Month: June 2018

What You Need to Know About Heat Stroke (US News & World Report)

THIS PAST MAY, AS HE does every year, Dr. Mark J. Conroy volunteered in the medical tent at the Dick’s Sporting Goods Pittsburgh Marathon. As is the case each year, Conroy and other medical personnel treated a handful of runners who suffered from heat stroke, which occurs when the body overheats and reaches an inner core temperature of 104 degrees Fahrenheit or higher. Most of the athletes Conroy treated were fit, athletic young men and women who were pushing themselves to achieve a good time on the race.

Not long ago, Conroy, a sports medicine and emergency medicine doctor at the Ohio State University Wexner Medical Center in Columbus, Ohio, provided care for a woman in her 70s who’d suffered heat stroke after sitting in the sun for about 90 minutes. The woman was obese and took medication for high blood pressure, both of which are risk factors for heat stroke. She displayed classic heat stroke symptoms: her temperature was elevated and she suffered dizziness.

The two episodes illustrate how heat stroke can affect people who are young and old, active and sedentary, Conroy says. It can strike people who are exercising vigorously as well as people simply sitting outside in the sun on a hot day. With the marathon runners Conroy treated, heat stroke developed over the course of several hours of physical activity. And it can strike even more quickly than that, he says. “If you’re out exercising at the wrong time of day or have some of the risk factors, you can develop heat stroke in 20 or 30 minutes,” Conroy says. And the case of the elderly and obese woman shows that heat stroke can also affect people who aren’t doing anything vigorous but are exposed to temperatures that are too hot for their body. “You don’t have to be out exercising for two hours; it can happen pretty quickly if you’re vulnerable to heat stroke and shouldn’t be out in 100-degree weather.”

How Long Does Heat Stroke Last?

The length of time that heat stroke affects someone is highly variable, says Douglas Casa, chief executive officer of the Korey Stringer Institute at the University of Connecticut in Storrs, Connecticut. The institute is named after a Minnesota Vikings offensive lineman who collapsed and died of heat stroke after a practice in July 2001. If a heat stroke victim’s core body temperature is brought below 104 degrees Fahrenheit within 30 minutes, he or she typically will recover completely and resume normal activities in two to four weeks, Casa says. If the core body temperature isn’t cooled down quickly enough, a heat stroke victim could suffer long-term complications such as cognitive problems, like memory loss; an intolerance and inability to cope with heat; muscle damage; and kidney and liver problems.

Heat Stroke Symptoms

Whether heat stroke strikes while you’re doing physical labor in the heat or simply sitting in the sun on an unusually hot day, the symptoms are mostly the same, says William W. Chow, a board-certified neurologist and an attending physician at Cedars-Sinai Medical Center in Los Angeles. These symptoms include a high body temperature, nausea, vomiting, rapid breathing, flushed skin, headache, a racing heart rate, confusion, agitation, slurred speech and irritability. Heat stroke can also lead to seizures and a coma.

What to Do for Heat Stroke

Immediate heat stroke treatment involves cooling the victim’s body as soon as he or she shows signs of distress, Casa says. Dousing the person with cold water from a hose or putting him or her in a cold shower can be effective. Wrapping a heat stroke victim in cold towels is also a good measure. Cooling the body of a heat stroke victim is crucial to reduce damage to the person’s brain and vital organs, according to the Mayo Clinic.

Heat stroke kills hundreds of people in the United States every year. In 2015, the latest year for which such statistics are available, heat stroke claimed 335 lives in the United States, according to the Centers for Disease Control and Prevention. “Heat-related illness is all too common during the summer months and can lead to serious complications and even death,” says Dr. Reginald Mason, total health lead for Kaiser Permanente in Atlanta. “While certain people are at higher risk for heat-related illness, anyone of any age, especially if they exercise in hot weather, can suffer from this. It is important to recognize that even well-conditioned athletes can suffer severe consequences from overexertion in the heat.”

Exertional and Non-Exertional Heat Stroke

There are two kinds of heat stroke: exertional, which is associated with vigorous physical activity, and non-exertional.

Exertional heat stroke is associated with an increase in core body temperature brought on by “intense physical activity in hot weather,” according to the Mayo Clinic. Anyone exercising or working in hot weather can get exertional heat stroke, but people who aren’t accustomed to high temperatures are more vulnerable than people used to warmer climates. Exertional heat stroke can even strike – and kill – young professional athletes. In July 2001, Stringer, the 335-pound offensive lineman for the Minnesota Vikings, collapsed after practicing on a stifling day where the temperature was in the low 90s and the humidity was high. Team personnel carted Stringer, 27, off the field; he had a core body temperature of 108.8 degrees Fahrenheit. Stringer died in a medical center.

