Month: August 2016

Does VHSL heat policy need an upgrade? (Daily Progress)

By Ben Cates

Currently, the Virginia High School League operates under heat guidelines it installed in the last decade. Those guidelines and restrictions are important, especially given the science behind heat-related illnesses and the dangers facing teenagers throughout summer and into the fall season.

Those guidelines are also thorough. They provide facts about the threat of extreme heat and humidity, signs and symptoms of illnesses and how environmental factors play a role in the risks facing young athletes, especially football players.

The VHSL relies on heat index (the combined effects of temperature and air humidity) to recommend when athletes should and should not practice, when they need to go without equipment and when they should be carefully monitored for heat-related illnesses.

For instance, when the “humiture” is below 89 degrees, the VHSL recommends water breaks every 20 to 30 minutes. On days when it’s between 90 and 94 degrees, equipment should be removed as often as possible. At 95 to 104 degrees, the VHSL recommends practicing without equipment. And at 105 degrees or higher, all outside activities should be canceled.

There is, however, at least one problem with this measurement.

The heat index literally has it made in the shade. That is, it’s supposed to be measured out of direct sunlight.

The last time I checked, there isn’t too much shade around football fields. And while the majority of fields are grass, some are synthetic turf, which adds at least 10 degrees to air temperatures.

A more accurate measurement can be reached with a wet bulb globe, which takes into account not only ambient temperature and humidity, but wind speed, cloud cover and sun angle.

According to the Korey Stringer Institute at the University of Connecticut, the majority of deaths in a given football season occur in August in the eastern part of the U.S. According to the organization’s website, “over half of the reported deaths occurred during morning practices when humidity levels were high. These results show a direct correlation between increased temperature and humidity levels and the risk of mortality as a result of [Exertional Heat Illness],” or EHI.

We are well beyond two-a-days now. Players are practicing directly after school. They’re busy working during hottest part of the day, in a month of high humidity, in the midst of a year featuring record-breaking temperatures.

For 2016-2017, the VHSL has required all its member high schools to have emergency action plans in place. While those policies are by no means an end-all approach toward complete safety, they are a start.

Requiring that all member schools have athletic trainers on site would be another step in the right direction. Those athletic trainers, though, are often stretched to the max. It isn’t conceivable for them, in the midst of high school duties, to assist at middle schools, where a certified athletic trainer usually isn’t present.

The good news is that with proper education and implementation, heat illnesses are often avoidable. Cramping, dizziness and excessive sweating are all signs of a problem, but heat-related struggles can exist without those symptoms. That’s what makes practicing in the summer and early fall so dangerous and, sometimes, life threatening.

Hydration, proper nutrition and regular weigh-ins are, of course, vital to lowering the risk of heat-related injuries. Socio-economic conditions, though, often determine whether a student is getting the right kinds of fluids and nutritious meals in a timely manner.

And take a look around you: there are athletes everywhere growing up in poverty. They deserve a chance to play sports and let their talents shine; they also deserve a fair chance: proper education and the opportunity to implement that knowledge on a regular basis.

Athletic trainers constantly drill safety lessons into young athletes. They are also charged with figuring out when it’s too hot for pads, when athletes need regular water breaks and watching for heat distress among their other duties.

These employees adhere to their own governing body, the National Athletic Trainers’ Association, or NATA. Through that organization and a healthy, ever-advancing body of research, athletic trainers have at their disposal wide-ranging, practical knowledge.

Many of them, for instance, already use a wet bulb globe, exceeding outdated standards. Those who don’t may run the risk of seriously handicapping not only their programs but their athletes.

Here’s hoping the VHSL moves to a less-antiquated form of measuring heat and does so soon.

Later may be too late.

