National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

Abstract

OBJECTIVE: To present recommendations for the prevention, recognition, and treatment of exertional heat illnesses and to describe the relevant physiology of thermoregulation. BACKGROUND: Certified athletic trainers evaluate and treat heat-related injuries during athletic activity in "safe" and high-risk environments. While the recognition of heat illness has improved, the subtle signs and symptoms associated with heat illness are often overlooked, resulting in more serious problems for affected athletes. The recommendations presented here provide athletic trainers and allied health providers with an integrated scientific and practical approach to the prevention, recognition, and treatment of heat illnesses. These recommendations can be modified based on the environmental conditions of the site, the specific sport, and individual considerations to maximize safety and performance. RECOMMENDATIONS: Certified athletic trainers and other allied health providers should use these recommendations to establish on-site emergency plans for their venues and athletes. The primary goal of athlete safety is addressed through the prevention and recognition of heat-related illnesses and a well-developed plan to evaluate and treat affected athletes. Even with a heat-illness prevention plan that includes medical screening, acclimatization, conditioning, environmental monitoring, and suitable practice adjustments, heat illness can and does occur. Athletic trainers and other allied health providers must be prepared to respond in an expedient manner to alleviate symptoms and minimize morbidity and mortality.

Figure 1

Risk of heat exhaustion or heat stroke while racing in hot environments. However, Figure 2 may be better suited for estimating heat-stroke risk when equipment is worn. Reprinted with permission from Convertino VA, Armstrong LE, Coyle EF, et al. American College of Sports Medicine position stand: exercise and fluid replacement. Med Sci Sports Exerc. 1996;28:i–vii.

Figure 2

Heat stress risk temperature and humidity graph. Heat-stroke risk rises with increasing heat and relative humidity. Fluid breaks should be scheduled for all practices and scheduled more frequently as the heat stress rises. Add 5° to temperature between 10 AM and 4 PM from mid May to mid September on bright, sunny days. Practices should be modified for the safety of the athletes to reflect the heat-stress conditions. Regular practices with full practice gear can be conducted for conditions that plot to the left of the triangles. Cancel all practices when the temperature and relative humidity plot is to the right of the circles; practices may be moved into air-conditioned spaces or held as walk-through sessions with no conditioning activities. Conditions that plot between squares and circles: increase rest-to-work ratio with 5- to 10-minute rest and fluid breaks every 15 to 20 minutes; practice should be in shorts only with all protective equipment removed. Conditions that plot between triangles and squares: increase rest-to-work ratio with 5- to 10-minute rest and fluid breaks every 20 to 30 minutes; practice should be in shorts with helmets and shoulder pads (not full equipment). Adapted with permission from Kulka J, Kenney WL. Heat balance limits in football uniforms: how different uniform ensembles alter the equation. Physician Sportsmed. 2002;30(7):29–39.