1. Essentials of Athletic Injury Management 10th Edition
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2. Chapter 7: Understanding the Potential Dangers of Adverse Environmental Conditions
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3. Hyperthermia
Athletic trainers require knowledge and information concerning temperature, humidity and weather to adequately make decisions regarding environmental dangers
Has caused a number of deaths over the years
Hyperthermia = increase in body temperature
Anyone that supervises athletes practicing and competing must realize that heat and humidity impact every geographic region of the United States
Imperative to be able to recognize signs and symptoms associated with heat-related illnesses and to be able to manage them appropriately
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4. Heat Stress Extreme caution should be used when training in the heat
Overexposure could result in heat stress
It is preventable
Athletes that train under these extreme conditions are at risk
Physiologically the body will continue to function if body temperature is maintained
Body must dissipate heat to maintain homeostasis
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5. Heat Stress, cont.
Heat can be dissipated from the body through 4 mechanisms
Conduction (direct contact)
Convection (contact with cool air or water mass)
Radiation (heat generated from metabolism)
Evaporation (sweat evaporating from the skin)
* Heat can also be gained via these four mechanisms
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6. Heat Stress, cont. Evaporative Heat Loss
Sweat glands allow water transport to surface
Evaporation of water takes heat with it
When radiant heat and environment temperature are higher than body temperature, loss of heat through evaporation is key
Lose 1 quart of water per hour for up to 2 hours
Air must be relatively water free for evaporation to occur
relative humidity of 65% impairs evaporation
relative humidity of 75% stops evaporation
Heat illness can still occur in cold environment if body is unable to dissipate heat
Caused by dehydration and inability to sweat
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7. Monitoring Heat Index
Heat, sunshine and humidity must be monitored closely
Takes into account ambient air temperature and relative humidity
Attempts to determine how hot it feels to the body
Wet bulb globe temperature index (WBGT) provides objective measure for determining precautions concerning participation in hot
WGBT incorporates different thermometer readings
Dry bulb (standard mercury temperature)
Wet bulb (thermometer with wet gauze that is swung around in air)
Black bulb (black casing that measures radiant heat)
DBT and WBT can be measured with psychrometer (combines both thermometers)
Used to relative humidity
Wet bulb will be lower due to evaporation of water
Drier air = greater depression of wet bulb temperature due to evaporation
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8. Heat Illnesses Heat Syncope (heat collapse)
Associated with rapid fatigue and overexposure, standing in heat for long periods of time
Caused by peripheral vasodilation, or pooling of blood in extremities resulting in dizziness and fainting
Treatment
Lay athlete down in cool environment, elevate lower extremities, consume fluids
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9. Exertional Heat Cramps
Painful muscle spasms (calf, abdominal) due to excessive water loss and electrolyte imbalance
Occurs in individual in good shape that overexert themselves
Treatment
Prevent by consuming extra fluids and maintaining electrolyte balance
Treat with fluid ingestion, light stretching with ice massage
Return to play unlikely due to continued cramping
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10. Exertional Heat Exhaustion
Result of inadequate fluid replacement
Signs & Symptoms
Profuse sweating, pale skin, mildly elevated temperature, dizziness, hyperventilation and rapid pulse
May develop heat cramps or become faint/dizzy
Core temperature will be ~102o
Critical to obtain accurate core temperature
Performance may decrease
Treatment
Immediate treatment includes fluid ingestion (intravenous replacement, ultimately), place in cool environment
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11. Exertional Heatstroke
Serious life-threatening condition, with unknown specific cause
Need emergency action plan in place to manage this life threatening condition
Signs & Symptoms
Sudden onset - sudden collapse, LOC, flushed hot skin, minimal sweating, shallow breathing, strong rapid pulse, and core temperature of > 104o F
Drastic measures must be taken to treat & cool the athlete
Strip clothing
Sponge with cool water
Immerse in water
Transport to hospital immediately
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12. Exertional Hyponatremia
Fluid/electrolyte disorder resulting in abnormally low concentration of sodium in blood
Caused by ingesting too much fluid before, during and after exercise
May be result of too little sodium in diet or in ingested fluids over a period of prolonged exercise
Athletes that ingest large quantities of water and sweat over several hours are at risk (marathon, triathlon)
Preventable – must maintain balance
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13. Preventing Heat Illness
Must exercise common sense and precaution
Consume fluids and stay cool
Fluid and Electrolyte Replacement
Single most important step taken by a coach to minimize the chance of heat illnesses
Continual re-hydration is critically important
Generally only 50% of fluid is ever replaced and should therefore be replaced before, during and after exercise
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14. Preventing Heat Illness, cont.
Fluid replacement should match sweat loss
Time of stomach emptying is critical
Water is absorbed rapidly from intestine
Drink with 6% CHO is eliminated at the same rate if the individual is hydrated
Cold drinks tend to empty rapidly and will not induce cramping or put heart at risk
Drinks with caffeine and alcohol will promote dehydration
Hydration levels can be monitored via urine color and volume
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15. Preventing Heat Illness, cont.
