Gary Clinton MS, AT/C, AT/LSports Medicine Instructor Yelm HS

WCTSMA President

Heat Acclimatization? Is it necessary in Washington State?

If a patient is suspected of Exertional Heat Stroke, what should be the first action taken in treatment of the condition?

A) Drive them to the hospital by parent/yourself.B) Contact EMS and wait for them to arrive. Don’t move athlete.C) Get them a bottle of water and put ice towels on them.D) Apply Biofreeze to the entire body. E) Contact EMS, but place athlete in cold water

immersion and stir the water aggressively before transport.

Pre-Test

Isaiah Laurencin- FL, Exertional SicklingTyquan Xavier Brantley- SC, Exertional SicklingLewis Ogloba- PA, Asthma led to Cardiac ArrestDJ Searcy- GA, Heat relatedForrest Jones- GA, Heat strokeMontel Williams- AR, Exertional SicklingSam Dickson- PA, (Congenital)Coronary ArteryAl Smith, Jr.- TX, unknown, 2nd day of FB practiceLatrell Dunbar-MS, Cardiac EventCandace Ortiz- TX, unknownAngela Gettis- CA, Cardiac Event

“Another bad Summer”NATA News, Nov. 2011

David Stinson, head coach Pleasure Ridge Park HS criminally charged in death of 15 year old, Aug. 20th 2008.

All coaches present, AD who was present, and Principal were named in a separate civil lawsuit.

“Reckless Homicide”- When a person fails to perceive a risk that a reasonable person in that situation would have seen.

Another player that day also collapsed and spent 2 days in the hospital.Coach alleged to have withheld water and continued

practice with a heat index of 94.Coach “would run the players until someone quit the

team”. It took 15 minutes to call 911.

Kentucky HS Football Coach Charged with Reckless Homicide

Coach Stinson was on paid administrative leave, reassigned, no longer coaches.

Community & school district torn apart.Coach Stinson was acquitted of criminal

charges.Civil suit was settled out of court for 1.75

million dollars.

End results from Kentucky

Focuses on two issues in HS FootballConcussions Heat Stroke

Arkansas, 2010Two heat stroke scenarios

1 died (Tyler Davenport)1 lived (Will James)

What was the difference in care?Frontline- “No one should die of Heatstroke”

“Football High” Frontline documentary

A set of guidelines that safely prepares athletes for competition.Released by the NATA in 2009 for Secondary Schools.

NFHS “A guide to Heat Acclimatization & Heat Illness Prevention” released this summer.7 components of plan released by NFHS this summer.

100% of heat related deaths are preventable!!WIAA currently has no guidelines?Korey Stringer Institute is pushing for all 50 states

to adopt guidelines for all high schools.NCAA has had guidelines in place since 2003.

One collegiate death in August since inception!Acclimatization is not “conditioning”

What does heat acclimatization mean?

Days 1-5No more than 1

practice per day.No longer than 3

hours1 hour max. ( walk

thru) permitted after 3 hours minimum rest.

Football:Days 1 & 2 Helmets

onlyDays 3-5 Helmets &

shoulder pads only

Days 6-14Double practice days

followed by a singleOn single days, 1 walk

thru permitted w/3 hrs rest.

Rest day doesn’t count towards 14 day total.

Doubles don’t exceed 3 hours for each. Not to exceed 5 hours total.

All activities included as practice time: conditioning, walk thru, weight room, etc.

Recommend certified AT onsite for all practices.

Area of Practice

Modification

Practices 1-5Practices 6-

14Days 1-2 Days 3-5

# of Practices Permitted Per Day 1 2, only every other

day

Equipment Helmets onlyHelmets & Shoulder

PadsFull Equipment

Maximum Duration of Single Practice

Session3 hours

3 hours (a total maximum of 5 hours

on double session days)

Permitted Walk Through Time

1 hour (but must be separated from practice for 3 continuous hours)

Contact No Contact

Contact only with blocking sleds/dummi

es

Full, 100% live contact drills

NOTE: warm-up, stretching, cool-down, walk-through, conditioning, and weight-room activities are Included as part of practice time

Secondary School Guidelines Preseason Heat-Acclimatization Guidelines for Secondary School Athletics. Journal of Athletic Training. 2009;44(3):332-333.

National Athletic Trainers AssociationAmerican College of Sports MedicineGatorade Sports Science InstituteNational Strength and Conditioning AssociationUS Army Research Institute for Environmental

MedicineAmerican Orthopaedic Society for Sports MedicineAmerican Medical Society for Sports MedicineAmerican Academy of PediatricsKorey Stringer Institute is doing extensive

research

Guideline contributors

“Goal is all 50 States” KSI Institute

“New Jersey, first to adopt heat guidelines”

From 1995 through 2008, 39 football players died of heatstroke.

Second most common cause of death for high school athletes, after spinal cord injury.

Currently 7 states meeting guidelines

WA has guidelines but is classified by KSI as deficient.

Common Sense?EAP’s in placeEarlier AM full gear

practices Shells for later PM

practices, installEmphasize pre-practice

hydrationEfficient hydration

availableAthlete differencesDiscourage supplements,

caffeine & stimulantsLower intensity & increase

breaks whenever necessary

Heat exhaustion symptoms include:Paleness CrampingHeavy sweating Fainting or

nauseaFast or shallow breathing DizzinessThe pulse rate is fast and weak.  

