Preventing heat stroke in young athletes: check with the coach

By Vicki Louk Balint | August 6, 2012

It’s time for football practice. And it’s hot outside.

Does your young athlete’s coach have an heat prevention plan?

Every year, thousands of young athletes wind up in the emergency room because of heat stroke or heat exhaustion. Exertional heat stroke ranks at the top of the list of preventable deaths in high school athletics.

Proactive hydration: football practice at Chaparral High School in Scottsdale. Photo by Daniel Friedman.

The main thing parents can do is to make sure that teams provide fluids to athletes and set water break times, and to make sure the kids drink during those times, says Delphis Richardson, M.D., a member of the Arizona Chapter of the American Academy of Pediatrics (AzAAP).

Stay ahead of your thirst, he adds, because by the time you begin to feel thirsty, you have already lost three percent of your hydration status (symptoms of heat stroke).

Richardson, who is in practice with Mesa Pediatrics, holds a diplomate in sports medicine and has a special interest in safety issues surrounding young athletes. Most high school coaches follow the protocols established by the Arizona Interscholastic Association (AIA) to keep athletes healthy, he says. Progress has been made, but “we’re not there yet.”

In August, humidity levels can rise as high as 60 percent in the Phoenix area. That can mean a higher overall heat index. Coaches need to monitor this index on a daily basis, says Richardson, and take care to follow the recommendations established by the National Athletic Trainers Association on carefully acclimating athletes to the heat.

Parents shouldn’t hesitate to have conversations with team coaches, says Richardson. It’s important to understand that line in the sand between a challenging yet productive practice on a hot day, and one that pushes an athlete into dangerous territory. “That macho attitude we have around sports will sometimes override common sense,” says Richardson. “You’re trying to make them tougher, but you need to keep them safe.”

There’s no excuse for any heat stroke deaths, say researchers at the National Center for Catastrophic Sport Injury Research at the University of North Carolina. These deaths are preventable with the proper precautions. Here are their recommendations:

Each athlete should have a complete physical examination with a medical history and an annual health history update. Any history of previous heat illness and the type of training activities that took place before organized practice begins should be included.

Acclimatize athletes to heat gradually by providing graduated practice sessions for the first seven to 10 days and other abnormally hot or humid days. Obey the rules pertaining to when full football uniforms may be used.

Know both the temperature and the humidity because it is more difficult for the body to cool itself in high humidity. Use of a sling psychrometer is recommended to measure the relative humidity; anytime the wet-bulb temperature is over 78 degrees, practices should be altered.

Adjust activity level and provide frequent rest periods. Rest in cool, shaded areas with some air movement and remove helmets and loosen or remove jerseys. Rest periods of 15 to 30 minutes should be provided during workouts of one hour.

Provide adequate cold water replacement during practice. Water should always be available and in unlimited quantities to the athletes. Give water regularly. Athletes should drink water before, during, and after practice.

Salt should be replaced daily; a liberal salting of the athlete’s food will accomplish this purpose. Coaches should not provide salt tablets to athletes. Attention must be directed to water replacement.

Athletes should weigh in each day before and after practice and weight charts should be checked in order so that athletes who lose excessive weight each day are identified and treated. Generally, a two to three percent body weight loss through sweating is safe; a five percent loss is in the danger zone.

Clothing is important. A player should avoid using long sleeves, long stockings and any excess clothing. Never use rubberized clothing or sweatsuits.

Some athletes are more susceptible to heat injury. These individuals are not accustomed to work in the heat, may be overweight, or may be eager athletes who constantly compete at capacity. Athletes with previous heat problems should be watched closely.

It is important to observe for signs of heat illness. Some trouble signs are nausea, incoherence, fatigue, weakness, vomiting, cramps, weak rapid pulse, flushed appearance, visual disturbances and unsteadiness. Heat stroke victims, contrary to popular belief, may sweat profusely. If heat illness is suspected, seek a physician’s immediate service. Recommended emergency procedures are vital. Plans should be in writing and all personnel should have copies.

An increasing number of medical personnel are using a treatment for heat illnesses that involves immersing the athlete in ice water. This technique will help bring down the body temperature and has proven to be effective. Some schools have plastic outdoor swim pools filled with ice water available at practice facilities.

— Source: National Center for Catastrophic Sport Injury Research at the University of North Carolina