Sports 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 ID: 775909
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Slide1
Gary Clinton MS, AT/C, AT/LSports Medicine Instructor Yelm HSWCTSMA President
Heat Acclimatization? Is it necessary in Washington State?
Slide2If 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
Slide3Isaiah 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
Slide4David 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
Slide5Coach 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
Slide6Focuses on two issues in HS FootballConcussions Heat StrokeArkansas, 2010Two heat stroke scenarios1 died (Tyler Davenport)1 lived (Will James)What was the difference in care?Frontline- “No one should die of Heatstroke”
“Football High” Frontline documentary
Slide7A set of guidelines that safely prepares athletes for competition.Released by the NATA in 2009 for Secondary Schools.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!
What does heat acclimatization mean?
Slide8Days 1-5
No 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
Slide9Days 6-14
Double 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.
Slide10National 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
Slide11“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.
Slide12Common Sense?
EAP’s in placeEarlier AM full gear practices Shells for later PM practices, installEmphasize pre-practice hydrationEfficient hydration availableDiscourage supplements, caffeine & stimulants
Slide13Heat 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
Slide14Heatstroke symptoms include both physical and neurological manifestations—a fast pulse and extremely high temperature (above 104 degrees) coupled with confusion or hallucination. 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
Slide15With 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
Slide16Is the only valid measure of body temperature.Can only be measured rectally or with an ingestible thermometer (Gastrointestinal).
Core Temperature
Slide17What if I don’t have/don’t want to measure temperature rectally?Common sense:Signs & SymptomsFast pulseConfusionNauseaDisorientationAltered level of ConsciousnessIrrational/Unusual BehaviorDizzinessLoss of Balance
Core Temperature
Slide18Activate EAPCall 911, but…Cool the body rapidly, before transportRemove from heatCold Water ImmersionIf not available:Douse with cold waterIce bags/towels, rotate : 3 mins.Put in any available water source
Exertional Heat Stroke Treatment
Slide19Goal is to get body temperature below 102 degrees within 30 minutes.Water temperature between 35-59 degrees.Ice always visible on surfaceContinuously 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
Slide20Muscle CrampingPainSwellingWeaknessTendernessInability to catch breathFatigue
Exertional Sickling Signs & Symptoms
Affects athletes with Sickle Cell Trait
Slide21Longer periods of recovery within conditioningExcluded from performance testsTimed mile run & serial sprintsAdjust work-rest cycles during hotter daysEmphasize hydrationDon’t work out if feeling illControl AsthmaHave supplemental oxygen available
Daily Treatment of SCT Athletes
Slide22Study of hydration1. Proper pre practice hydration½ given water½ withheld waterNo significant difference in core temperature!2. Start practice dehydrated½ given water½ withheld waterSignificant difference in core temperatureEmphasis needs to be on effective hydration by the athlete!
Proper Hydration
Slide23AsthmaCatastrophic Brain InjuriesCervical Spine injuriesDiabetesExertional Heat StrokeExertional HyponatremiaExertional 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.
Slide24If 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
Slide25Korey Stringer Institute, www.ksi.uconn.edu EAP’sCWI guidelinesExertional Heat Stroke survival kitRectal Probes & thermometersHydration kitsHot weather practice procedures outlineState athletic association guidelines
Resources
Slide26Binkley 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
Slide27Mueller 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
Slide28Gary Clinton MS, AT/C, AT/LSports Medicine Instructor Yelm HSWCTSMA Presidentgclinton@ycs.wednet.edu(360)458-7777
Thank you for your time!