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HEAT AND HYDRATION

Heat Illness represents conditions resulting from heat stress, which can be imposed by several factors but usually result from the environment or the body creating this heat load itself.

Four most common heat illnesses: 

  1. Heat syncope 
  2. Heat cramps
  3. Heat exhaustion
  4. Exertional heat stroke (EHS)
HEAT SYNCOPE

A fainting episode that someone can experience in high environmental temperatures. Usually happens during the initial days of heat exposure. Occurs when an individual in a hot environment does not have adequate blood flow to the brain, causing the person to lose consciousness.

SIGNS AND SYMPTOMS OF HEAT SYNCOPE
  • Dizziness (vertigo) or lightheadedness
  • Weakness Loss of consciousness
  • Tunnel vision
  • Pale or sweaty skin
  • Decreased or weak pulse
TREATMENT FOR HEAT SYNCOPE
  • Move the person to shaded/cool area to decrease body temperature.
  • Remove equipment.
  • Have the athlete sit or lie down as soon as they begin to feel symptoms.
  • Monitor signs to ensure the person does not also acquire another medical condition.
  • Elevate legs to promote blood returning to the heart.
  • Rehydrate with water or a sports beverage.
HEAT CRAMPS

Heat cramps are painful, involuntary cramping often in the legs, arms or abdomen. Often caused by dehydration and sodium loss. Cramping usually occurs in the preseason conditioning phase when the body is not properly conditioned and more subject to fatigue.

SIGNS AND SYMPTOMS OF HEAT CRAMPS
  • Dehydration, thirst, sweating, short-term muscle cramps and fatigue.
  • Painful, involuntary muscle spasms (usually occurring in the legs) assoicated with exercise in the heat when athletes have been sweating profusely.
  • A precursor to the initial onset of cramps involves muscle twitches.
TREATMENT FOR HEAT CRAMPS
  • Remove the athlete from the exercise session and have them rest in the shade or an air-conditioned room.
  • Stretch, massage and knead the muscles that are cramping in its full-length or stretched position (joints should be extended).
  • Provide the athlete with fluids, such as water and an electrolyte sports drink to replace those lost during sweating.
  • Provide food high in salt content to replenish the electrolytes lost from sweat.
  • In cases of heat cramps that persist, use ice massage on the affected muscle.
HEAT EXHAUSTION

The most common heat-related condition observed in active populations including athletes.  It is the inability to continue exercise in the heat due to lack of blood being pumped to the heart. Energy depletion that may or may not be associated with physical collapse.

SIGNS AND SYMPTOMS OF HEAT EXHAUSTION
  • Headache. Nausea, Vomitting 
  • Fainting, Dizziness/lighthead, Diarrhea
  • Chills, Irritability, Decreased Urine Output/Dehydration
  • Core body, temperature between 96.8-105°F (36-40.5°C)
  • Decreased, Blood Pressure, Hyperventilation
  • Decreased Muscle Coordination, Sodium Loss, Fatigue
  • Weakness, Pale, Heavy Sweating.
TREATMENT FOR HEAT EXHAUSTION

• Move the individual to a cool/shaded area and remove excess clothing and equipment.
• Elevate legs to promote venous return.
• Cool the individual with fans, rotating ice towels or ice bags.
• Provide oral fluids for rehydration

EXERTIONAL HEAT STROKE (EHS)

Exertional Heat Stroke is a medical emergency requiring immediate intervention! Exertional heat stroke occurs when the body reaches temperatures above 104 degrees Fahrenheit and there is obvious central nervous system (CNS) dysfunction. CNS dysfunction can include any of the following: dizziness, collapse, confusion, irrational behavior, hysteria, aggressiveness, combativeness, disorientation, seizures and coma.