Source: Daily Progress

Back in Falmouth

By Yuri Hosokawa, MAT, ATC, Director of Communication and Education

IMG_8657Twenty-seven research and medical volunteers from the Korey Stringer Institute, EC Lee Lab and University of Connecticut joined the 44th New Balance Falmouth Road Race in Falmouth, MA on August 21st. This was the fourth consecutive year in which KSI conducted a field research study at the race in conjunction with working in the medical tent treating exertional heat stroke patients. In this year’s study, we aimed to (1) investigate runner’s knowledge on heat and hydration and behaviors on race day and (2) investigate the use of real time gastrointestinal temperature feedback in altering runner’s behavior during the race. We also assessed participants’ readiness to exercise in the heat by measuring their cardiovascular fitness and their response to heat stress in our environmental chamber.



KSI’s Rebecca Stearns, PhD, ATC and Luke Belval, MS, ATC also spoke at the Medical Symposium hosted by the Falmouth Hospital, which was attended by many medical volunteers and local healthcare professionals. Dr. Stearns’ presentation, The Tale of Two Heat Strokes, introduced case studies of two runners who suffered from exertional heat stroke at the same race with distinctly different prognosis due to the different treatment they received. Belval’s presentation, The Fluid Needs for Today’s Athletes, provided evidence-based suggestions on hydration. At the Health & Fitness Expo, William Adams, PhD, ATC spoke on Optimizing Safety and Maximizing Performance During Running the Heat, which was attended by many runners who were going to be racing the following day.


We would like to thank the Falmouth Road Race Board of Directors for their continued support and partnership with the Korey Stringer Institute in supporting our mission to educate runners and continue our research in ways to optimize their performance and safety during warm weather road races such as Falmouth Road Race.




High schools must adopt guidelines to prevent sudden deaths of athletes (The Post and Courier)

The death of 14-year-old Lewis Simpkins has once again raised questions about whether we are doing enough to prevent sudden deaths in sports.

The sophomore defensive tackle at River Bluff High School stumbled through the end of a 2-hour, 15-minute football practice before collapsing in the locker room on Aug. 10. Coaches gave him CPR and used a defibrillator. Paramedics took him to Lexington Medical Center, where he was pronounced dead.

Over a recent 20-year period, 243 deaths occurred during high school and college football practices and games. That’s about 12 per season. The most common causes were heart failure, brain injury and heat illness. The cause of Simpkins’ death has not yet been determined.

A recent article in The State newspaper pointed out that South Carolina high schools show poor compliance with guidelines to prevent sudden death. These guidelines come from the Korey Stringer Institute, a leader in research and education to improve safety and prevent sudden deaths for athletes and the military.

In the article, South Carolina High School League commissioner Jerome Singleton noted that he wasn’t familiar with the Institute or its guidelines. He did point out that coaches in this state must complete online courses regarding heat acclimatization and concussions. He also emphasized that the SCHSL reviews its medical policies annually.

Korey Stringer was an NFL offensive lineman for the Minnesota Vikings. He died from exertional heat stroke after an August practice in 2001. His wife Kelci partnered with heat stroke expert Dr. Douglas Casa at the University of Connecticut to create the Korey Stringer Institute. The NFL, Gatorade and other companies and organizations contribute to the Institute’s efforts.

One area of concern for football teams in the South is the heat, with 63 percent of deaths from heat stroke in football occurring in the South. Fortunately, these deaths are largely preventable. Unfortunately, South Carolina does a poor job complying with guidelines that can prevent these deaths.

While North Carolina and Georgia, as well as Alabama, Mississippi, Arkansas and Texas, meet the minimum best practice guidelines for heat acclimatization, South Carolina only meets one of the seven KSI guidelines. These guidelines include limits to the number and length of practices in the first weeks of summer football and recommendations for gradually adding protective equipment.

South Carolina schools also meet none of the guidelines regarding the use of Wet Bulb Globe Temperature (WBGT). The WBGT requires a special device to measure the outside environment for heat stress. It’s likely that the cost of the device plays a factor in our poor compliance, but Georgia meets all nine of the best practice guidelines for WBGT.

