Recommendations for practices in the heat/humidity:
- Wear light colored, loose fitting clothing and/or moisture wicking fabrics
- Drink at least 16 oz. of water 1-2 hours prior to exercise and 8 oz. of water 15 minutes prior to exercise
- Modify activities according to heat index
- Take water breaks every 15-20 minutes
- Make sure student-athletes are acclimated to conditions (physiological adjustment to heat)
- Practice early in day or later in the evening
The highest heat indexes are usually between 1 and 7 pm. Acclimatization takes about 7-10 days and is a slow progression increasing intensity and duration. Most adverse heat reactions occur in the first few days of practice. The athletic training staff will monitor environmental conditions during the day and make recommendations on continuing practices with modifications or cancellation of practice. If the National Weather Service issues a Heat Advisory with Heat Index surpassing 98, practices will not take place outdoors during the window of the Heat Advisory.
Heat illnesses are thermoregulatory problems caused by inadequate water and electrolyte replacement. Lack of water intake before activity, during activity, after activity, improper diet, tight clothing, or some systemic infections can lead to these problems. Other than heat problems caused by a systemic infection, these problems are completely preventable! The athletic trainer need only ensure that all athletes receive ample opportunities to drink and see that coaches allow the athletes to do so. IF YOU NOTICE AN ATHLETE SUFFERING FROM ANY OF THESE OR AN ATHLETE REPORTS ANY OF THESE SYMPTOMS TO YOU, IMMEDIATELY REPORT IT TO THE HEAD ATHLETIC TRAINER BEFORE IT BECOMES A MEDICAL EMERGENCY. **Remind your athletes that their urine should resemble lemonade and not apple juice. This is a good judge of their hydration levels.**
Any athlete that vomits during practice will be held out for 15 minutes the first time to take in fluids and cool off. The second time any athlete vomits during practice after a 15 minute “time-out”, they will be done with practice for the day. At this point they are not keeping fluids down, and therefore dehydrating as well as depleting essential nutrients. How the athlete is feeling the next day will determine whether or not they will practice.
- Heat cramps
- Intense muscle spasms that usually affect in order the
- Abdominal muscles
- Upper extremities
- Shoes, socks, pant cuffs that are too tight
- Tape around the top of the socks
- Inadequate water and/or electrolyte replacement
- Adverse reaction to medications such as aspirin, antibiotics, antihistamines
- Loosen or lower the socks, pants cuffs
- As much as possible stretch the muscle
- Massage vigorously, towards the heart to increase venous return
- Give plenty of fluids in small amounts; electrolyte drinks may be given
- Heat exhaustion
- Extreme fatigue due to muscle spasms, dehydration
- Skin becomes clammy (imagine touching Jello)
- Skin will be damp and cool
- Patient may experience hyperventilation
- Body temperature will be slightly lower and patient will experience chills
- Remove damp clothing; replace with dry and cool athlete with ice bags
- Give ample liquids in small amounts
- Patient should drink plenty of liquids during the next 2-3 days; electrolyte drinks may be given
- Patient should be withheld from activity a minimum of one day; more if lethargy persists (DETERMINED BY ATHLETIC TRAINER)
III. Heat stroke
- A true medical emergency that requires immediate call to 9-1-1
- The final outcome if heat exhaustion if not cared for is DEATH
- Hot, dry skin
- Red skin
- Core temperature of 105 – 108o F (98.6 F is normal)
- Patient may present with delirium, loss of consciousness, and/or seizures
- The body’s thermoregulatory system has shut down due to excessive water and/or electrolyte loss and lack of replacement
- Management – CALL 9-1-1!!!!
- Remove as much clothing as modestly possible
- Cool the patient with cold water by immersing in the “stroke tank” and using icy ammonia water towels and DO NOT remove until the athlete begins to visibly shiver or until their core temperature is under 102* (measured with rectal thermometer), EVEN IF THE AMBULANCE IS ALREADY THERE
- Remember – this is an emergency and failure to act promptly could result in permanent brain damage due to the high body temperature or even death
A nutritional point that you need to be aware of is the athletes’ consumption of sugar and caffeine. Sugared drinks such as electrolyte drinks (Gatorade, PowerAde, etc.) and soft drinks will cause the athlete to dehydrate due to water gathering inside the stomach; it is “drawn” from the muscle fibers. It is for this reason that only water should be given during and before activity. The electrolyte drinks are much better suited for post-activity unless an athlete begins to exhibit symptoms of a heat illness.
- Situations that may benefit
- Prolonged continuous activity of greater than 45 minutes
- Extremely intense exercise with risk of heat injury
- Extremely hot and humid conditions
- Individuals that may benefit
- Poor hydration prior to participation
- Increased sweat rate
- Poor caloric intake prior to participation
o Poor acclimation to heat and humidity
Caffeine is a stimulant drug but in adequate amounts is a vasoconstrictor. This means that the blood vessels will become smaller thereby decreasing blood flow to and from the muscles. This leads to a build-up of lactic acid (a waste by product of cellular respiration) which in turn can cause heat cramps.
Athlete’s lack of eating a nutritional and full breakfast and lunch can also contribute to heat illness. They are not getting vital nutrients that their bodies need to function.
Students with Sickle Cell Trait
Sickle cell trait (SCT) is not a disease, but having it means that a person has inherited the sickle cell gene from one of his or her parents. People with SCT usually do not have any of the symptoms of sickle cell disease (SCD) and live a normal life.
SCT is most common in blacks or African Americans. If an athlete has SCT, it is imperative that the head athletic trainer and coaches are aware.
Sickle cell trait is the inheritance of one gene for sickle hemoglobin and one for normal hemoglobin. During intense
or extensive exertion, the sickle hemoglobin can change the shape of red cells from round to quarter-moon, or
“sickle.” This change, exertional sickling, can pose a grave risk for some athletes. In the past seven years, exertional
sickling has killed nine athletes, ages 12 through 19. The sickle cells block blood vessels and can lead to collapse from ischemic rhambdomyolysis, the rapid breakdown of muscles starved of blood, and can be life threatening.
Unlike heat collapse, sickling collapse often occurs within the first half hour onfield, as during initial windsprints. Core temperature is not greatly elevated. Sickling is often confused with heat cramping; but, athletes who have had both syndromes know the difference, as indicated by the following distinctions:
1) Heat cramping often has a prodrome of muscle twinges; whereas, sickling has none;
2) The pain is different – heat-cramping pain is more excruciating;
3) What stops the athlete is different – heat crampers hobble to a halt with “locked-up” muscles, while
sickling players slump to the ground with weak muscles;
4) Physical findings are different – heat crampers writhe and yell in pain, with muscles visibly contracted
and rock-hard; whereas, sicklers lie fairly still, not yelling in pain, with muscles that look and feel normal;
5) The response is different – sickling players caught early and treated right recover faster than players with major heat cramping.