By contrast, non-exertional heat stroke can develop in people who are not exerting themselves physically but are in weather that’s too hot for their body, Conroy says. The obese 78-year-old woman Conroy treated suffered from non-exertional heat stroke. The elderly, young children and anyone who’s dehydrated at any age are vulnerable to non-exertional heat stroke, Conroy says. People with chronic health conditions, like obesity, are also at risk for heat stroke, as are people who take blood pressure medications such as beta blockers and diuretics. Some drugs that physicians prescribe for psychiatric disorders, like clozapine, can also harm the body’s ability to regulate its core body temperature. Drinking alcoholic beverages – which dehydrate the body – can make one vulnerable to heat stroke, too, Conroy says.

Heat stroke causes alterations in sweating, according to the Mayo Clinic. In heat stroke caused by being in hot weather, your skin will feel hot and dry to the touch. That’s a little different from heat stroke brought on by exercising strenuously in the heat, which can cause your skin to feel slightly moist or dry.

It’s important to remember that on particularly hot days, our hearts need to pump harder to prompt our bodies to sweat, which cools the body. This can cause stress on the cardiovascular system of people who already have a weakened heart. This situation can become deadly during a heat wave. A 1995 heat wave in Chicago claimed more than 700 lives, authorities said. Of those who died, 39 percent had prior heart conditions, according to a 2014 study published by the National Center for Biotechnology Information, part of the National Institutes of Health.

Heat Stroke Prevention

Whether you have a heart condition, are elderly and obese or young and athletic, it’s important to take steps to prevent heat stroke. Experts recommend these strategies:

1. Try to avoid being outdoors during the hottest part of the day. “Instead of mowing the lawn in the middle of the day when it’s 100 degrees, I suggest you do it at 8 a.m. or at night,” Conroy says. “Sports teams take this advice; many of them practice early in the day rather than in the middle of the day, when temperatures are highest.” Some people, like construction workers or traffic officers, have no choice as to when they work. If you’re exercising or working in the heat, modify your work-to-rest ratio depending on the environmental conditions, Casa says. “If it’s hotter outside, you’d do more rest than physical activity,” Casa says. You should also try to acclimatize yourself gradually to hotter temperatures over a span of a week to 10 days. Slowly increase the amount and intensity of work or exercise you do in the heat.

2. Drink lots of water. “Hydration is the single most important aspect of heat stroke prevention, since sweating is the most important mechanism our bodies have to get rid of heat,” says Dr. Dustin J. Calhoun, assistant professor in the department of emergency medicine at the University of Cincinnati College of Medicine. Be careful to work in some snacks with your water intake, he says. Drinking too much water without consuming any electrolytes – such as calcium, potassium and magnesium – can dilute the body’s sodium, leading to such problems as headache, nausea, vomiting, muscle spasms and seizures. “Simply eating a snack while drinking water is the safest way to go,” Calhoun says.

3. Wear loose-fitting, light-colored clothing. You don’t want to wear tight-fitting clothes in hot weather, says Dr. Raymond L. Fowler, professor and chief of emergency medicine services at UT Southwestern Medical Center in Dallas. You’re better off wearing clothes that are loose enough to allow breezes to pass through, he says. Same goes for light-colored clothing, which absorbs less heat than dark-colored items. Wear a hat with a brim that shields the sun from your face.

4. Take frequent breaks. If you have to be outdoors during the hottest part of the day, take as many opportunities as you can to get out of the heat, Conroy says. If there’s an air-conditioned public building nearby, go inside for a few minutes. Shade is another option – if it’s available, spend as much time as you can in it, as opposed to being in the sun. One of the best options for people who play team sports is to cool down with cold and wet towels during any opportunity when the sport presents a break during a game or practice or at halftime, Casa says.

Source: US News & World Report

Preventing Heatstroke Top of Mind for Football Coaches (Athletic Business)

Copyright 2018 Collier County Publishing Company
All Rights Reserved

Naples Daily News (Florida)


Football coaches in Collier County won’t be mandated to buy equipment to prevent heatstroke, but they still are taking some of the steps necessary to prevent it.

Five weeks ago, the Florida High School Athletic Association postponed a decision on whether to mandate access to ice tubs in case of heatstroke, as well as thermometers that measure heat stress.

