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Understanding Heat Stroke in 7 Steps

Athletes can develop life-threatening exertional heat stroke (EHS) for a variety of reasons. But there is virtually no reason for EHS to occur when coaches and conditioning personnel put their players’ safety first. The recent death of Kent State football player Tyler Heintz serves as a harsh reminder of the importance of knowing how to prevent, recognize, and properly treat this devastating, yet completely survivable condition.

Following is a summary of the excellent materials on exertional heat stroke developed by The Korey Stringer Institute (KSI), named for the Minnesota Vikings lineman who died of EHS in 2001. For access to the full materials and a checklist on how to prevent EHS, visit the Korey Stringer Institute website.

1. Heat stroke: What is it?

Since Stringer died of EHS in 2001, researchers have learned much about heat, hydration and safe training practices. The KSI defines EHS as a life-threatening condition that usually occurs during the summer months, following prolonged physical conditioning that raises the body temperature above 104°F.

2. How do you prevent exertional heat stroke?

In addition to ensuring proper rest and dieting, experts at KSI recommend wearing loose-fitting, absorbent or moisture-wicking clothing without extra equipment, if possible. They also advise training in the shade, not scheduling practice during the hottest parts of the day (10 a.m. – 5 p.m.) and gradually increasing workout intensities in the heat. This gradual increase in workout intensity is called heat acclimatization. See KSI’s essential activity modification guidelines and checklist on preventing heat stroke.

3. What puts an individual at risk for exertional heat stroke?

A number of factors might cause certain players to be at heightened risk for EHS, including poor hydration, being overweight, and being highly motivated and ultra-competitive. Other factors include too little rest during workouts and lack of awareness about EHS among coaches, athletes and medical staff, according to KSI. See KSI’s full list of risk factors.

4. Heat stroke recognition: Look for these symptoms

Following the collapse of a player on the field, the two main criteria for diagnosing EHS are rectal temperature in excess of 104°F (40°C) and central nervous system problems (for example, irrational behavior, irritability, dizziness, collapse). Other symptoms may include confusion, nausea or vomiting, quick breathing and more. Heat stroke can mimic the symptoms of other severe conditions (such as heat exhaustion, brain injury or cardiac arrest), so it is crucial that staff are educated about EHS, use rectal temperature in a suspected case and create smart practice habits.

5. How do you treat an individual with exertional heat stroke?

If you see an individual suffer EHS, a common action plan would include removing all equipment and excess clothing before cooling the athlete as quickly as possible (within 30 minutes) through whole body ice water immersion—while calling 911. Once body temperature has reached 102°F (38.9°C), it is safe to transport the athlete to the hospital. For more information on treating a heat stroke victim, see this KSI checklist.

6. When can the athlete return to activity?

After EHS, athletes may have difficulty regulating their body temperature and not tolerate hot playing conditions. A safe return to the field should follow a doctor’s clearance and guidelines for a gradual return to activity. After heat exhaustion, guidelines recommend against returning the same day. After heat stroke, athletes may be able to begin modified activities within a month. See KSI’s full return-to-play checklist.

7. What can I do to ensure safe training in the heat?

A wealth of information is available online for athletes, parents and coaches who want more information on EHS and best training practices. For information on taking rectal temperature, cold-water immersion and other safety guidelines, KSI has downloadable materials.