South Carolina does somewhat better with access to automated external defibrillators (AEDs) and training in CPR and AED use — meeting five to six of the Korey Stringer Institute’s eight best practice guidelines.

In terms of plans for emergencies like the tragedy at River Bluff, South Carolina again needs work. Of the 11 guidelines issued by KSI regarding emergency action plans — schools coordinating with local EMS, athletic trainers and physicians on-site to develop plans should a medical emergency occur — South Carolina meets none of them.

The South Carolina High School League needs to adopt these heat acclimatization and emergency action plan guidelines. It should work with its high schools and the state legislature to arrange funding for WBGT and certified athletic trainers for each school.

Schools, though, don’t have to wait for a statewide mandate to take action. Concerned parents of high school athletes can talk to the athletic directors and coaches to discuss plans to treat and prevent deaths from cardiac arrest, heat stroke and brain injury.

This isn’t about pointing blame at the SCHSL or the high school athletic directors and coaches around the state. My goal is to raise awareness and encourage change.

As tragic as the sudden death of a high school athlete is, it creates a perfect time to take steps to prevent another one.

Dr. David Geier is an orthopaedic surgeon in Charleston. For more information about football injuries and other sports medicine topics, go to

Source: The Post and Courier

Everything you need to know about preventing heat stroke this summer (The New York Post)

When 18-year-old Ariel Newman set off for Israel in September 2014 for a nine-month gap year, he gave his dad a huge bear hug. Tragically, the farewell at JFK was the last time that Mark Newman and his wife, Ellen, would see their only child — eight days later, he collapsed from exertional heat stroke (EHS) while hiking in the desert.

The SUNY Binghamton-bound Ariel literally roasted to death 45 minutes from the end of a grueling 9.5-mile trek in temperatures in the mid- to upper 90s.
After Ariel Newman died due to exertional heat stroke, his parents, Ellen and Mark, created a guide to keep it from happening to others.

“His death was completely preventable if the right measures had been taken,” says interior designer Ellen, her voice cracking from the heartbreak. “Just some basic knowledge about hiking in heat could have saved him.”

Now, to show that Ariel’s passing was not in vain, the Great Neck, LI, parents joined forces with expert medics to produce a guide, Ariel’s Checklist, raising awareness of EHS and ways to avoid it.

While the condition is not always life-threatening, it can cause severe organ damage and lead to death if not recognized and treated properly. It is a particular danger to sports enthusiasts.

The Newmans have examined what went wrong on what Mark calls Ariel’s “death march.” Not only was Ariel a beginner, but, at 230 pounds, he was out of shape for the two-day challenge. His parents insist the organizers of the program should never have allowed him on such a tough hike in the first place.

Despite their grief, Ellen and Mark teamed with EHS experts including Dr. Robert Huggins of the Korey Stringer Institute, a research center at the University of Connecticut that aims to prevent deaths in sports. The resulting 10-point guide is aimed at hikers throughout the US — especially those in ultrahot environments — as well as abroad, including Israel.

“Bringing enough water and ensuring everyone wears a hat is not nearly enough,” says Mark, who works for the IRS in Manhattan. “Acclimatizing, getting a good night’s sleep ahead of the hike and wearing loose, moisture-wicking clothes are among other key factors.”

The Newmans hope the guide — which also recommends work-to-rest cycles and recognizing limits — will make a difference.

Says Ellen: “Ariel wasn’t an effusive character, but I think he’d be like, ‘Cool, Mom!’ and be quietly very proud of us.”

Source: The New York Post

Dehydration looms for anyone working, playing or practicing outdoors (The Gadsden Times)

It’s the heat, and the humidity, and when you throw in the hard work of getting ready for a game or the show, there is potential for tragedy if care is not taken to keep people hydrated.

The sunny skies, high temperatures and oppressive humidity of an Alabama summer take their toll on anyone doing anything outside. Young athletes and band members find themselves in the midst of it, as practices heat up before it’s time to take to the field.

