In the University of Maryland Medical Center hospital wing where he had lain five years earlier, battling for his life, Gavin Class leaned over the bed of Jordan McNair, grasped his hand and whispered to him.
“Be strong, Jordan,” Class recalled saying in his early-June visit. “Fight every day. Be positive.”
McNair, 19, an offensive lineman for the University of Maryland football team, had by then been hospitalized at Baltimore’s Maryland Shock Trauma Center for a week. After the former McDonogh star collapsed during a late-afternoon May 29 workout, he was taken to Washington Adventist Hospital and later Shock Trauma. McNair died June 13, about a week after Class’ visit, of heatstroke.
Maryland’s timeline of the day McNair collapsed offers only a general account of what happened from the time he began “having problems recovering” to when a 911 call was placed.
But medical experts said Monday that McNair’s health could have hinged on Maryland’s adherence to medical guidelines for treating heatstroke, including cold-water immersion — a practice which doctors said likely saved Class’ life after he was stricken during a Towson University football practice in 2013.
Attorney William H. “Billy” Murphy Jr. and associate Malcolm Ruff, who are considering filing a lawsuit on behalf of McNair’s family, say the firm has corroborating evidence that suggests McNair was showing signs of exertional heatstroke as he completed a series of sprints.
When McNair was taken from the workout in College Park to nearby Washington Adventist Hospital, Ruff told The Baltimore Sun on Monday, medical records indicate his body temperature was 106 degrees, a sign of heatstroke.
Douglas Casa, CEO of the University of Connecticut’s Korey Stringer Institute, a nonprofit dedicated to preventing sudden death in sports, outlined a best-practice approach for treating possible heatstroke. The two key diagnostic criteria, he said, are central nervous system dysfunction — signs include confusion, altered consciousness and seizures — and a rectal temperature of at least 105 degrees.
If those symptoms are present, Casa said, cold-water immersion should be used.
“It’s the magic elixir,” said Casa, who said he has treated over 285 heatstrokes and studied over 2,000 such cases. In cold-water immersion, he added, body temperature can fall about a degree Fahrenheit every three minutes. “That’s the thing that’s going to allow the person to survive.”
Dr. Raj Deu, an assistant professor of orthopedic surgery at the Johns Hopkins University School of Medicine, said that the more a body is exposed to cold water, the more effective the treatment.
University officials have not said whether McNair’s treatment included cold-water immersion. Asked about that, they referred a reporter to their official timeline, which does not mention it. Ruff said Sunday that there were no ice baths present at McNair’s workout.
The fallout from McNair’s death has thrown the Terps’ program into disarray, with coach DJ Durkin and three other staff members placed on administrative leave amid reports of an abusive coaching culture. The university is awaiting the results of an external review of the protocols and procedures relating to the death of the Randallstown native. Walters Inc., a sports medicine consulting firm, is expected to conclude its investigation by Sept. 15.
According to Maryland’s timeline, the team’s practice began at 4:15 p.m. Athletic director Damon Evans has said players did a “dynamic workout” of 15 to 20 minutes of stretching before turning to 10 repetitions of 110-yard sprints.
The timeline says athletic trainers “began supporting an active recovery and providing care” when they noticed McNair having problems, but the university account does not say what time that happened. Later, the university said, he was taken to the athletic training room on a Gator utility vehicle for “further observation and continued treatment.”
Shortly before 6 p.m., according to tapes obtained through a public-records request, a 911 call was placed in which an unidentified caller described McNair as having breathing problems. McNair arrived at Washington Adventist Hospital at 6:36 p.m., according to a Prince George’s County incident report. At the hospital, Ruff said, McNair’s body temperature dropped to 102 degrees within minutes of cold-water immersion by hospital staff.
Prolonged hyperthermia can cause “large-scale” damage, Casa said. A body temperature around 105.5 degrees is a “critical threshold” for cell damage, he said, but human bodies normally can handle about a half-hour above that temperature without long-term complications.
After that time, Casa said, cells denature. This disruption of their molecular structure “obviously causes things to happen that are not optimal,” he said. Vital organs like the kidney, liver and brain can be affected.
“I would say many would die if you go up to 60 minutes [of hyperthermia],” he said.
The doctors who treated Class five years ago have said the treatment he received, including cold-water immersion, was critical to his survival.
Class went to visit McNair in the hospital in June after McNair’s family reached out to him.
