NATA calls for heat-readiness to protect student athletes

July 1, 2019

Just prior to its annual convention the NATA called for all sports organizations to evaluate their readiness to prevent and treat exertional heat stroke, one of the three leading causes of death in sports. 

Exertional heat stroke is a severe condition that occurs when physical activity, environmental heat exposure and other factors cause an individual’s body temperature to rise to an unsafe level, often above 104-105°F. The condition also is characterized by central nervous system dysfunction. While extremely serious, exertional heat stroke is 100% survivable with prompt recognition and immediate cooling of the individual to a safe temperature within the first 30 minutes following collapse. 

“The death of any student athlete is a tragedy,” said NATA President Tory Lindley, MA, ATC.  “NATA is committed to increasing awareness of established guidelines and preventative procedures, and we expect all involved in sports to ensure lifesaving guidelines are in place to protect student athletes. The tragic deaths of athletes during the past year are reminders to everyone including athletic trainers and coaches how important these guidelines and procedures are.” 

NATA advocates for colleges and high schools to implement the guidelines, possess safety equipment, such as a cold-water immersion tub, and ensure athletics and medical staff are trained to use it. Institutions should look to the NFL as a model – the league has not had a single player die from exertional heat stroke since revising its heat-related illness protocols in 2001. 

NATA provides the following recommendations to everyone involved in preventing, recognizing and treating heat illness in student athletes this summer: 

  1. Heat acclimatization. All athletes need to become accustomed to exercising in the heat. Heat acclimatization involves the phasing in of activity (duration and intensity) over seven to 14 days to help the body physically adapt to better cope with heat stress. 
  1. Adjust to the environmental conditions.Be aware of heat-stress conditions using a Wet-Bulb Globe Temperature (WBGT) device, which measures ambient temperature, relative humidity, wind speed and radiation from the sun. WBGT measurements should be used to adjust activity accordingly. These adjustments include work-to-rest ratios, water breaks, equipment worn and length of activity.
  • Identify appropriate work-to-rest ratios.The length of rest breaks should be dictated by the environmental conditions and should be increased as ambient temperature and WBGT rise.
  • Unlimited access to water.Hydrate adequately before, during and after activity. Water should be available for athletes to drink at all times throughout the course of activity. Hydration needs are individualized and depend on the amount of fluid each individual loses during exercise, but a common rule-of-thumb is to consume at least one cup (200 to 300 milliliters) of fluid every 15 minutes of exercise. When individuals are not aware of their fluid needs based on sweat rate, thirst sensation is a helpful indicator of hydration needs. Athletes should also monitor urine color – pale yellow indicates a proper level of hydration.
  • Modify equipment.When environmental conditions become extreme, remove excess clothing and equipment, such as helmets and shoulder pads. Clothing worn by athletes should be light colored, loose-fitting and made of fabrics that draw moisture away from the body.
  • Follow a shortened practice schedule. Activity length and intensity should be based on the environmental conditions, starting with shorter blocks of activity early in the season and limiting activity to cooler parts of the day (early morning, evening) when possible. 
  1. Be aware of signs and symptoms of heat-related conditions.
  • Heat cramps: Characterized by painful muscle spasms, sweating, dehydration, increased thirst and fatigue.
  • Heat syncope: Fainting in hot environments, usually during the initial days of heat exposure. Other symptoms may include dizziness, light-headedness, weakness, pale or sweaty skin and weak pulse.
  • Heat exhaustion:The inability to continue exercise or physical activity in the heat. Signs and symptoms include headache, dizziness, light-headedness, fainting, fatigue, nausea and/or vomiting and weakness. 
  • Exertional heat stroke: An emergency condition characterized by extreme hyperthermia(body temperature above 104°F/40°C taken with a rectal thermometer) and central nervous system dysfunction (e.g. altered consciousness, combativeness, seizures, confusion, emotional instability, irrational behavior, decreased mental acuity). Other signs and symptoms include nausea, vomiting, or diarrhea, headache, dizziness, or weakness, increased heart rate, decreased blood pressure and dehydration. 
  1. Ask if teams are prepared for a heat-related emergency. All schools or teams should have protocols for prevention and treatment of exertional heat stroke, and anyone providing sports-related oversight should be aware of them. Here are lifesaving measures to have:
  • An emergency action plan (EAP) in place.Appropriate personnel (medical staff, coaching staff, athletic administrators) should be familiar with the EAP for exertional heat illnesses and be prepared to activate the plan if an emergency occurs. If an individual’s rectal temperature is 104-105°F degrees or higher and exertional heat stroke is suspected, call 911 simultaneously while treating the athlete using cold water immersion. Rectal temperature should be continuously monitored while cooling until the athlete’s temperature has dropped to 102-103°F. Once the body temperature has normalized, the athlete should be cared for by emergency medical services providers.
  • A cold-water immersion tub onsite. Exertional heat stroke is 100% survivable when the athlete is cooled via cold-water immersion within the first 30 minutes after collapse. A cold-water immersion tub or a substitute, such as a kiddie pool, should be onsite and filled with water prior to the start of activity. Ice should be added to the tub just before immersing the body to ensure the temperature of the water is optimal for cooling. Continuously stir the water and rotate cold, wet towels on any areas of the body that are not submerged in the tub (e.g. head, neck, arms, legs).
  • Medical personnel readily available.Athletic trainers are healthcare professionals trained in the prevention, recognition and treatment of athletic-related injuries, illnesses, and causes of sudden death in sport. Having an athletic trainer or other appropriate medical personnel onsite and available to respond to emergency situations, such as an exertional heat stroke, will ensure timely recognition of the condition and initiation of treatment. The risk of long-term or permanent complications, and even death, is directly related to the number of minutes an individual remains hyperthermic. The presence of an on-site medical professional will ensure proper emergency measures are in place and that an athlete with EHS is cooled promptly and effectively. 

“Research tells us that these guidelines save lives. NATA is committed to making sure these best practices are understood and used at all levels of play,” said Lindley. “In addition, we encourage parents to ask more questions. Are there heat illness guidelines in place? Is staff trained in prevention and treatment of exertional heat illness? And are those trained staff onsite and ready to jump into action in an emergency?” 

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