Heat-related information

Exertional Heatstroke (EHS) is the leading cause of preventable death in high school athletics. Student-athletes participating in high-intensity, long-duration, or repeated same-day sports practices and training activities during the summer months or other hot-weather days are at greatest risk.
All schools are required to use a Wet Bulb Globe Thermometer (WBGT), cold immersion tub, or other cooling devices, and have an Emergency Action Plan in place.

1. Wet Bulb Globe Temperature (WBGT) considers the combined effects of air temperature, humidity, and solar radiation on the human body. WBGT should be measured (using a scientifically approved device) for all sports when student-athletes may be at risk for exertional heat illness (EHI).
   1. WBGT thermometer should be on site and utilized.  Do not rely on local weather updates as they do not provide an accurate reading for your specific venue.
   2. WBGT should be accessed every hour beginning 30 minutes before the start of practice
   3. As WBGT increases, minimize clothing and equipment.
   4. Provide unlimited drinking opportunities during hotter practices.  NEVER withhold water from athletes.
   5. Pre and post-practice weigh-ins are recommended for all sports participating during periods of high heat and humidity.
   6. If WBGT is at 92.1 or above, suspend/postpone practice/competitions.
   7. If WBGT at the beginning of practice is between 90.0-92.0, then drops during practice, you are allowed only 1 additional hour of practice.
2. WBGT Device example:

3. Guidelines for the Modification of Athletic Competition in Hot or Humid Environments

4.  Recognition of Heat Illness:
   1.  Heat Exhaustion
      1. The clinical criteria for heat exhaustion generally include the following:
         1. The athlete has obvious difficulty continuing with exercise
         2. Body temperature is usually 101 to 104°F (38.3 to 40.0°C) at the time of collapse or need to drop out of activity.
         3.  No significant dysfunction of the central nervous system is present (e.g., seizure, altered consciousness, persistent delirium)
      2. If any central nervous system dysfunction develops, such as mild confusion, it resolves quickly with rest and cooling.
      3. Patients with heat exhaustion may also manifest:
         1. Tachycardia (very fast heart rate) and weak pulse
         2. Extreme weakness
         3. Dehydration and electrolyte loss
         4. Ataxia (loss of muscle control) and coordination problems, syncope (passing out), light-headedness
         5. Profuse sweating, pallor (paleness), “prickly heat” sensation
         6. Headache
         7. Abdominal cramps, nausea, vomiting, diarrhea
         8. Persistent muscle cramps

2. Exertional Heat Stroke
   1. EHS is a medical emergency that requires the immediate recognition and implementation of the EAP
   2. The two main criteria for diagnosing exertional heat stroke
      1. Rectal temperature above 103°F (40°C), measured immediately following a collapse during strenuous activity.
      2. Central Nervous System dysfunction 
   3. What to look for:
      1. Hot, red, dry skin
      2. Dizziness
      3. Headache
      4. Nausea
      5. Confusion
      6. Loss or altered consciousness
      7. Emotional instability

5. Management of Heat Illness:
   1. Football and other sports that participate outdoors must have access to a cold immersion tub or other suitable devices (taco/burrito immersion technique, cold towels) when the temperatures begin to rise (WBGT is 82 or greater). Cold water immersion should typically be available from May through October.
   2. The primary goal of the management of heat illness is to reduce core body temperature as quickly as possible. When exertional heat stroke is suspected, immediately initiate cooling, and then activate the emergency medical system. Remember “Cool First, Transport Second”.
      1. Remove all equipment and excess clothing.
      2. 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 the cooling process.
      3. If immersion is not available, take athlete inside an air-conditioned facility or to a shaded, cool area and use rotating cold, wet towels to cover as much of the body surface as possible.
      4. Maintain airway, breathing, and circulation.
      5. After cooling has been initiated, activate the emergency medical system by calling 911.
      6. Monitor vital signs such as rectal temperature, heart rate, respiratory rate, blood pressure, monitor CNS status.
         1. 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.
      7. Cease cooling when rectal temperature reaches 101–102°F (38.3–38.9°C).
   3. Optimally, the best practices should be carried out by a certified athletic trainer or a designated healthcare professional.  In the event one of these healthcare professionals is not available, the cooling technique should be implemented by the school personnel until EMS arrives.

6. Prevention of Heat Illness:

1. Ensure hydration
   1. To ensure hydration, athletes can observe the color of your urine, which should be a light yellow or the color of lemonade
   2. Measure the athletes’ weight before and after each practice to ensure they do not lose more than 2% of their pre-workout weight, assuming they started in a hydrated state. Use the equation: (Pre-exercise weight minus post-exercise weight divided by pre-exercise weight) x 100. By the time next practice begins, athletes should ingest fluids and weigh the original weight. This equation assumes that they do not eat, drink or go to the bathroom during practice.
   3. Encourage drinking throughout practice, in the shade if possible, and throughout the day, especially when having multiple practices.
   4. As they become used to exercising in the heat they will sweat more and therefore need to replace a greater amount of fluids during the course of the workout.
   5. Encourage drinking both water and fluids containing sodium.
2. Wear loose-fitting, absorbent or moisture-wicking clothing
   1. During hot or humid conditions minimize the amount of equipment and clothing worn.
3. Sleep at least 6–8 hours and eat a well-balanced diet.
4. Practice and perform conditioning drills at appropriate times during the day, avoiding the hottest part of the day (10am–5pm).
5. Work with coaches and administration to follow acclimation guidelines.
6. Slowly progress the amount of time and intensity of conditioning and practices throughout the season.
7. Ensure that proper medical coverage is provided and familiar with exertional heat illness (EHI) policies.
8. Be aware of the intrinsic factors (mostly in your control/items you can adjust) and extrinsic factors (mostly outside your control) that cause EHS

Note: Exertional heat stroke has had a 100% survival rate when immediate cooling (via cold water immersion or aggressive whole-body cold water dousing) was initiated within 10 minutes of collapse.