For Class, the traumas of the two strapping offensive linemen seemed unbearably similar. In August 2013, Class collapsed during a Towson practice and was rushed first to the University of Maryland St. Joseph Medical Center, then to Shock Trauma with kidney failure and a dying liver. His temperature peaked at 108 degrees, and he arrived at Shock Trauma in cardiac arrest. Twice, his parents were told to brace for the worst.
As he lay comatose, awaiting surgery for a liver transplant, his mother, Danielle Class, pleaded with her son: “Keep fighting. Keep fighting. You’re strong. Don’t give up!”
In June, Class echoed those words as he stood over the bed of McNair, whose family had asked Class to come.
“They were so grateful that I took time to come [to the hospital], though in my mind, there was no option,” said Class, 25, an assistant strength and conditioning coach at Johns Hopkins. “I was there to provide hope and to help any way that I could. We talked about our faiths and how God does this to people who can handle it and how it happens for a purpose.”
“My family and I prayed for Jordan every day,” Class said. When he learned McNair had died, “I was in shock; there’s no way this should happen.”
When Class collapsed at practice, Towson trainers immediately immersed his body, neck-high, in a 300-gallon Rubbermaid tub filled with cold water that they kept on the sideline, the athletic training staff said then. They kept him in the 50-degree water for seven to 10 minutes, while coaches and trainers stirred frantically by hand.
“That time in the ice bath absolutely saved me,” Class said Monday, the day after the five-year anniversary of his own heatstroke.
Minnesota Vikings Pro Bowl tackle Korey Stringer’s death at practice in 2001 led to increased awareness and education on the dangers of heatstroke during summer football conditioning.
But it hasn’t come close to eliminating the threat, according to Rebecca Stearns, chief operating officer for Korey Stringer Foundation.
“We see an average of about three deaths per year from heatstroke across all levels,” Stearns told USA TODAY Sports. “But the last five years have been really telling because we have seen a gradual increase in the number of exertional heatstroke deaths.”
The issue is in the news again this weekend. Maryland put football coach DJ Durkin on leave Saturday, a day after putting other athletic department personnel on leave as an investigation continues into the death of a football player during offseason workouts earlier this summer.
Late Friday, ESPN published a story in which players and former staffers talked atmosphere of “fear and humiliation” that included verbal abuse at Maryland under Durkin. Specifically cited as helping create that culture was strength and conditioning coach Rick Court.
According to the Mayo Clinic, heatstroke is caused by the body overheating, “usually as a result of prolonged exposure, or physical exertion, in high temperatures.”
The Mayo Clinic refers to it as “the most serious form of heat injury.” It occurs if a body’s temperature rises to 104 degrees or higher. Untreated heatstroke can quickly damage a person’s brain, heart, kidneys and muscles.
Football players are vulnerable because they practice, often wearing helmets, in the August heat. Besides, McNair, defensive back Darius Minor of Maine also collapsed and died at a workout, and a state of Washington high school player also died. The high school player, according to Q13 Fox TV, was determined the King County medical examiner to be hypertrophic cardiomyopathy, an abnormal enlargement of the heart.
Football players certainly are not the only one affected. Oklahoma Fox affiliate KXII reported this week that members of the Atoka High School marching band suffered from severe dehydration and heatstroke after they took part in a practice. According to KXII, six members of the Atoka band were taken to a clinic and three were hospitalized.
According to Stearns, there were eight deaths from heatstroke across all levels of football from 2005 to 2009. From 2010 to 2014, there were 14. Eight players have died since 2015.
Stearns said the encouraging news about heatstroke is that there’s strong data to support the belief that there “is 100 percent survival when it is treated aggressively and appropriately.”
“That is why (the death rate) is very concerning from our perspective,” Stearns said. “We have some cheap, effective interventions that can save lives and we are still seeing deaths.”
Stearns said most heatstroke cases arise during preseason conditioning, when proper medical personnel may not be readily available. “And, unfortunately a lot of policies are not in place to act aggressively enough and quickly enough to treat exertional heatstroke when it does happen,” she said. “You need policies in place, so everyone is aware of what steps should be taken and you need a medical professional present who can identify the condition. Unfortunately, heatstroke can be confused with many other conditions.”
Stringer died of heatstroke during the Vikings’ 2001 training camp, and the Stringer Institute was created with the hope of preventing sudden deaths in sports.
No NFL players have died of heatstroke since Stringer’s death, but here are college players who have died:
2018: Jordan McNair, University of Maryland: A 19-year-old, 325-pound sophomore offensive lineman, McNair was observed struggling during a May 29 conditioning test at the school, which included multiple 110-yard sprints. He was hospitalized that night and died June 13. The Jordan McNair Foundation announced he died of heatstroke.