Heat-related problems — heat stress, heat exhaustion and heat stroke — are real threats, and coaches need to know how to recognize, react and most importantly, to prevent those conditions.

The doctors of Northeast Orthopedics made dehydration a focus in their annual clinic for Etowah County coaches and band directors.

Athletic trainer Chris Russell said kids today don’t spend as much time outdoors in the heat as they did in earlier generations, and are not as accustomed to exertion in hot weather. “That’s one of the main reasons we see so much more heat illness now,” he said.

Young people often don’t eat and drink properly for daily life, Russell said, much less for the exertions of athletic practice.

It’s not enough to just give kids water breaks. “You’ve got to make them drink,” Russell said.

Heat-related illness can kill people. It’s important to know more about it, because it can be prevented.

According to information in Pernacity, a publication of the Korey Stringer Institute, 15 states, including Alabama, mandated practice schedules for football designed to acclimatize young people to the heat. There have been no heat-related football deaths in any of those states since then.

It was a no-cost fix; practice schedules were altered to limit time in the heat in early days, letting kids get accustomed to the heat before going full-on, in full gear.

Talk about heat issues in athletics, and Stringer’s name is sure to come up. The Minnesota Vikings’ Pro Bowler died from an exertional heat stroke in August 2001 during practice.

KSI is devoted to research, education and advocacy to maximize performance and prevent sudden death from heat-related issues and other causes for athletes, soldiers and laborers.

Since 1995, 54 football players have died from heat stroke — 42 high school players, nine college players, two professionals and one sandlot player, according to a 2014 survey of football injuries by the National Center for Catastrophic Sport Injury Research.

Russell said players need to drink 24 ounces of water or Gatorade or a similar drink before starting practice — and no caffeine. “Caffeine sucks the water out of you,” he said.

They then need to drink eight to 10 ounces every 15 minutes, whether they are thirsty or not. “If you are thirsty, it’s already too late,” Russell said.

It’s not uncommon for those exerting themselves in the heat to lose one to one-and-a-half liters of sweat, he said. Kids can lose seven or eight pounds, in water, during a day of practice.

Some body types are more likely to suffer heat-related issues — big kids (“your offensive linemen) and those that have low body fat, because they don’t have a lot of water in their systems.

There also are personality types that are more likely to have problems. “You’ve got kids who won’t tell you,” Russell said, that they don’t feel well. “The go-getters — they’ll try to push through it.”

Before they, their coach or band director know it, they can be in big trouble.

Russell said he dealt with a player like that last week. “This is the kid who never takes a knee, and he was taking a knee. Then he was bending over,” he said.

While these kids may think they are giving the team everything they’ve got, they aren’t.

“If a kid is dehydrated, it’s affecting his performance,” Russell said.

Heat stress is the first phase of heat-related illness, he said, marked by cramps because of low electrolytes, and possibly muscle spasms.

“That’s your muscle saying it’s out of something,” Russell said. “Get that kid to the sidelines. He needs something like Gatorade or electrolyte pills — what we used to call salt pills.”

Stretching and ice also help, he said, and the problem usually will resolve itself.

Heat exhaustion causes excessive thirst and lethargy, and comes when the core body temperature is 102 to 104 degrees. Russell said that kid needs to be gotten into air conditioning or at least shade, and have ice applied to the back of the neck, armpits and groin area. If a cold whirlpool is available, the kid should be placed into it.

“This kid is on the verge of something bad happening,” Russell said. “It’s nothing to play around with. I know we all have kids who are ‘high drama,’ but you need to take it seriously.”

Russell said he’s seen players with heat stroke twice — one in college and one in high school. “Heat stroke is when kids can die,” he said.

Symptoms include headache, vomiting and diarrhea. “That’s the body telling you something’s very wrong,” Russell said.

