By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- Heat Illness is a broad term used for a range of problems such as dehydration, cramping, dizziness, heat exhaustion and a very serious problem called heat stroke
- Milder forms of heat illness are common in athletes
- Early recognition of heat illness can lead to rapid recovery and greatly lower the chance of developing heat stroke
- Exertional heat stroke is a medical emergency requiring immediate cooling and transport to an emergency medical facility
This is the time of year we need to review some aspects of heat illness, and a potentially deadly form of heat injury called exertional heat stroke. A recently published study of NCAA athletesrevealed that heat illness is most common in preseason training, and that tackle football has the highest incidence but athletes in all sports are potentially at risk. I highly recommend this 2017 New York Times article by neurosurgeon Dr. Julian Bailes, in which he describes the effects of heat stroke and argues for banning football two-a-days at the high school level. The NCAA Division 1 and the NFL have banned two-a-days.
What Is Heat Illness?
“Heat Illness” is a broad term used for a range of problems such as dehydration, cramping, dizziness, heat exhaustion and a very serious problem called heat stroke. Young athletes are at a higher risk than adults for developing heat illnesses. Children absorb heat faster than adults, they don’t sweat as much (sweat helps the body cool), they take longer to get conditioned to exercising in warmer weather and often they don’t feel the need to drink fluids before or during exercise. Helmets and pads add to the possible heat build-up under the uniform.
What is Exertional Heat Stroke (EHS)?
EHS is a severe form of heat-related illness and a medical emergency that can result in brain and other organ damage, or even death in some cases. EHS occurs when the core body temperature rises to dangerous levels – 104 degrees Fahrenheit or greater. Such a high core body temperature, even for a short period of time, can cause permanent damageto the brain, liver, kidneys and other organs.
Recognizing Heat Illness
Most young athletes will first start to show signs of heat-related illness through dehydration. The athlete may come off the field complaining of being tired, having leg cramps or feeling light-headed. Fortunately, there are a number of simple steps that can greatly reduce the risk of heat illnesses when playing in hot weather.
Here are some things you may notice from the young player with heat illness:
- Decreased performance
- Skin that ranges from pale or sweaty to cool and clammy. If the skin is hot it’s a red flag!
- Possibly irritable
- May have difficulty paying attention or following directions.
- Exertional heat stroke is a very severe form of heat illness; athletes with EHS will often look to be in deep distress with red, hot, dry skin and disorientation or even unconsciousness. This CDC page has detail.
And here are some simple steps to help manage early heat illness:
- Get the athlete off the field and let her/him lie down in a cool, shaded place.
- Elevate the legs above the level of the head.
- Provide a sports drink (not carbonated, no caffeine).
- Remove helmet, pads, and any tight fitting clothing and remove socks.
- If the player doesn’t start to feel better within 10-15 minutes, seek medical help.
- Prevent future dehydration with a good hydration strategy.
Young athletes should respond within 10-15 minutes from re-hydrating. You should see him “perk up” and get back towards his normal attitude and appearance. If an athlete does not improve, it may signal more severe dehydration and he should be evaluated in the emergency department of the local hospital. As with any medical condition it’s always best to get qualified medical help (EMTs or other emergency transport) if you have any questions whatsoever about the young athlete’s health.