2017: Tyler Heintz, Kent State: A coroner confirmed Heintz, 19, a freshman 275-pound offensive lineman, died of heatstroke after completing his second day of conditioning drills at Dix Stadium
2014: Marquese Meadow, Morgan State: According to the Baltimore Sun, he became disoriented after an Aug. 10 practice, was hospitalized, slipped into a coma, and died two weeks later. Cause of death was listed as heatstroke. The high temperature on Aug. 10 was 86 degrees.
2008: Chad Wiley, North Carolina A&T: A fifth-year senior, Wiley complained of dizziness at a voluntary workout on campus. He lost consciousness when he was being treated in the trainer’s room. According to the United Press International, the autopsy showed Wiley died of heatstroke complications, resulting from a sickle cell trait.
2001: Eraste Autin, Florida: An incoming freshman, Autin, a 250-pound fullback was expected to compete for a starting job. But according to the Associated Press, he died of complications from heatstroke after collapsing while jogging back to the locker room after a voluntary conditioning session.
The University of Maryland placed multiple members of its athletics staff on administrative leave as an external review of the death of football player Jordan McNair continues, a school spokesman confirmed Friday.
Maryland would not specify which staff members were placed on leave, calling it a “personnel issue” and saying in a statement, “We will be able to speak in greater detail when the review is complete and shared with the public.” Coach DJ Durkin was seen running practice Friday in footage posted to social media by the Big Ten Network.
The review is being conducted by Walters Inc., an athletic training consulting firm, and is expected to conclude Sept. 15, according to a contract obtained by The Washington Post through a public records request.
McNair, an offensive lineman, died June 13 after suffering heatstroke at a team workout May 29. He was 19. McNair’s parents announced the cause of death in early July on a website promoting the Jordan McNair Foundation, which they started after their son’s death. Attorney Billy Murphy, who is helping the family explore legal options, told The Post on Friday that a lawsuit is likely.
Maryland started training camp last week and has not opened practice to reporters, nor has it made coaches or players available for interviews.
An ESPN story published late Friday afternoon, citing former staffers and current and former players, described a toxic Maryland football culture that includes an “environment based on fear and humiliation,” regular verbal abuse of players and an encouragement of unhealthy eating habits to gain weight. The story depicts a culture that was cultivated by Durkin and largely carried out by strength and conditioning coach Rick Court.
Through a spokesman, the university declined to comment on the ESPN report Friday night. Efforts to reach Court were unsuccessful.
Court was one of Durkin’s first hires when the coach came to Maryland in 2015, and he heads the strength and conditioning staff that supervised the workout that led to McNair’s hospitalization. A former Maryland football player, who was on the team for Durkin’s two seasons with the program, told The Post that Court “was always cursing and yelling at guys, calling them names.”
“That was just Rick; it was all him,” said the player, who painted a culture that mirrored the one described by the ESPN story. The player, who played one season under former coach Randy Edsall, noted that the atmosphere he described began with Durkin’s first year in the program. “There was just constant degrading of players, and that was the culture they brought to the program, and they thought it would toughen us up.”
In a 2017 story on Court, Durkin told The Post: “To me, if the head coach and the strength coach are not totally in line with one another, there’s something that’s going to miss. Me and Rick are in line.”
The former player confirmed to The Post that a former offensive lineman was forced to eat candy bars while watching his teammates work out, a tactic used to embarrass him into losing weight. The former player also said Court once made an injured player participate in a tug-of-war against a group of teammates, and the player was berated by Court when he did not win. Players who won a game of tug-of-war were the first to eat breakfast, the former player said, and he added, “We showed up everyday sort of scared of what may happen. It was kind of crazy.”
He also said that an injured player’s locker was moved to the showers as a way to “humiliate him, which really wasn’t necessary.” Maryland players are encouraged to finish workouts at all costs, multiple people have told The Post, and are degraded if they are unable to do so.
“It became the standard. No one was going to accept, ‘I just won’t finish the workout because I’m exhausted.’ You had to finish,” the former player told The Post on Friday. “Workouts determine if you are going to play for Coach Durkin. If you show you can’t work out to that standard, then you’re not going to see playing time. I don’t know how it is in other programs, but if you show weakness during workouts, I’m pretty sure [Durkin] is automatically going to think that, when the pads come on and it’s time to play, he can’t trust you.”