At this point, the body’s core temperature can be 104 degrees. “Call 911,” Russell said. “Get the kid in air-conditioning or shade,” and get clothing off and apply ice.

Coaches and trainers need to emphasize to players — or band members, cheerleaders or anyone else working out in the heat — the importance of good nutrition and proper hydration. It’s not a worry limited to athletic fields.

“Anyone outside in the heat, working in their yard or garden, needs to be properly hydrated,” Russell said.

It’s not unusual for older people to end up in the emergency room after getting dehydrated while working in a garden.

Knowing about proper hydration is the key, Russell said, and information from TSI supports that.

Heat stroke deaths averaged 2.6 per year from 2010 to 2014, down from the previous five-year period. However, in one year that recorded two dehydration deaths, there also were two deaths from over-hydration.

Source: The Gadsden Times

SC trails other states in ‘sudden death’ football safety policies (The State)

Getting burned by pushing envelope in the heat (NWI Times)

Looking ahead to the next few days, the weather forecast calls for highs in the 80s to low 90s with high humidity. Thus, it may be worthwhile to look back at two tragedies that occurred in the U.S. last month in hopes of avoiding the same in this area.

On July 21, Oklahoma State basketball player Tyrek Coger, 22, collapsed after 40 minutes of running football stadium stairs in 99-degree heat in Stillwater, Oklahoma. The official cause of death was an enlarged heart. However, it is hard to believe that the intense heat was not a major contributing factor.

On July 28, Johnny Tolbert Jr., 12, passed away in Atlanta. His death came two weeks after he collapsed during a two-hour football practice in 90-plus degree heat.

Media reports out of Georgia indicate that no water breaks were taken during the practice. Worse, apparently no lifesaving measures were attempted during the 40 minutes it took for paramedics to arrive. Worst of all, with the temperature being above 92 degrees when practice started, the Atlanta Journal Constitution reports Georgia high school rules would have prohibited a football practice. Unfortunately, Tolbert was playing for a park league team.

That park league may not have been subject to the GHSA rule that would have cost a school $500-$1000 for practicing in such conditions. However, league officials and coaches may very well find themselves in a civil court being asked why they ignored that standard of care.

I don’t know what answer they could give to satisfy any jury.

Nor do I know what Oklahoma State athletic director Mike Holder was thinking at a July 22 news conference when he said, “If you want to be great at something, you’ve got to push the envelope. That’s what conditioning is all about.”

I thought conditioning was about improving performance. And improving in your chosen sport is all about practicing/conditioning in an environment as close to game conditions as possible. Consequently, running sprints in the arena would have been entirely appropriate. But stairs outside in the heat? Did Oklahoma State anticipate their basketball team playing in such conditions between November and March?

Those aren’t the only questions the Cowboys athletic department may eventually be compelled to answer.

Why did 40 minutes elapse between the time paramedics were called and the time Coger arrived at a medical center barely one mile away?

Was an athletic trainer present? If an athletic trainer was not there, was the strength coach CPR/AED certified? Was an AED on hand and put to use?

Agreeing — for the sake of argument — that there was some benefit to be had from conditioning basketball players in such heat, had Coger and his teammates gone through a heat acclimatization program over the previous 7 to 14 days? That is the minimum and well-known time frame recommended by UConn’s Korey Stringer Institute, which is dedicated to the prevention of sudden death in sports.

Finally, with Coger being new to Stillwater, having transferred from a junior college, what medical screening(s) did he undergo upon his arrival, just 16 days before? OSU officials won’t specify, citing federal privacy laws.

Surely, though, an echocardiogram would have discovered the condition to which he succumbed.

Oklahoma State officials had better have the right answers ready if a lawyer for Coger’s family pushes an envelope across the table notifying them of a wrongful death lawsuit.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at Follow him on Twitter @JDohertyATCPT.

