Heat Illness Protocol

Conval High School

Heat illnesses are a threat to all athletes at any time of year, but precaution should be taken during periods of high temperatures and high humidity. If a student athlete begins to exhibit any signs and symptoms of the following heat illnesses, the associated treatment(s) described in this document should be carried out by an Athletic Trainer, Head Coach or designee. The three main forms of heat illness are heat cramps, heat exhaustion and heat stroke. This document identifies signs and symptoms of each type of heat illness, as well as the recommended steps of treatment for each.

Heat Cramps:

Definition – Exercise-associated heat cramps are described as involuntary, painful contraction of a muscle during or after exercise. The cause of exercise-associated muscle cramps is not fully understood, but contributing factors include electrolyte imbalances, dehydration and fatigue.

Recognition – An athlete suffering from exercise-associated muscle cramps will likely exhibit the following signs/symptoms: visible muscle cramping or tightening of the muscle, pain, and signs of dehydration including excessive thirst, sweating and fatigue.

Treatment - Most exercise-associated muscle cramps are short in duration (usually not longer lasting than 5-10 minutes), but the athlete should be removed from participation and treated along the following guidelines.

• Passive stretching of the muscle should be performed until the cramping begins to subside.

• Icing and gentle massaging of the muscle can also be used to help relieve an athlete’s pain.

• Ideally, the athlete should hydrate with a beverage containing sodium to help correct any electrolyte imbalances (Gatorade-type beverages work as well). If a beverage containing sodium is not readily available, the athlete should drink water.

Heat Exhaustion:

Definition – Heat exhaustion is described as the inability to exercise effectively in the heat as a result of multiple factors including (but not limited to) cardiovascular insufficiency, high blood pressure and energy depletion/fatigue. This condition occurs at an elevated core body temperature (typically <104°F). It normally occurs in environments of high temperatures and high humidity, but can occur in other environmental conditions as a result of physical activity. Heat exhaustion most commonly effects in dehydrated individuals, or heat-unacclimatized individuals.

Recognition – An athlete suffering from heat exhaustion will likely exhibit the following signs/symptoms: excessive fatigue, fainting, collapsing, headache, dizziness, weakness, vomiting, nausea, light headedness, low blood pressure and impaired muscle coordination.

Treatment – Treatment of heat exhaustion should begin with removing any excess clothing/equipment to increase skin surface area and facilitate cooling, and moving the athlete to a cool, shady environment. The following steps should then be taken:

• Athlete cooling should take place immediately, ideally by cold water immersion in an ice bath. If an ice bath is not readily available, ice bags should be placed around the patient’s neck, underarms, and between the athlete’s legs.

• If athlete’s condition worsens or does not improve after initial cooling, the Emergency Action Plan for the athletic venue should be followed and EMS should be activated.

Exertional Heat Stroke:

Definition – Exertional heat stroke (EHS) if the most severe form of heat illness and if it is suspected EMS should be activated immediately. It is characterized by brain function impairment and an excessively high core body temperature (>105°F). It occurs when temperature-regulating bodily functions are impaired due to excessive heat production and/or inhibited heat-loss. This condition most commonly effects athletes exercising in environments of high heat and high humidity, but can also be the result of intense physical exertion in less hot and humid environments.

Recognition – Cognitive dysfunction and a core body temperature above 105°F are the two main identifiers for EHS. Common signs and symptoms of cognitive dysfunction associate with EHS include disorientation, confusion, dizziness, loss of balance, staggering, irritability, irrational/unusual behavior, apathy, aggressiveness, hysteria, delirium, collapse or loss of consciousness. In cases of heat stroke the patient’s symptoms will likely worsen rapidly. Other symptoms that may present include signs of dehydration, hot/wet skin, high blood pressure and an abnormally high rate of breathing.

Treatment – If EHS is suspected the Athletic Trainer (AT) should be notified immediately. If the AT is not readily available, coaching staff should initiate the emergency action plan and begin cooling of the patient until EMS arrives. The primary goal of treatment of an athlete with EHS is to lower their body temperature as quickly as possible. The longer an athlete’s core body temperature remains elevated above ~102°F, the higher risk of serious complications, including death. If EHS is suspected the athlete should be immersed in a pool/tub of cold water as soon as possible (preferably between 35°F and 59°F). Removal of excess/additional clothing will enhance cooling, but should be performed after cold water immersion has taken place. If no form of cold water immersion is available, the athlete’s body should be covered in wet ice towels.

*** The only method of accurately measuring core body temperature is with a rectal thermometer. If an AT, head coach and/or designee does not have the resources to accurately obtain a core body temperature, and an athlete is showing signs and symptoms of heat exhaustion or EHS, then immediate cooling should begin and the emergency action plan should be activated. ***

 

Prevention of Heat Related Illness

The most important step that should be taken in order to help prevent heat illness from occurring is heat acclimatization. Athletes who are going to be exercising in hot and humid conditions should be acclimatized gradually over 7-14 days. The following heat acclimatization model should be used in planning pre-season practices for high school athletes:

Practice Days 1-2

Practices permitted per day:	1
Equipment:	Helmets only
Max duration of practice:	2 hours
Max duration of walkthrough (not included as practice time):	1 hour (must be separate from practice for 3 continuous hours)
Degree of contact:	Bags (no player-to-player contact)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Practice Days 3-5

Practices permitted per day:	1
Equipment:	Shells (helmets and shoulder pads)
Max duration of practice:	3 hours
Max duration of walkthrough (not included as practice time):	1 hour (must be separate from practice for 3 continuous hours)
Degree of contact:	Bags (No player-to-player contact)

 

Practice Days 6-14

Practices permitted per day:	2, only every other day
Equipment:	Full pads
Max duration of practice:	3 hours (total max of 5 hours on double session days)
Max duration of walkthrough (not included as practice time):	1 hour (must be separate from practice for 3 continuous hours)
Degree of contact:	Bags, Control, Thud, Live Action (limit full contact – Thud and Live – to 30 minutes per day)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*This table provides guidelines and should be used in conjunction with good judgement. Times listed are maximum practice times; conditions may warrant shorter practice times and intensity.

 

*A ‘walkthrough’ is defined as time used for reviewing plays and field positions.

In addition to following these acclimatization guidelines, another important aspect of injury prevention is hydration. The following steps should be taken to help ensure that athletes are adequately hydrated before/during each session.

• Athletes should consume 16-24 ounces of water or sports drink prior to exercise.

• Athletes should have unlimited access to water during exercise.

• If exercise sessions should exceed 60 minutes it is recommended that sports drinks be available. (Sports drinks are defined as drinks containing electrolytes, sugar and water and help replenish nutrients).

• Pre-determined breaks should be established every 15 minutes during exercise.