The May 29 workout was supervised by Maryland’s strength and conditioning staff, and athletic trainers were present throughout, according to a loose account of the day provided by the university. Durkin was also at the workout, which was held at Maryland’s outdoor practice facilities in roughly 80-degree weather. McNair had trouble recovering from a conditioning test that consisted of 10 110-yard sprints, according to the university. Seizures are a known symptom of exertional heatstroke.
ESPN reported Friday that McNair suffered a seizure around 5 p.m., according to his attorney, 45 minutes into the team workout. An incident report written by Prince George’s County medical responders, obtained by The Post through a public records request, shows that a first 911 call was made at 5:57 p.m. and a second was made 10 minutes later. McNair was transported to nearby Washington Adventist Hospital, where he arrived at 6:36, and was soon airlifted to R Adams Cowley Shock Trauma Center in Baltimore. That is where McNair remained until his death.
Multiple medical experts said death from exertional heatstroke is 100 percent preventable if a patient is submerged in a cold-water tub and the body temperature is cooled to 104 degrees within 30 minutes of symptoms appearing. It is unclear whether Maryland treated McNair with cold-water immersion after he started showing symptoms of heatstroke, though Murphy told ESPN that McNair “presented at the hospital with a temperature of 106, which means he was not cooled down.”
“The bottom line when you look at a case like this, and I’m not doing this to point blame or anything, but there was something done incorrectly in this situation,” Douglas Casa, chief executive of the Korey Stringer Institute at the University of Connecticut, told The Post last month. The institute — named for the NFL player who died after suffering complications brought on by heatstroke in 2001 — works to prevent sudden death in sport. “We know that because he died from heatstroke, and within an organized sports setting, no one should die from heatstroke.
“It would be different if you had a situation that was 70 percent effective or 60 percent effective; this is 100 percent effective if you utilize cold-water immersion within 30 minutes and you get someone’s temperature down rapidly. It’s not hard to get someone’s temperature down to 104 within 30 minutes if you use the right cooling modality.”
Was it hard to concentrate during that long meeting? Or, does the crossword seem a little tougher? You could be mildly dehydrated.
A growing body of evidence finds that being just a little dehydrated is tied to a range of subtle effects — from mood changes to muddled thinking.
“We find that when people are mildly dehydrated they really don’t do as well on tasks that require complex processing or on tasks that require a lot of their attention,” says Mindy Millard-Stafford, director of the Exercise Physiology Laboratory at Georgia Institute of Technology. She published an analysis of the evidence this month, based on 33 studies.
How long does it take to become mildly dehydrated in the summer heat? Not long at all, studies show, especially when you exercise outdoors.
“If I were hiking at moderate intensity for one hour, I could reach about 1.5 percent to 2 percent dehydration,” says Doug Casa, a professor of kinesiology at the University of Connecticut, and CEO of the Korey Stringer Institute.
For an average-size person, 2 percent dehydration equates to sweating out about a liter of water.
“Most people don’t realize how high their sweat rate is in the heat,” Casa says. If you’re going hard during a run, you can reach that level of dehydration in about 30 minutes.
And, at this level of dehydration the feeling of thirst, for many of us, is only just beginning to kick in. “Most people can’t perceive that they’re 1.5 percent dehydrated,” Casa says.
But, already, there are subtle — maybe even imperceptible — effects on our bodies and our mental performance.
Take, for example, the findings from a recent study of young, healthy and active women who agreed to take a bunch of cognitive tests, and also agreed to restrict their fluid intake to no more than six ounces for one day.
“We did manage to dehydrate them by [about] 1 percent just by telling them not to drink for the day,” says Nina Stachenfeld of the Yale School of Medicine and the John B. Pierce Laboratory, who led the research.
The women took one test designed to measure cognitive flexibility. It’s a card game that requires a lot of attention, since the rules keep changing throughout the game.
“When the women were dehydrated they had about 12 percent more total errors” in the game, says Stachenfeld.
She repeated the tests after the women drank sufficient water, and their performance improved. “We were able to improve executive function back to normal — in other words— back to the baseline day — when they rehydrated,” the scientist says.
Dehydration didn’t hamper performance on all the tests; the women’s reaction time, for example was not impeded. The decline was seen during thecomplicated tasks.
Though the study was small, and funded by PepsiCo, which sells bottled water, Stachenfeld designed the methods and completed the analysis independently. And other scientists say her findings fit with a growing body of independent evidence that points to similar conclusions.
