2. Management of Exertional Heat Illness Signs and symptoms for coaches, parents, and staff Shawn Hanlon Sunday, May 24, 2015

3. Just FYI Use extreme caution in hot, humid weather Athletes can suffer from heat illness or even DEATH Watch for signs of Dehydration Recognize who is more susceptible than others

4. Wet bulb globe scale flag conditions  Green: 80-84.9°  Yellow:85-87.9°  Red:88-89.9°  Black:90°+ This flag will be hung outside the ATF by 2pm Just FYI

5. Hydration Instruct your athletes to be well hydrated 24 hours prior to activity 17-24 fluid ounces 3-4 hours before exercise 7-10 fluid ounces 15 minutes before exercise Small amounts throughout the day Drink me 15 minutes before exercise!

6. Determining Hydration Urine color is a good indicator Light yellow= well hydrated Dark yellow-brown= dehydrated Body weight under normal conditions compared to post-exercise – When 1-2% of BW is lost to sweat, athletes begin to feel thirsty

7. Fluid Replacement Sports drinks are better than water Allow unlimited, easy access to fluids Flavored drinks will stimulate thirst and increase fluid intake (compared to water) Fluid intake should be as much as possible during exercise, but should not exceed the amount of fluid loss For vigorous activity lasting longer than 1 hour, adding sodium (0.3-0.7g per 8oz. Water) and carbohydrates (14g per 8oz. Water) to drinks

8. Susceptible Individual Characteristics Consider body type – Those with more muscle mass are more prone to heat illness Overweight individuals Previous history of heat illness Poor fitness level Young or elderly

9. Acclimatization Process Days 1-5Only one practice per day Days 1 and 2Helmets only Days 3 and 4Helmets and shoulder pads only Day 5Full Pads After Day 5May begin two-a-days every other day *Based on two hour practices

10. Heat Illness Prevention

11. Recognizing Heat Stress Symptoms: – muscle twitching – Cramps – Muscle spasms

12. Treatment of Heat Stress Get them into air conditioning if possible Intake large amounts of fluids Ice massage for muscle cramps Stretching Ice bag across the neck/shoulders

13. Recognizing Heat Exhaustion Symptoms: – Excessive thirst – Seeming slowed down – Dry mouth – Temperature 102°-104° – Weakness – Fatigue

14. Treatment of Heat Exhaustion Get them out of the sun and into a cool room Encourage them to drink as much as possible Sponge with cool water Ice bags under armpits, groin, and on back of neck Cold tank emersion

15. Recognizing Heat Stroke Headache or decreased mental acuity Vomiting/diarrehea Flushed skin Increased heart rate (160-180) Core temperature 104°+ Feels like they are burning up COULD LEAD TO PERMANENT BRAIN DAMAGE

16. Treatment of Heat Stroke LIFE-THREATENING EMERGENCY activate EMS Ice bath emersion in the meantime Sponge with cool water and fan if ice bath is not available Have them try to drink fluids Must lower their body temperature as soon as possible

17. Exertional Rhabdomyolysis Sudden muscle catabolism (breaking down) and degeneration Can occur in healthy athletes during intense exercise in extreme climates Gradual onset of muscle weakness, swelling, pain Can progress to renal failure or even death

18. Pre-season Checklist Review CPR skills Review the emergency action plan (EAP) Encourage your athletes to start hydrating the night before practice Have unlimited fluids readily available DO NOT take away water as punishment

19. Hanlon’s Recommendations Educate yourself and others Don’t panic, take a breath and act NATA Position Statement on exertional heat illnessexertional heat illness NATA Position Statement on Fluid ReplacementFluid Replacement When in doubt, ship them out

20. Hanlon’s Recommendations Exercise Intensity Decreases Temperature Increases

21. NATA recommendations for Heat Illness Prevention Ensure appropriate medical care Conduct pre-participation physicals to identify susceptible individuals Acclimatize athletes over 10 to 14 days Educate athletes and coaches regarding prevention, recognition, and treatment of heat illnesses Educate athletes to balance fluid intake with sweat and urine loss Encourage 6-8 hours of sleep Monitor environmental conditions and develop guidelines for altering practices Provide an adequate supply of water or sports drinks Weigh high-risk athletes before and after practices Minimize the equipment worn on hot days Minimize warmup on hot days Have appropriate emergency equipment available (ice, cold bath, water, thermometer) Arnheim’s Principles of Athletic Training, 2009

22. Heat Illness Prevention Video

23. Questions?