“Coaches around here expect Florida football to be hot – it always has been,” said Naples High School head football coach Bill Kramer. “But for my team, we have cooling misting fans and kiddie pools filled with water and ice, and we’ve been doing stuff like that forever.”

Kramer has coached at Naples High School since 1998.

“Everybody wants to keep their players safe,” he said. “I don’t know any coach who wouldn’t do the most they can for their players and their safety.”

At Immokalee High School, head coach Anthony Rodelin also has ice tubs, makes his players take mandatory waters breaks and is constantly reminding them to stay hydrated.

“Coach has us hydrating every day,” Immokalee quarterback R.J. Rosales said. “We’ve got the ice tubs and he’s always telling us the conditions outside so that we can stay safe.”

Another way coaches try to help players stay cool is by cooling down the temperatures on the field.

“About 10 years ago, when we got our new field, they put in a sprinkler system that keeps the field temperature down,” Kramer said.

Rodelin goes one step further.

“During the season, right before practice every day, I make sure our sprinkler system comes (on),” he said. “I set it for a time that I will actually be able to see, and sometimes it even gets the players a little wet during warmups.”

Since Rodelin was a player at Immokalee in 2005, things have changed a lot in terms of heatstroke prevention, but he’s still worried about the cost of a new FHSAA policy.

“If you’re going to mandate coaches do something, then provide the funding,” he said. “I’m OK with restrictions on us, but just give us the money.”

Worst state for heatstroke deaths

Since 2010 Florida has had more high school athletes die from heatstroke than any other state, according to the University of Connecticut’s Korey Stringer Institute, a research, education and advocacy organization whose goal is to prevent sudden death in sports.

From 1995 to 2015, 61 football players have died from heat-related illness, 46 of those in high school. Ninety percent of those deaths occurred during practice.

Riverdale High School football player Zachary Polsenberg collapsed from heatstroke last June in Fort Myers during summer practice after registering a core temperature of 107 degrees.

“The FHSAA seems determined not to address heat illness best practice guidelines to protect high school athletes,” Polsenberg’s mother, Laurie Martin Giordano, said. “I am confused why the FHSAA would completely disregard the recommendation of their own advisory board and the nation’s leading physicians and athletic trainers on this topic.

Douglas Casa, head of the Korey Stringer Institute, met with FHSAA board members and medical advisers the past two years on heat safety policies and was just as disappointed in their decision.

“Between now and 20 years from now, they’re going to require cold-water immersion tubs. It’s going to happen,” he said. “Why do we have to keep having more young kids die needlessly because you didn’t enforce a policy that would have saved them?”

The Fort Myers News-Press contributed to this report.

Tips for preventing heat exhaustion

Hydrate before, during and after exercise.

Maintain appropriate work-to-rest ratios based on the heat and conditions.

Increase rest breaks as temperatures increase.

If you think an athlete is suffering from heat exhaustion, elevate legs and cool person with fans, rotating ice towels, ice bags or ice bath.

Source: Athletic Business

Loudoun County Public Schools Approves EHS Protocol

Paul A. Peterson MA, LAT, ATC

Athletic Trainer, Woodgrove High School

(May 17, 2018 Virginia)-  We are proud to announce that Loudoun County Public Schools has approved an exertional heat stroke (EHS) protocol that includes the use of rectal thermometry.  We hope this decision will encourage other secondary school districts in the state of Virginia and throughout the United States, who are having difficulties convincing their administrators the vital importance of rectal thermometry, to continue their pursuit.

In the past, our school district administration was adamantly opposed to approving rectal thermometry.  They denied our athletic trainers, on numerous requests, permission to purchase and use rectal thermistors.  Ironically, this past fall, one of our student-athlete cross-country runners suffered EHS during a championship meet.  The athletic trainers and EMS volunteers immediately assessed the student-athlete’s internal body temperature at 107.7°F via rectal thermometry, placed him in an ice water immersion tub and didn’t transport him to the ER until his internal body temperature dropped to 102°F.  Fortunately, the student-athlete was released from the ER later that night with no organ damage and made a full recovery.

By following best practice guidelines in the treatment of EHS, the athletic trainers and EMS volunteers, almost certainly prevented a catastrophic outcome.  This incident, once again, brought the need for our school district administration to approve the use of rectal thermometry in the treatment of EHS to the forefront.  After an eight-month process to help educate the administration on the vital importance of rectal thermometry, we finally received consent and this policy is now officially part of our EHS protocol.