“I absolutely think there could be big implications of having a mild cognitive deficiency with small amounts of dehydration,” Casa says.
If you’re a student, for example, a 12 percent increase in errors on a test might matter. And whether you’re a pilot, a soldier, a surgeon or a scholar, many daily tasks depend on the ability to be precise and pay attention.
For anyone trying to do their best work, the findings raise a number of questions:
How much water do we need?
There are no exact daily requirements, but there are general recommendations.
A panel of scholars convened several years ago by the National Academies of Sciences, Engineering and Medicine concluded that women should consume, on average, about 91 ounces of total water per day. For men, the suggested level is even higher (125 ounces).
Note that this total includes water from all sources, including food and other beverages, such as coffee and tea. Typically, people get about 20 percent of the water they need daily from fruits, vegetables and other food.
Also, water needs vary from person to person. For example, body weight and muscle mass matter. Also, physical activity and heat exposure can increase the amount of fluid a person needs.
How can you tell if you’re dehydrated?
One easy test: The color of your urine is a good guide. As a general rule of thumb, the darker the color, the more likely you are to be dehydrated. Aim for shades that have been described as “pale lemonade” or “straw.” A color chart developed by physiologist and University of Connecticut professor Lawrence Armstrong can be a helpful guide, researchers say.
Are older people more vulnerable to dehydration?
As we age, we’re not as good at recognizing thirst. And there’s evidence that older adults are prone to the same dips in mental sharpness as anyone else when mildly dehydrated.
Don’t wait until you’re thirsty. A good rule of thumb is to sip fluids throughout the day. No need to chug huge amounts at one time; there are some risks to overhydrating, too.
Can coffee, tea and other caffeinated drinks have a dehydrating effect?
The most recent evidence finds that coffee provides similar hydrating qualities to water. In other words, yes, your morning cup of joe — or whatever caffeinated beverage you fancy, can help to keep you hydrated.
As we reported in 2014, people who routinely drink coffee or tea develop a tolerance to the potential diuretic effects of caffeine.
Most states rank poorly on heat safety for their high school football players. Too many teens have paid the price, and temperatures are only getting worse.
JUL 20, 2018
Laurie Giordano had just arrived after her son collapsed on his high school football practice field in Fort Myers, Florida.
It was June 29, 2017, and she remembers it with painful clarity.
The Riverdale High School teammate who knocked on her car window at the end of a sweaty practice, telling her that her son couldn’t get up on his feet. Her son, cradled in a coach’s arms, making a slow, repetitive moaning sound, while players poured water in his mouth. The coach saying the player was just a little overheated.
The ambulance arrived, but 10 days later, Zach Martin-Polsenberg, a 16-year-old lineman, was dead, a victim of heat stroke. In the ambulance, Zach opened his eyes a few times and squeezed his mother’s hands, but that was the last of their communication.
Through her grief, a shocked Giordano tried to figure out how this could have happened and concluded Zach’s high school had not taken the potential for heat stroke seriously.
So she spent the last year trying to convince Florida authorities to tighten their heat-safety rules. Giordano shared Zach’s story with the leadership of the Florida High School Athletic Association, but she was only partly successful; the association bucked its own medical advisory committee by voting to “strongly recommend,” but not mandate, a first-aid tool experts say could have saved Zach’s life—a cooling tub, water and some ice.
“I felt like I couldn’t just sit in my grief and have it happen again,” Giordano said. “I don’t think I could live with that, knowing that I hadn’t done anything to try to make for change.”
Heat stroke can occur in all states. But researchers studying student athletes, especially football players during summer workouts, see more of it in the East, and particularly the Southeast, where sweltering temperatures, high humidity and intense sunshine make for a trifecta of deadly risk, and where high school football is very popular. These weather conditions are only getting worse as the climate changes, bringing more heat and humidity.
Just as coastal cities brace for rising seas and communities and farms look for ways to manage heavier rain, there’s an increasing awareness that adapting to climate change includes protecting people from heat, including young athletes. Yet a new ranking of states by their heat safety measures for youth sports shows that many states are failing to require simple precautions that could save lives.
“Heat is already a major safety hazard for athletes and the broader public,” said Andrew Grundstein, a University of Georgia professor of geography and climate science. “Yet we should still be able to do the activities like sports that we enjoy. Considering that our climate is warming, it is even more important that we have heat safety guidelines and policies. This will help us adapt and be more prepared for the more frequent hot conditions.”