Source: NWI Times

Heat Safety Still a Hot Topic as Fall Sports Tryouts Begin (Bethesda Magazine)

Five things you need to know about heat-related illness and dehydration

It has been five years since Montgomery County’s heat acclimatization guidelines—which enforce a safe progression into the rigors of fall sports during the hottest time of the year—were implemented, as required by state law.

The change in preseason protocol was sparked by the high-profile exertional heat stroke death in 2001 of Korey Stringer, a pro-bowl tackle for the Minnesota Vikings. Stringer’s body reached 108 degrees after a practice in 91-degree weather.

In 2009 the National Athletic Trainers’ Association (NATA) released a set of guidelines to help student-athletes adjust to potentially oppressive heat at the start of the fall season.

According to the Centers for Disease Control and Prevention (CDC), heat illness during practice or competition is the leading cause of death among U.S. high school athletes. With Wednesday marking the first day of tryouts/practice for Montgomery County fall sport athletes—and 90-degree weather forecasted—county coaches agreed it is vital to players’ safety to ensure that parents and student-athletes alike are aware of and educated on the topics of heat-related illness and dehydration.

According to the Korey Stringer Institute, which is housed at the University of Connecticut, there have been no preseason deaths among high school football players in states with heat acclimatization guidelines. Aside from the regulations, it is important to remember athletes arrive to fall tryouts with varying levels of fitness, said Winston Churchill High School girls soccer coach Haroot Hakopian.

County coaches undergo extensive training and certification but they additionally benefit from working alongside their school’s assigned certified athletic trainers in creating a safe environment for student-athletes, said Walt Whitman football coach Jim Kuhn.

Here are five things you need to know about heat-related illness and dehydration:

There are several types of heat illness—heat cramps, heat exhaustion and heat stroke, among others— and they range in severity.

According to the CDC, symptoms of heat exhaustion include heavy sweating; weakness; cold, pale and clammy skin; fast or weak pulse; nausea or vomiting; and fainting. Signs of heat stroke include high body temperature; hot, red, dry or wet skin; rapid and strong pulse; and possible unconsciousness.

Dizziness is also a common symptom and coaches urge their athletes to pay attention to the color of their urine—darker yellow is a clear sign of dehydration.

Bethesda-Chevy Chase football coach Chris Pope said it’s important for coaches to be on the lookout for lesser-known signs of a problem, such as discoloration of the eyes—red or yellow in particular—and drastic changes in breathing patterns and neurological behavior. Similar to symptoms of a concussion, student-athletes who are suffering from a heat-related illness or dehydration can also exhibit neurological symptoms, such as confusion and clumsiness.

Added Kuhn: “If you’re trying to run a play and a kid is getting confused and can’t remember anything short term, like what the count was on, you can really kind of tell something isn’t right here and they’re struggling in some way, it could be a concussion but it could also be a hydration issue. The symptoms of concussions and hydration manifest themselves similarly.”

Heat illness/dehydration can occur when it’s not scorching hot.

Heat illness is inherent to physical activity, according to NATA, and its incidence increases with rising temperature and humidity. But exertional heat stroke occurs when the body’s core temperature gets too high because of physical activity, according to the Korey Stringer Institute. Such a condition, as well as dehydration, can happen in any climate.

Practice is too late to start hydrating.

Frequent water breaks are required, per the heat acclimatization rules. And coaches say water is readily available to athletes whenever they need it—Kuhn said he has four water stations set up, one in each corner of the practice field—and they are encouraged to continue hydrating. But too much water during a rigorous practice can also have an adverse effect.

“If you drink too much water on the field, all that water rustling around in your stomach, you’re probably going to throw it up,” Kuhn said.

It’s not what players do on the field, in terms of drinking water and other fluids, Kuhn said, it’s what they’ve done in the 24 hours before each practice to get their bodies ready to perform.

“If they’re already in a deficit when they get onto the field at 8 a.m., it’s going to be a tough day,” Kuhn said.

