn’t need any further medical intervention.
A couple of weeks later Rachel was able to reflect on the situation, “It was definitely a ‘whoa moment.’ Without Ian’s training and having Hannah on site, this player could have died.”
But she didn’t!
If there’s a moral to this story, it’s that pretty much every story about exertional heat stroke could have a happy ending.
That is if all tournaments, games, practices, camps, clinics that take place in the heat have an exertional heat stroke station set up and an athletic trainer on the sideline.
For more info exertional heat stroke we recommend these sites:
For instructions on how to set up and stock an exertional heat stroke station go here:
And to get an athletic trainer on your sideline for your game, practice, camp, clinic or tournament, we shamelessly recommend Go4Ellis. Which, in fact, was where NXT Sports hired the one and only, day-saving Hannah Wohltmann. You can read all about her by clicking here.
If you’re an AT looking to pick up a shift or two, click the links below to download the app.
Go4Ellis is the preferred per diem platform of the National Athletic Trainers’ Association.
Every sideline. Everywhere.
1. Casa, D. J., DeMatini, J. K., Bergeron, M. F., Csillan, D., Eichner, R., Lopez, R. M., … & Yeargin, S. W. (2015). National Athletic Trainers’ Association position statement: Exertional heat illness. Journal of Athletic Training, 50(9), 986-1000.
2. Belval, L.N., Casa D.J., Adams, W.M., Chimpas G.T., Holschen, J.C., Hosokawa, Y. (2018). Consensus Statement: Prehospital Care of Exertional Heat Stroke. Prehospital Emergency Care, 22(3), 392-397.