Summer Days Are Getting Hotter
Since 1995, three football players a year on average have died of heat stroke, most of them high schoolers, according to the National Center for Catastrophic Sport Injury Research, which tracks football injuries and deaths. In the last five years, the average was about two—still too many when these deaths are avoidable.
Max Gilpin, a 15-year-old, was overcome by heat during an August football practice in 2008 at his Louisville, Kentucky, high school. There was no cooling tub there, either, recalled his mother, Michele Crockett.
“This was preventable,” said Crockett, who advocates for football safety through the Max Gilpin Beat the Heat Fund.
“What our family went through was horrific,” she said. “He struggled for three days in the hospital. We watched all that. We watched as his organs shut down. I never saw him regain consciousness again.”
Grundstein has been studying the impact of extreme heat on high school football for several years. He and his fellow researchers have identified the players most at risk of heat stroke—the largest ones—and studied the most dangerous practice weather based on a more sophisticated way of measuring heat.
Developed for the military, certain kinds of heat stress monitors now recommended for high school football practices take into account temperature, humidity, wind speed, sun angle and solar intensity instead of merely temperature. Heat stress monitors also go beyond the commonly used “heat index,” which factors in temperature and humidity to provide the “feels like” temperature numbers commonly used by forecasters and weather apps.
Southeastern states, Grundstein said, already experience 40 to 60 days when heat stress factors can become extreme enough for schools to stop outdoor practices—roughly a heat index of 103 degrees. In the next 20 to 50 years, Grundstein expects an additional 30 days of these conditions in the Southeast, with other parts of the country also affected, but to a lesser yet still significant degree.
“Almost the whole country is going to see a lot more of these days in the summer, and they will extend into the spring and fall,” Grundstein said. “In the long term, we are going to see more hot, humid days that are going to pose a hazard to athletes.”
Since the 1980s, nationally, “it’s been steamrolling upward, and the story is not different than that in the Southeast. If you look at the Southeast now, since the 2010s, it’s actually the warmest period on record.”
As global warming continues, Kunkel said, the Southeast’s temperatures will rise.
Hydration Is for Survivors
Football’s tradition for tough summer workouts despite heat and humidity was described in a 1975 commentary, “Dog Days and Siriasis—How to Kill a Football Player”, in the Journal of the American Medical Association, by Dr. James P. Knochel of Dallas. An archaic term for heat stroke—siriasis—came from the expression “the dog days of summer,” or the time of the year when the dog star, Sirius, rose in the morning with the sun, Knochel wrote.
It was not uncommon, according to the JAMA commentary, to deny players water or to give overweight lineman diuretic pills to help them lose weight by ridding their bodies of needed water and salt.
Wearing full protective gear and helmets in the heat would also toughen up the players, the coaches’ believed.
“People thought hydration was for weaklings,” said Michael F. Bergeron, an expert on exercise-heat stress who has advised the International Olympic Committee and the Federation of State High School Associations. He recalled a scene in the 2000 movie “Remember the Titans” in which the coach played by Denzel Washington tells a player that “water is for cowards.”
Hydration helps maintain blood flow to muscles, vital organs and the brain, and assists in sweating, which cools the body, Bergeron said. But in hot, humid weather, sweat does not evaporate very well. So people cannot release as much heat through sweating and are at greater risk for dangerously overheating. Well hydrated athletes can still overheat “if the activity is too hard, for too long, especially while wearing too much uniform and protective gear,” said Bergeron, the senior vice president of SIVOTEC Analytics, a sports technology and analytics company.
Heat stroke, with a rectal temperature greater than 104 degrees and other symptoms, can cause the brain or other organs to swell, possibly resulting in permanent damage or death, according to the Mayo Clinic.
These High School Policies Can Save Lives
If cooling tubs can now be considered climate adaptation, so can other heat-safety recommendations from the Korey Stringer Institute at the University of Connecticut, named for the Minnesota Vikings football player who died from heat stroke in 2001
The institute conducts research and education on how to keep athletes, soldiers and laborers safe from sudden death, including heat stroke.
Last year, the institute published its first health and safety state rankingsfor high school athletes. The institute’s experts believe all high school teams should follow certain policies in categories such as sudden cardiac arrest, brain injury and heat, and its rankings are based on whether those recommendations are followed.
When it comes to heat, the institute wants coaches to ease players into summer workouts, limit the use of full gear and the duration of outdoor practices on hot days, and provide three hours of air conditioned breaks when two practices are held in the same day. It stresses the importance of life-saving cooling tubs by allotting three points out of 20 total possible points for states that mandate their use, and it gives more points for heat stress monitors.