Core body temperature below 104 degrees

Heat Exhaustion vs. Heat Stroke

Heatstroke symptoms include both physical and neurological manifestations—a fast pulse and extremely high temperature (above 104 degrees) coupled with confusion or hallucination. NFHS recommends taking WBGT at location

People may experience nausea, fatigue, vomiting, diarrhea, loss of balance, irritability, irrational or unusual behavior, apathy, hysteria, and headaches, as well as dizziness and disorientation.

Heat Exhaustion vs. Heat Stroke

With NEHS, the body stops or decreases sweat production so the skin feels hot and dry.

With EHS, the body can still produce sweat, so the skin can be moist though the core temperature remains just as high.

Sometimes, there will be no clear evidence of a problem until the athlete collapses.

Heat Exhaustion vs. Heat Stroke

Is the only valid measure of body temperature.

Can only be measured rectally or with an ingestible thermometer (Gastrointestinal).

Core Temperature

What if I don’t have/don’t want to measure temperature rectally?

Common sense:Signs & Symptoms

Fast pulseConfusionNauseaDisorientationAltered level of ConsciousnessIrrational/Unusual BehaviorDizzinessLoss of Balance

Core Temperature

Activate EAPCall 911, but…

Cool the body rapidly, before transportRemove from heatCold water immersion

If not available:Douse with cold waterIce bags/towels, rotate : 3 mins.Put in any available water source

Exertional Heat Stroke Treatment

Goal is to get body temperature below 102 degrees within 30 minutes.

Water temperature between 35-59 degrees.Ice always visible on surface

Continuously stirred.Cooling rate in general is 1 degree: 3

minutes.Basic guideline:

Water temp of 38-42 degree10-15 minutes of immersion time

Cold Water Immersion

Muscle CrampingPainSwellingWeakness

TendernessInability to catch

breathFatigue

Exertional Sickling Signs & SymptomsAffects athletes with Sickle Cell Trait

Longer periods of recovery within conditioning

Excluded from performance testsTimed mile run & serial sprints

Adjust work-rest cycles during hotter daysEmphasize hydrationDon’t work out if feeling illControl asthmaHave supplemental oxygen available

Daily Treatment of SCT Athletes

Study of hydration1. Proper pre practice hydration

½ given water½ withheld water

No significant difference in core temperature!

2. Start practice dehydrated½ given water½ withheld water

Significant difference in core temperature

Emphasis needs to be on effective hydration by the athlete!

Proper Hydration

AsthmaCatastrophic Brain

InjuriesCervical Spine

injuriesDiabetesExertional Heat

Stroke

Exertional Hyponatremia

Exertional SicklingLightningHead-down contactSudden Cardiac

Arrest

Preventing Sudden Death in SportsJournal of Athletic Training, February 2012

10 Most common conditions with treatment and Emergency Action Plans included.

If a patient is suspected of Exertional Heat Stroke, what should be the 1st action taken in treatment of the condition?

A) Drive them to the hospital by parent/yourself.B) Contact EMS and wait for them to arrive. Don’t move athlete.C) Get them a bottle of water and put ice towels on them.D) Apply Biofreeze to the entire body. E) Contact EMS, but place athlete in cold water immersion

and stir the water aggressively before transport.

Post-Test

Korey Stringer Institute, www.ksi.uconn.edu EAP’sCWI guidelinesExertional Heat Stroke survival kitRectal Probes & thermometersHydration kitsHot weather practice procedures outlineState athletic association guidelines

Resources

Binkley HM, Beckett J, Casa DJ, Kleiner DM, Plummer PE. National Athletic Trainers’ Association position statement: exertional heat illnesses. J Athletic Training. 2002; 37(3):329–343.

Casa DJ, Guskiewicz KM, Anderson SA, Courson RW, Heck JF, Jimenez CC, McDermott BP, Miller MG, Stearns RL, Swartz EE, Walsh KM. National Athletic Trainers’ Association position statement: preventing sudden death in sports. J Athletic Training. 2011; 47(1):96–118.

Casa DJ, McDermott BM, Lee EC, Yeargin SW, Armstrong LE, Maresh CM. Cold-water immersion: The gold standard for exertional heat stroke treatment. Exercise and Sports Science Reviews. 2007; 35(3):141-149.

Heatstroke. eMedicine website. http://emedicine.medscape.com/article/166320-overview. Updated September 2009

References

Mueller FO, Colgate B. Annual survey of football injury research 1931–2008. The American Football Coaches Association, the National Collegiate Athletic Association, and the National Federation of State High School Associations. www.unc.edu/depts/nccsi/FootballAnnual.pdf.

No sweat: Recognizing and preventing heat-related illnesses . CMA Today. 2010; 43(4) July/August.

Understanding heat-related illness: symptoms. WebMD. http://www.webmd.com/a-to-z-guides/understanding-heat-related-illness-symptoms.

Yeargin SW, Casa DJ, Judelson DA, McDermott BP, Ganio MS, Lee EC, Lopez RM, Stearns RL, Anderson JM, Armstrong LE, Kraemer WJ, Maresh CM. Thermoregulatory Responses and Hydration Practices in Heat-Acclimatized Adolescents During Preseason High School Football. J Athletic Training. 2010; 45(2): 136–146.

References continued

Gary Clinton MS, AT/C, AT/LSports Medicine Instructor Yelm HSWCTSMA Presidentgclinton@ycs.wednet.edu(360)458-7777

Thank you for your time!