Kuhn said he keeps his office refrigerator stocked with Pedialyte. Bringing the electrolyte count back up is key in rehydrating, he said. Even though sports drinks such as Gatorade and Powerade are high in sugar, they are also quite helpful; Kuhn said he encourages his athletes to dilute them 50 percent with water.

While athletes are not weighed in and out every practice, Hakopian , the Churchill girls soccer coach, said many of his players keep a daily log to make sure they’re not losing too much water weight; Kuhn said his players will be weighed in on Tuesday and weight fluctuations will be closely gauged.

Recognize early signs and seek treatment

The National Federation of State High School Associations said it best: First aid should not be delayed. Students should not be afraid to speak up if they aren’t feeling right, Hakopian said. It’s important to get treatment as quickly as possible to reverse the effects at the onset of a heat-related illness or dehydration. Hakopian said while he pays close attention to the classic symptoms and changes in behavior from his athletes, he also educates and asks his senior leaders to inform him of any warning signs in younger teammates.

If the condition is severe, do not administer fluids.

If a player is exhibiting signs of heat stroke, the CDC defines this as a medical emergency and recommends calling 911. In the meantime, it is important to move the athlete to a cooler environment and lower his or her temperature, whether with cool cloths or an ice bath. But do not, according to the CDC, give fluids.

Source: Bethesda Magazine

Colby Concussion Summit and Beach to Beacon Road Race

By William Adams, PhD, ATC, Vice President of Sport Safety

This past weekend, KSI’s Vice President of Sport Safety William Adams, PhD, ATC and Director of Communication and Education Yuri Hosokawa, MAT, ATC were in attendance at the first annual concussion summit held at Colby College, hosted by the Concussion Institute at Colby College. They joined representatives from the National Athletic Trainers’ Association, as well as faculty members from the University of New Hampshire, University of Pittsburgh, Colby College and others.


The purpose of the meeting was to discuss the diagnosis and management of concussion and to establish the next steps that are needed from a research perspective to enhance clinician’s objective assessment of concussion in athletes.  The meeting concluded with an action plan to examine specific areas of concussion diagnosis and management to continue to add to the body of scientific literature surrounding the validity and reliability of tools that clinicians can use in their toolbox for concussion management.

Colby Concussion Summit 16


Following the concussion summit, KSI traveled south to Portland, Maine for the Beach to Beacon Road Race. The race weekend began with the medical symposium, where both William Adams and Yuri Hosokawa were two of the invited speakers. Adams spoke on hydration in today’s athletes while Hosokawa presented a case series examining the treatment and management of two exertional cases recently published by Stearns et al. in Current Sports Medicine Reports. The symposium was a huge hit and was extremely well received by all of the attendees.


The road race occurred on Saturday in Cape Elizabeth, Maine. For those unfamiliar, Beach to Beacon is a 10-kilometer (6.1 mile) road race finishing at the picturesque Portland Headlight Lighthouse in Fort Williams. KSI staff members William Adams, Yuri Hosokawa and Samm Scarneo had the opportunity to volunteer as medical staff during the race. The day finished off with roughly 6,500 runners finishing the race and the medical volunteers providing excellent care to those needing it, including four individuals who had suffered exertional heat stroke. The best part of the race weekend were the new friendships that were made with the other physicians, nurses and athletic trainers who were also volunteering in the medical tent.


Beating the heat (Greenville Online)

It seems to happen somewhere every year — a fresh-faced teen practicing football in the sweltering heat collapses on the field and dies.

With high school football practice in Greenville County officially underway, games starting in a couple of weeks and daytime temperatures in the 90s with no end in sight, exertion in the heat, especially with helmets and pads, could be dangerous.

So on Monday morning, Don Frost, football coach at Christ Church Episcopal School in Greenville, called off practice when the heat index made it feel like it was 104 degrees outside.

“They were in T-shirts and shorts, but we decided to just send them on in,” he told The Greenville News. “That real feel is what’s against your skin so you’ve got to be very, very careful. You don’t want your kids to get sick or hurt or anything. We try to protect them as much as possible.”