Heat stress monitors, which cost around $100 to $200, are “the gold standard” and reflect conditions on the practice field, said Samantha Scarneo, vice president of sport safety for the institute. The tubs are the most effective way for teams to bring down body temperature, limit damage and save lives, she added.
“Without a doubt, cold water immersion has a very good cooling rate compared to other previously studied cooling methods, and it is the most feasible,” she said.
The Rankings: States and Heat Safety Measures
Using the institute’s latest state-by-state safety data, updated on July 19, InsideClimate News separated out the heat scores and ranked states accordingly.
North Carolina, Hawaii, New Jersey, Utah, Georgia and Kentucky came out on top. Texas, Washington, New Mexico, California, Colorado and New Hampshire were at the bottom.
Thirty-six states received less than half the maximum heat-safety points. Only 12 states require cooling tubs, and only six require heat stress monitors.
Georgia, a state that had been considered a leader with its response following a series of heat deaths several years ago, made for a perplexing case. Cooling tubs were first required by the Georgia High School Athletic Association in 2012, and a checklist that goes to coaches includes that. But it is unclear if the measure was ever enforced. Steve Figueroa, a spokesman for the association, said the requirement was left out of its main rulebook and only reinstated recently after InsideClimate News raised questions about it.
The rankings rankled some state associations and their National Federation of State High School Associations, which criticized last year’s study as incomplete and flawed by what they saw as a one-size-fits-all approach. “There has never been a time that coaches, athletic directors and school administrators were more focused on risk minimization,” the federation said.
Still, the federation acknowledged “room for improvement” and said schools need more funding.
States that don’t like the rankings tend to be the ones that haven’t scored as well, said Julian Tackett, commissioner of the Kentucky High School Athletic Association. “Anything that brings awareness is good,” he said.
Grundstein said heat safety policies are important but should reflect regional differences.
In the Deep South, players get used to really hot conditions, and that can help them during practices, he said. In northern states, student athletes can be less able to tolerate intense heat because they’re not as accustomed to it, he added.
A Dangerous Loophole: Summer Practice
Max’s death in Kentucky prompted officials there to make heat awareness training mandatory for all coaches and players—something Florida only required this year after Zach died.
Scarneo, of the Korey Stringer Institute, says Florida has had four high school football deaths from heat since 2010, the most for any state. The Institute wanted the Florida High School Athletic Association to mandate heat stress monitors and cooling tubs, too, she said.
So did the state association’s own medical advisory committee.
“We were a little surprised that the board wasn’t accepting of our recommendations,” said Robert Sefcik, executive director of the Jacksonville Sports Medicine Program, a nonprofit that advocates for youth sports injury prevention, and a member of the advisory committee. That the association “strongly recommended” heat stress monitors and cooling tubs was a step in the right direction, he added.
Kyle Niblett, spokesman for the Florida High School Athletic Association, would not answer questions about why the association’s board of directors had rejected its medical advisory committee recommendations.
Sefcik said association officials were worried that they didn’t have legal authority to mandate the purchase of cooling tubs or heat stress monitors and had questions about enforcement and liability. Niblett would only say in an email that the association will inform member schools of all heat safety precautions before fall practices are set to begin on July 30.
That date brings up another Florida controversy.
The association leaves heat safety up to county school districts for summer practices, held before July 30. Zach was in a summer practice when he developed heat stroke.
“It’s a huge loophole,” Sefcik said.
He said surveys suggest more than 95 percent of Florida high schools have cooling tubs already. But that doesn’t mean they always use them.
Zach’s high school is an example of that, he said. “The school did have an immersion tub, however it was in the locker room and not accessible either because it was out of sight or out of mind,” Sefcik said. “Nobody thought to utilize it.”
Zach’s family has submitted a notice of intent to sue the School District of Lee County. Giordano said the family is weighing legal options.
Because of potential litigation, district spokesman Rob Spiker said he was limited in what he could say. But he said Lee County schools will be using cooling tubs and buying heat stress monitors.
That’s a start, Giordano said. She is now working with Florida lawmakers to tighten up statewide heat safety rules that were punted by the association.
“I am frustrated they didn’t do more,” she said. “Even if Zach had lived, we would still be doing this. There is no way he would have let this go by without saying we need to do something. He was a protector.”