SIGNS AND SYMPTOMS THAT MAY INDICATE SOMEONE (ATHLETE) IS SUFFERING FROM EHS
  • Rectal temperature greater than 104°F (40.5°C)
  • Irrational behavior, irritability, emotional instability
  • Altered consciousness, coma
  • Disorientation or dizziness
  • Headache, confusion or just look “out of it”
  • Nausea, vomiting, or diarrhea
  • Muscle cramps, loss of muscle function/balance, inability to walk
  • Collapse, staggering or sluggish feeling
  • Profuse sweating, decreasing performance or weakness
  • Dehydration, dry mouth, thirst
  • Rapid pulse, low blood pressure, quick breathing
  • Other outside factors that may suggest EHS include:
    - The athlete is out of shape or obese.
    - It is a hot and humid day.
    - Practice is near the start of the season, and near the end of practice
    - It is the first day in full pads and equipment.
TREATMENT FOR EXERTIONAL HEAT STROKE (EHS)
  • Activate your Emergency Action Plan.
  • Remove all equipment and excess clothing.
  • Cool the athlete as quickly as possible (within 30 minutes) via whole body ice water immersion (place them in a tub/stock tank with ice and water approximately 35–58°F); stir water and add ice throughout cooling process.
  • If immersion is not possible (no tub or no water supply), take the athlete to a shaded, cool area and use rotating cold, wet towels to cover as much of the body surface as possible.
  • Maintain airway, breathing and circulation.
  • After cooling has been initiated, activate emergency medical system by calling 911.
  • Monitor vital signs such as rectal temperature, heart rate, respiratory rate, blood pressure and monitor central nervous system status.
  • Cease cooling when rectal temperature reaches 101–102°F (38.3–38.9°C).
  •  If rectal temperature is not available, DO NOT USE AN ALTERNATE METHOD (oral, tympanic, axillary, forehead sticker, etc.). These devices are not accurate and should never be used to assess an athlete exercising in the heat (rectal temperature should only be obtained by qualified personnel.
    Korey Stringer Institute. (2020, November 19). Heat Illness. https://ksi.uconn.edu/emergency-conditions/heat-illnesses/
HYDRATION STRATEGIES
Dehydration is influenced by
  • Exercise intensity.
  • Environmental conditions (temperature and humidity).
  • Availability of fluids during exercise.
An appropriate hydration strategy includes
  • Athletes beginning exercise hydrated.
  • Minimizing fluid losses during exercise.
  • Replacing fluid losses after exercise.
Hydration recommendations

Hydration needs are individualistic, so athletes should be
aware of their own hydration requirements.

  • The rule-of-thumb is for athletes to consume about 200-300ml of fluid every 15 minutes during exercise
  • Before practice/competition: 16 to 24 oz. of water or sports drinks.
  • During practice/competition: unlimited access to water with no limits on amount that athletes drink.
  • Provide longer water breaks.
  • Set up a shaded area for breaks.
  • Consider sports drinks if exercise is greater than 60 minutes or in intense heat.
  • After practice/competition: athletes should consume 16 oz. of water or sports drinks for each pound of weight lost during exercise session.

    Korey Stringer Institute. (2020, November 19). Hydration. https://ksi.uconn.edu/
    prevention/hydration/
ACCLIMATIZATION
Acclimatization
  • A series of adaptations that helps the body prepare for exercise in the heat.
  • These changes help the body maintain lower temperature and heart rate, enhance sweating and store more water.
  • These adaptations allow athletes to perform better and safer in the heat.
Pre-Season Acclimatization Recommendations
  • Conduct a 10- to 14-day period during which intensity, duration and the amount of equipmen worn are gradually increased to allow athletes to become accustomed to the stress of exercise in the conditions.
  • Consult with state and local health authorities regarding specific policies as they may differ in your community.
  • The best way to protect your athletes is to modify the risk factors that are responsible for causing heat illness.
  • Changing practice times, taking off equipment and providing more breaks.
Wet Bulb Globe Temperature (WBGT)
  • WBGT is the preferred measurement of environmental conditions:
  •  If WBGT device or chart is not available, use of the heat index is acceptable as an alternative.
  • When establishing WBGT guidelines for physical activity, the guidelines must be region (geographic) specific.
  •  Be familiar with and apply any league, local and State guidelines relative to practice restrictions in regard to WBGT and/or heat index readings.
Heat Acclimatization Tips:
1

Follow USA Football’s practice guidelines for time and frequency based on the age of the athlete you are coaching.

2

Game-types using equipment; follow USA Football’s acclimatization chart for gradually introducing equipment and drills.

3

Remind your athletes (and their parents) to have the athlete properly hydrated before, during and after practice.

4

Gradually increase the intensity of practice over the course of a few days.

5

Do not hesitate to modify practices as needed.

6

Have cooling methods available during practice (ice towels, ice tubs).

7

Take breaks frequently to avoid your athlete’s bodies from overheating.

8

Never practice more than once per day.

9

Make sure to monitor for signs of heat illness.

01/09