This policy implementation would not have been possible without the support of several individuals. First and foremost, we had the support of our Athletics Supervisor. Second, we received support and the go ahead from our Health Services’ Supervisors and Director.  Third, we received support and further go ahead from our Risk Management Supervisor.  Then finally, we received approval from our School Administration Director to include our EHS protocol in the LCPS policies and procedures section of the student-athlete handbook.

The key to our success was a team effort approach.  With help and support from many individuals most notably, the LCPS athletic trainers, the orthopedic physicians and staff from The National Sports Medicine Institute (NSMI), the researchers at the Korey Stringer Institute (KSI), Dr. Kevin Miller at Central Michigan University, and Darryl Conway at The University of Michigan, we were finally able to convince our administration to allow the medical professionals in the school system to make the medical decisions and act within published best practices.

With patience and perseverance, the LCPS athletic trainers were able to accomplish the goal of getting an appropriate EHS protocol approved to ensure the future health and safety of LCPS student-athletes who may suffer from EHS.

High schools: FHSAA refusing to change stance on heat illness safety equipment (Naples Daily News)

By Seth Soffian

The Florida High School Athletic Association is drawing the ire of heat safety advocates and medical professionals after refusing to change its stance on life-saving equipment.

Five weeks after the state agency postponed a decision whether to mandate access to ice tubs in case of heat stroke as well as thermometers that measure heat stress, the agenda for next week’s board meeting again stops short of requiring the basic items.

That goes against the advice of the FHSAA’s own medical advisers, who spent the past five weeks supplying the FHSAA with additional requested material in support of their position, as well as widespread industry standards for combating heat illnesses.

“It is with extreme disappointment that I review the agenda items,” Pat Helma, a Cooper City chiropractor and chair of the FHSAA’s 15-person Sports Medicine Advisory Committee, wrote in an email to FHSAA board president Frank Prendergast.

“Our Committee seeks to work WITH the FHSAA to improve sports safety; however, without communication from the latter, it appears the FHSAA is moving forward with the medical opinion of its Attorney.”

Prior to the previous board meeting in late April, for which the agenda again only recommended the use of ice tubs and wet-bulb globe thermometers, the agency publicly indicated that it would only mandate their use if required to do so by Florida lawmakers.

Barring a decision by board members next week to override the agenda language and formally mandate the heat safety equipment, that may still occur.

Florida Sen. Kathleen Passidomo, R-Naples, whose district covers large areas of Southwest Florida, previously told The News-Press she was “very concerned” about the issue. Passidomo could not be reached for comment this week.

“In somewhat confusing strategy, it has been suggested that these policies should be initiated through our state Legislators,” Helma wrote, “when in-fact, last year the FHSAA reached out to our Committee members and suggested we craft letters of support for the FHSAA to our state Legislators essentially asking them to back off and leave the FHSAA alone to govern high school sports.

“Now the (board of directors) has been directed to ask the Legislature to tell the FHSAA what to do with a thermometer and a Rubbermaid tub?”

FHSAA spokesman Kyle Niblett noted that next week’s agenda is not yet policy.

“We anticipate there to be further discussion at next week’s Board of Directors meeting regarding the proposed policy changes,” Niblett wrote to The News-Press. “The feedback from the SMAC will be part of that discussion.”

Douglas Casa, head of the Korey Stringer Institute at the University of Connecticut and one of the nation’s foremost authorities on what is known as exertional heat stroke, held out hope that the FHSAA’s position remains the result of not being “fully informed.”

“I think the lawyer’s not informed,” Casa said.

But Casa, who has met with FHSAA board members and medical advisers the past two years on heat safety policies, was equally disheartened by the agency’s position.

“Between now and 20 years from now, they’re going to require cold-water immersion tubs. It’s going to happen,” he said. “Why do we have to keep having more young kids die needlessly because you didn’t enforce a policy that would have saved them?

“It’s such a simple solution to such a serious problem.”

Heat safety experts cite a “100 percent” survivability rate in cases of heat stroke – the most severe heat illness, when core temperatures reach 104 degrees – when the person suffering is immersed in cold water within 5-10 minutes of a medical event.

Florida, meanwhile, has seen more high school athletes die from exertional heat stroke since 2010 than any other state, according to the Korey Stringer Institute, named for the former NFL offensive lineman who died from heat stroke in 2001.

Nationwide, exertional heatstroke killed an average of three football players a year at all age levels from 1995-2015, according to the National Center for Catastrophic Sport Injury Research.