Using Sports Drinks
More effective than just replacing fluids with water
Flavoring results in increased desire to consume
Replaces fluids and electrolytes
Water alone can prematurely stop thirst response and initiate fluid removal by kidneys
Small amounts of sodium help in retention of water
Optimal CHO level is 14g per 8 ounces of water
More CHO results in slower absorption
Effective for both short & long term activities
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16. Gradual Acclimatization
Most effective method of avoiding heat stress
Involves becoming accustomed to heat and exercising in heat
Early pre-season training and graded intensity changes are recommended with progressive exposure over 7-10 day period
80% of acclimatization can be achieved during first 5-6 days with 2 hour morning and afternoon practice sessions
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17. Gradual Acclimatization, cont. Identifying Susceptible Individuals
Athletes with large muscle mass
Overweight athletes are at an increased risk
Related to proportionality of metabolic heat production to surface area
Athlete with increased fluid loss
Precautionary measures apply to both males and females
Medications or supplements may impair sweating and may predispose them to injury
Poor fitness levels, a history of heat-related illnesses or anyone with febrile conditions are at increased risk
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18. Gradual Acclimatization, cont. Uniform Selection
Base on temperature and humidity
Dress for the weather and temperature
Avoid rubberized suits
Weight Records
Keep track of before and after measures for first two weeks
If increase in temperature and humidity occurs during the season, weights should again be recorded
A loss of 3-5% = reduced blood volume and could be a health threat
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19. Hypothermia Cold weather vs. nature of particular sport
Most activity allows for adequate heat production and dissipation, allowing for sufficient functioning
Temperature in conjunction with wind chill and dampness or wetness can increase chances of hypothermia. With muscular fatigue, in cold weather, rate of exercise begins to drop and rate of heat loss relative to heat production may shift
Results in impaired neuromuscular responses and exhaustion
Drop in core stimulates shivering but stops after temp. drops below 85-90oF
Death is imminent when temp falls below 77-85oF.
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20. Cold Disorders Fluid replacement is critical
Dehydration = decreased blood volume = less fluid available for tissue warming
May be useful to monitor weight of athletes training in cold temperatures
Injury/illness due to the cold can occur
Endurance type activities
Winter sports
Swimming in cold water
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21. Cold Disorders, cont. Frost nip
Involves, ears, nose, chin, fingers, and toes
Occurs with high wind and/or severe cold
Skin appears firm with cold painless areas that may peel and blister (24-72 hours)
Treat with firm pressure, blowing warm air or hands in armpits (if fingers involved)
Do not rub
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22. Cold Disorders, cont. Frostbite
Superficial Frostbite involves only skin and subcutaneous tissue
Appears pale, hard, cold and waxy
When re-warming the area will feel numb, then sting and burn
It may blister and be painful for several weeks
Deep Frostbite indicates frozen skin requiring hospitalization
Gradual re-warming is necessary ( oF)
Tissue will become blotchy red, swollen, painful and may become gangrenous
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23. Cold Disorders, cont. Prevention
Apparel geared for weather to provide semitropical microclimate for body and prevent chilling
Waterproof and windproof fabrics wick moisture away from skin, allowing passage of heat and sweat
Layers and adjusting them are key to maintaining body temperature (during period of (in)activity)
Inadequate clothing, improper warm-up and chill factor can lead to injury, frostbite, and/or minor respiratory problems
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24. Overexposure to Sun
Precautions must be taken to protect athletes, coaches, athletic trainers and support staff
Long Term Effects on Skin
Premature aging and skin cancer due to ultraviolet exposure
Premature aging is characterized by dryness, cracking and inelasticity of the skin
Skin cancer is the most common malignant tumor found in humans
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25. Overexposure to Sun, cont.
Sunscreen
Can help prevent effects of UV radiation
Sun Protection Factor (SPF)
Sunscreen effectiveness
Indicates how many times longer an individual can be exposed to the sun with vs. without sunscreen before skin turns red.
Use
When outside considerable amount
Individuals with fair complexion, light hair, blue eyes or skin that burns easily
Throughout the year
Apply minutes prior to exposure
Re-apply after exposure to water, excess sweating, rubbing skin with clothing or a towel
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26. Safety in Lightening and Thunderstorms
Emergency action plans must be set for this type of event
Involving chain of command, monitoring of weather service, decision making regarding removal and return to field
NATA has a position statement
Other guidelines
Avoid large trees, flag/light poles, standing water, telephones, pools, showers, and metal objects
If hair stands up on hand you are in imminent danger and should get down on the ground but not flat as that increases surface area
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27. Safety in Lightening and Thunderstorms, cont.
Additional Guidelines
Lightening is generally accompanied by thunder (except 20-40% of the time due to atmospheric disturbances)
Flash-to-bang methods estimates distance away for the storm
From time lightening is sighted to the clap of thunder count, divide by 5 to calculate the number of mile away
Count of 30 indicates inherent danger and everyone should leave the field
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28. Safety in Lightening and Thunderstorms, cont.
NATA, NCAA and National Weather Service recommend returning to the field 30 minutes following the last clap of thunder or lightening strike
Major misconception is that lightening that is seen striking is coming down
In actuality it is the return stroke of the lightening going back up after it has already hit the ground
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29. Safety in Lightening and Thunderstorms, cont.
Lightening Detectors
Hand-held instrument with electronic system to detect presence and distance of lightening/thunderstorm activity (w/in 40 miles)
Can determine level of activity and direction of movement
Provides audible and visual warning signals
Inexpensive alternative to contracting weather services
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