It’s 90 degrees and humid outside. The last thing you want to do is workout in this temperature – but did you know that training in the heat could actually work to your advantage?
A couple weeks ago, I had the opportunity to visit the Mission Heat Lab at the University of Connecticut campus in Storrs, CT. The lab is open to anyone – everyday Joe’s and athletes alike – all you have to do is reserve a time to visit.
In the lab is a heat chamber that can be set to up to 110 degrees, and the humidity set between 10 and 90 percent. Inside the chamber, you can hop on one of the bikes or treadmills which will track your heart rate, core temperature, body mass, wattage, pace/speed and sweat rate. All of these factors are then used for sweat electrolyte and sodium balance tests, which can tell a person the amount of electrolytes he or she loses at a particular temperature, going a specific wattage, for a set amount of time.
“For athletes, they can set the temperature and humidity to match specific race conditions,” explains Robert Huggins, PhD, ATC, vice president of research and athletic performance and safety at the Korey Stringer Institute at the University of Connecticut. This would allow, for example, a triathlete to set Kona, Hawaii-like conditions so that they test in the same environment in which they’ll be racing.
“Using the electrolyte test, which involves sweat weight before and after, and a distilled water washdown to remove electrolytes to back calculate the concentrations, we can give recommendations that the athlete would need for that race based on the amount [of weight and electrolytes] they lost during the test.” That number can then be taken and used to help map out proper hydration and fueling for a longer race if need be.
Since I’m obviously not a professional athlete, I was just curious to find out my sweat rate running in the heat for a half hour. By taking an ingestible core body temperature sensor pill, which wirelessly transmitted readings to a recorder device outside my body, measuring my weight before and after the test, and exactly how much water I drank during the heated run, I was able to learn that I lose .74 liters per hour. That means that at that same temperature, if I were to run an hour, the perfect amount of fluid I should be taking in would be .74 liters because that’s how much I was sweating out.
Running in the heat for that long didn’t seem all too daunting at first, but by the end, I was so sweaty that I was counting down the minutes for it to be over. But I learned that when done safely, working out in the heat is actually very beneficial.
“With as little as five to seven days of training in the heat, and keeping your core temp between 101.5 to 103.0 with proper hydration for 60 minutes, you can achieve lots of benefits,” explained Huggins. Achieving this stabilization of core temperature and proper hydration is often called heat acclimatization.
“From a physiological standpoint [with heat acclimatization], your heart rate is lower at a given intensity, and blood volume expands allowing you to deliver more blood to the exercising muscles and to the skin for cooling via sweat,” Huggins said. “Most importantly, your core temperature is lower both at rest and during exercise and your body becomes a more efficient sweater.” And, he explained, if you can push heat training up to 10 to 14 days consecutively, you can also hold onto electrolytes and fluids better. Overall, you can become a more efficient athlete by sweating more efficiently, adjusting to the heat and maximizing your use of electrolytes.
For most athletes or people who exercise three to five times per week, it can take about two to three sessions of training in the heat for someone to feel more comfortable moving the body in hot conditions. But each person is different – some may take a full week depending on their fitness level. “In general, the more aerobically fit you are, the quicker you get used to it,” explains Huggins. “Once you achieve heat acclimatization, or ‘Heat Acc’ for short, in order to hold onto the benefits of the adaptations your body has made, you need to continue to exercise once every five days in the heat.” However, even after achieving Heat Acc, “if you go 10 to 14 days without exercising in the heat, a majority of those adaptations will be lost,” Huggins adds.
Of course, it’s easy to track your core temperature in a lab like the one I was in. For everyday athletes who don’t have access to a lab, the only way to accurately track your core temp – to be sure it’s in the correct range without spiking to an unsafe level – is to take your temperature rectally. That would mean pausing your run, bike or workout to get your temperature – not exactly ideal, or likely to happen.
The good news is you can track your sweat rate to find out how much fluid you’re losing when you exercise for a certain amount of time in a particular environment. Simply step onto a scale with a full water bottle before your workout, then work out and drink the water, and when you finish, step back onto the scale. The difference in your weight is your sweat rate or how much fluid you lost.
For athletes looking to improve performance, or for those who are just trying to stay hydrated on that next summer trail run, this could be a game changer. “If you’re having fueling issues, whether it’s over or under hydrating, this is a great way to hone in on that and figure out exactly how much fluids your body needs in specific conditions for a specified amount of time,” Huggins concludes.
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.
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 HighSchoolAthleticAssociation 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 athletictrainers 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.
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.”
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.