But every year, an average four or five high school or college football players die from heat stroke, said Yuri Hosokawa, director of communication and education for the Korey Stringer Institute, established at the University of Connecticut in memory of the Minnesota Vikings offensive lineman who died from heat stroke in 2001.

A variety of conditions can occur with heat exposure, according to the U.S. Centers for Disease Control and Prevention, including heat exhaustion and heat stroke.

Heat exhaustion, which results from excessive loss of water and salt, is marked by headache, nausea, dizziness, weakness, heavy sweating and elevated body temperature.

Heat stroke, which is the most serious condition, happens when the body temperature rises rapidly and can’t cool down, according to CDC.

Symptoms include hot, dry skin or profuse sweating, confusion, altered mental status, slurred speech, loss of consciousness and seizures, and can result in death or permanent disability without emergency treatment.

And that’s the last thing a coach wants to see on his field, or anyone else’s, said Hillcrest High School coach Greg Porter.

‘Take care of my kids’

“In the back of your head, you always have that thought in your mind — if this was my kid, how would you want them treated,” he said. “So I make sure I take care of my kids.”

In Greenville County, Greenville Health System supplies certified athletic trainers to all public high schools and four private schools who have expertise in sports injuries, including heat-related illnesses, said David Webb, an athletic trainer at Eastside High School.

They are on the field at all practices and games, he said, adding physicians are on hand for the games.

And there are usually one or two cases of heat exhaustion a year in this area, he said. So lots of precautions are taken to keep players safe.

One of the most common is holding practices early in the morning so players are off the field during the worst of the heat so that the body isn’t at as great a risk for heat stress, Webb said. Another is frequent breaks and hydration.

Frost said his players practice from 8-10:15 a.m. and then break for an hour and go from 11:15 a.m. to noon. And they never practice more than 20 minutes at a time without a water break, he said.

Porter, who limits practices to three hours, also makes sure his players get plenty of water breaks.

“I try to teach my kids that rehydration for the next practice or next game begins when you step out of the locker room,” Webb said. “And I tell them to keep it clear, no bubbles and no caffeine. And for every pound lost during exercise, especially at this time of year, they need a maintenance dose of at least three quarts of water per day.”

Light-colored, breathable jerseys also help, Webb said, as does having any players not actively in a drill remove their helmets and shoulder pads when possible.

Following the guidelines

Getting acclimated to the heat is also important, said Porter.

Frost has the players practice three days in helmets and shorts, two days in shoulder pads and shorts, and then full pads and helmets to acclimate them.

And trainers, the coaches agree, have the final call.

“If they say it’s too hot, we stay inside and spend more time on film,” Porter said.

“If it’s too hot, there’s no argument. If he says pull the kids out, no argument,” adds Frost. “He has full control.”

Heat stroke statistics are increasing, said Hosokowa. Two decades ago there were an average two or three fatalities a year, she said.

But the reason for the rise is unclear. It could be from increased reporting, or a surge in competitiveness, or kids being put at high risk during the preseason when they’re not acclimated to the heat, she said.

However, she added, most fatalities occur when there isn’t a health care professional or athletic trainer on-site and the right protocols aren’t followed.

Hosokowa noted a person who is cooled down to 102 degrees — the best method is submersion in cool water — within 30 minutes of collapse is likely to survive without complications. And, she said, it’s best to cool the person down before transporting them to the ER.

Frost, who’s been a coach for 37 years, said that none of his players has ever succumbed to the heat, but a player on another team once had to have IV fluids during a game because of the heat.

Webb said that by insisting that players are drinking plenty of water, practicing during the coolest part of the day, and continuing to sweat as the heat index increases, most problems can be avoided.

“In any sport, injuries will happen,” Webb said. “But following the (National Athletic Trainers Association) guidelines should reduce the risk of that occurring.”


Source: Greenville Online