Of 61 deaths in those years, 46 were in high school, 11 in college, two in youth football and two in professional football. Ninety percent of the deaths occurred during practice.

Those numbers also are for football only, and they don’t include hospitalizations for heat illnesses that didn’t result in death or other heat events that didn’t result in hospitalizations.

In addition to declining thus far to make ice tubs and wet-bulb globe thermometers mandatory, the FHSAA also has not acted on its sports medicine advisory committee’s recommendation to make its heat safety policies apply to summer months.

Those months are left almost exclusively in the hands of individual districts and schools to regulate.

“The FHSAA seems determined not to address heat illness best practice guidelines to protect high school athletes,” said Laurie Martin Giordano, whose son, Zach Martin Polsenberg, died of exertional heat stroke last summer after collapsing at Riverdale High School football practice.

“I am confused why the FHSAA would completely disregard the recommendation of their own advisory board and the nation’s leading physicians and athletic trainers on this topic. I am also disgusted at the apathy displayed for the loss of children’s lives that will surely continue while they hold the power to prevent them.”


Source: Naples Daily News

Athletes Can Prevent Heat Stroke With This Important First Step (GOOD)

by Lisa L. Lewis

Heat stroke is one of the top three causes of sudden death for athletes.

But it’s 100% survivable when it’s recognized and treated right away, according to the University of Connecticut’s Korey Stringer Institute. The organization is named for the Minnesota Vikings player who died from heat stroke in 2001 after being overcome by the heat during training camp.

Time is of the essence when it comes to bringing the athlete’s core temperature down below the danger threshold.

In a consensus statement published earlier in 2018, experts convened by the institute stressed the importance of cooling athletes immediately on site before taking them to a hospital, given that critical damage to cells can occur when body temperature is at or above 104.5 degrees Fahrenheit for longer than 30 minutes.

This timeframe is what really makes a difference,” says Luke Beval, director of research at the Korey Stringer Institute and lead author of the statement, published in Prehospital Emergency Care. “The sooner you cool someone, the greater their chance of survival.”

Recognizing and treating heat stroke

Being able to provide immediate treatment requires quickly recognizing the symptoms of heat stroke. While central nervous system dysfunction is one of two main criteria, symptoms can be similar to those of other critical health issues common in athletes. For example, dizziness, vomiting, and confusion are also common concussion symptoms.

The consensus statement debunks the misconceptions that athletes with heat stroke will have stopped sweating, have hot skin, or will have lapsed into unconsciousness.

Accurately diagnosing exertional heat stroke requires taking the athlete’s rectal temperature, the authors note. Other methods may not provide an accurate reading of the person’s internal temperature, which can provide a false sense of assurance that the athlete is OK.

Using the principle of “cool first, transport second,” athletic trainers and other on-site first responders should immediately begin cooling the athlete rather than waste critical time waiting for emergency personnel to arrive.

The most effective method is to immerse the stricken athlete in a tub of ice-cold water from the neck down, which cools the maximum body surface area and is more effective than cold wet towels, ice packs, or cold showers. This on-site treatment should continue until the athlete’s body temperature drops to about 101.5 degrees; only then should the athlete be taken to the hospital. Crucially, the consensus statement notes that most hospital emergency departments lack the equipment for full-body cold water immersion.

Practice prevention, but be prepared

In addition to having emergency plans and equipment in place, coaches and trainers should also be prepared to adjust workouts when hot weather is expected. Hot, humid weather heightens the risk of exertional heat stroke, given that it reduces the body’s ability to cool itself by sweating. The most accurate measurement is with a wet bulb globe temperature monitor, which measures temperature, humidity, and other contributing factors.

In an interview with GOOD Sports, Beval stressed the importance of giving athletes time to adapt to the heat. This includes not wearing heavy equipment during the first days of practice, minimizing the number and duration of two-a-day practices, gradually ramping up the intensity level, and allowing adequate rest and recovery time.

Heat acclimatization is incredibly effective. Of all the extreme environments we can subject our bodies to, like cold or altitude, we have the best ability to adapt to the heat,” says Beval. “Where these practices have been adopted, we’ve seen a drop in deaths.”

Of course, it’s far better to prevent exertional heat stroke in the first place.

On its site, the Korey Stringer Institute notes key preventive measures, including proper hydration, wearing appropriate clothing, avoiding practice during the hottest part of the day, and heat acclimatization to allow the body time to adjust to the weather. Similar guidelines can be found in the Heat and Athletes section of the Centers for Disease Control and Prevention site.

Source: GOOD Sports