Beat the Heat! Prevention and Treatment of Heat-Related Illness
Peter Ostergaard, MD and Elizabeth Matzkin, MD

With August training camps and pre-season practices just around the corner, exertional heat illness prevention, recognition and treatment strategies must not be overlooked. In fact, the month of August brings the highest rate of heat-related illnesses, including exertional heat stroke, which has risen to the third leading cause of on-field sudden death in athletes. 

Exertional heat illness (EHI) can be broken down into two general types: heat exhaustion and exertional heat stroke (EHS). While heat exhaustion is more common and should be treated with urgency, exertional heat stroke is a medical emergency. The difference lies in the athlete’s core temperature, and their ability to auto-regulate that temperature, with exertional heat stroke defined as a temperature greater than 104 degrees F and usually a change in mental status. It is important to note however that the conditions exist on a spectrum, and athlete’s suffering from heat exhaustion may quickly progress to heat stroke if proper action is not taken. Knowing the signs and symptoms of both conditions can help.

Heat exhaustion can present in numerous ways including weakness, dizziness, syncope, nausea, headaches, muscle cramps and profuse sweating. Heat stroke can present in similar fashion, however more likely involves decreased or absence of sweat as the body has lost the ability to auto-regulate, with altered mental status, and in serious cases seizure or coma. Medical responsiveness is paramount to successful treatment.

Determining the athlete’s core temperature is of highest importance. Simultaneous attention should be turned to removal of all equipment and placing the athlete in a cool, shaded environment. In the case of heat exhaustion, the athlete should be cooled with ice towels and given oral rehydration as soon as possible. Vital signs, core body temperature and mental status should be serially monitored. The athlete should not return to play for the remainder of the day. If the athlete’s core temperature is found to be greater then 104 degrees F at any point, ice water bath immersion should take place immediately. Athletes suffering from EHS should be cooled rapidly to a core temperature of 102 degrees F, at which point the athlete should be removed to avoid over-cooling. Athletes suffering from EHS generally require hospitalization, however the dogma of ‘cool first, transport second’ should always be applied, as time of core temperature above 105 degrees F dictates long term disability. 

Equally as important as treatment, is prevention. Prevention strategies include: acclimation, hydration, equipment/clothing modifications and awareness of predisposing internal/external risk factors. Acclimation involves gradually increasing the frequency, duration and intensity of outdoor workouts. This should occur in the weeks prior to initiation of formal training activities. Hydration should include consuming at least 16-24oz of water or sports drinks in the hours leading up to training, continuing to drink fluids while training no less than every 30 minutes, and consuming 16-24oz of fluid per pound lost after the workout. Multiple external factors can pre-dispose to EHI, including increased outdoor temperature and humidity, wearing dark-colored or non-moisture-wicking clothing or consuming high amounts of caffeine or nutritional supplements containing ephedrine. In addition, individual predispositions such as obesity, endocrine disorders, sickle-cell trait, or prior heat illness increase an athlete’s chances of EHI. With proper preparation, knowledge of the symptoms of exertional heat illness and preparedness for medical response to such conditions, athletes, coaches and medical personnel can help to prevent and treat this process effectively.