It’s that dangerous time of year again.Thousands of athletes, from high school to the pros, are working out in intense heat to prepare for football season, cross country season or just about any outdoor sport.With hot weather and humidity comes the increased awareness of heat-related illnesses, particularly in Texas.Exertional heatstroke is one of the three leading causes of death in sports (and the leading cause in the summer), according to the National Athletic Trainers’ Association.It can happenThere are not too many triple-digit temperatures in Mankato, Minn. In fact, the average high in July and August is around 82 degrees. So on July 31, 2001, when the temperature hovered just over 90 for much of the day and the heat index reached 110 degrees, trouble loomed for Vikings offensive lineman Korey Stringer. Stringer, a father of two and a six-year NFL veteran, died the next morning after his body temperature climbed as high as 108 degrees.His death helped launch a debate directly about player safety and health at all levels of the game. In February, NATA, which has partnered with the Korey Stringer Institute at the University of Connecticut, released recommended guidelines for heat-related illness for secondary schools and colleges.According to NATA, the recommendations are believed to be a first effort at giving specific protocols to ensure effective and efficient sports medicine procedures in schools.Whereas college and university programs have already implemented drastic changes in the past 10 years, some smaller high school programs still don’t have full-time athletic trainers.Athletic trainers are health-care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sports-related illnesses.“For the ones that don’t [have athletic trainers] or the ones where coaches act in that role, these will help them and give them a specific playbook to go by,” Stephenville athletic trainer Mike Carroll said. “It’s going to be real hit-and-miss as to what guidelines they are or are not following, but most larger programs are doing this already.”Hydration has become the centerpiece of athletic training — not just in football camps, but all sports. That’s especially true in the Metroplex, where August temperatures average a full 14 degrees higher (96 degrees) than in Mankato.Still, guidelines or no, the onus on preparing for or acclimating to heat falls heavily on the athletes. Preventative careRebecca Lopez, assistant professor of athletics training and strength and conditioning coach at the University of South Florida, said understanding an athlete’s needs starts with the athlete.“We have a process,” she said. “Athletic trainers make athletes complete their preseason conditioning forms prior to camp. So, assuming they’ve filled it out and disclosed everything, athletic trainers are conditioned to observe and understand how to react in the extreme cases of heat-related illness.”Those signals could come in a number of ways, but Lopez said athletic trainers should have a specific protocol to react to all of them. NATA guidelines include a foremost medical or patient approach to heat and hydration treatment. The organization represents and supports 39,000 members of the athletic training profession.NATA also recommends creating policies and procedures for athletic trainers as well as establishing performance appraisals.“The athletic director that hired me after graduate school in 1992 reminded me that he didn’t have trainers when he coached,” Carroll said. “There’s not too many of those guys still around, but if there is, it sure doesn’t mean that a school shouldn’t have guidelines and best practices.“Athletic training is an allied health occupation and an educational background in medical training is needed. Whatever the feelings toward athletic trainers of the past, that doesn’t exist in Stephenville.”Carroll said his coaches take time to recap the stated policies in the school’s medical handbook every year.“Like any school, we’ll have new coaches that come in and we make sure they understand how we handle the kids here,” Carroll said. “I think, by and large, coaches know this issue is a serious one.”The patientExerting and pushing the body to the limit means that management and understanding on a medical level is needed for an athlete to reach his or her potential. For the schools fortunate enough to have them, athletic trainers are on the front lines of observation and assessment. Athletic trainers require a health and disclosure form from all athletes who want to play. From there, trainers assess information that ranges from total health to medication consumption and conditioning. “Every athlete from seventh grade on up is a patient,” Aledo athletic trainer Troy Little said. “There are things that we look to take care of, as far as preventative care, before they even step on to the field.“Are they in shape? What kind of nutrition are they following? Things like that. We do our physicals and know our kids pretty well. I’m going to know if they are on medication as long as they disclose that on the form. And with that, I know that medication will make them sweat more, they may be more prone to cramping or having other issues.”Little, who’s been at Aledo for 12 seasons, said he spends considerable time visiting with athletes in and outside of school in hopes the conversations will at least make them more aware of taking care of themselves — and ultimately become better athletes.“That doesn’t take precedent over a player that’s under a doctor’s care, but if the doctor’s cleared them to be a part of any team, it’s on athletic trainers to have protocol in place for all kinds of injuries,” Little said. That’s where NATA’s stated guidelines on heat and hydration come in. During the training camp months, for football especially, heat and hydration are top priorities. To some extent, conditioning of NFL players is measured at the start of camp to compare where a player is currently to baselines of the past. Dallas Cowboys head coach Jason Garrett canceled the conditioning tests to open the 2014 camp. But high school players and, to some extent, college football players can’t be monitored year-round or throughout the summer like professionals routinely are. Little said he and the Aledo coaching staff try to remind players through the summer months to start getting acclimated to Texas heat. “You’ll have some participation in the off-season programs, but a lot of that is indoors,” he said. “We try to remind them to get out and mow lawns or something and start getting ready. We teach our coaches to do the same in the first days of camp as well.”The UIL implemented new practice policies in 2013, which include the abolition of consecutive two-a-day practices and a four-day acclimation period in which players do not work out in pads or have contact. “The non-contact period helps out because they are not fully padded and not going full speed,” Little said. “That helps us assess them, but it also helps the athletes assess themselves. When they have pads on, they’re not paying attention to how much they are sweating.”While water breaks were few and far between in years past or coaches used water as a reward or disciplinary tool, those ideas are a thing of the past.“Mostly, our colleagues are on the same page as a whole, and we bounce things off each other as to what’s working,” Little said. “But there are a few schools that do have some different approaches. Our players at Aledo are never told they can’t have water.”Little insisted that fluid intake also needs to be assessed. “You want them to have plenty of the right fluids,” he said. “You have to encourage them also to stay away from any of the diuretics, teas, caffeine and Cokes.”With different body types, weight and overall build, there’s not just one formula of hydration that works for every player. “Everybody has different sweat rate and fluid needs, but the guidelines are roughly the same,” Lopez said. “It’s imperative to make sure players have the time to adjust to the heat and that’s different for everyone.”Rapid reactionLittle said he works with his student trainers to recognize if a player might be overheated. In most recent instances, the player’s condition can be corrected quickly by simply sitting in the shade and drinking water. But that’s only an initial step in making a determination. “If we come across a player in cold sweats, we try to cool them down outside first and, if we can, the player can still watch or in some cases continue practice,” he said. “If a kid gets dizzy or vomits, we can sit them down right and get them to chew ice or take their helmet off.“If we can’t get them stable, we take them to an air-conditioned room and, in extreme cases, we’re prepared to do cold pool immersions while we wait on EMS. Luckily, we’ve always caught them early.”Carroll said not knowing isn’t an excuse any longer. “I’ve continued to carry the same message to my coaches,” Carroll said. “Heat illness is 100 percent preventable and no one should ever die of heatstroke.”
Some recommendations from the National Athletic Trainers’ Association to deal with heat illnesses:
• A preseason heat acclimatization policy should be implemented to allow athletes to be acclimatized to the heat gradually over a period of 7 to 14 days. This is optimal for full heat acclimatization.
• Plan rest breaks and modify the work-to-rest ratio to match environmental conditions and the intensity of the activity.
• The two main diagnostic criteria for exertional heatstroke are profound central nervous system (CNS) dysfunction and a core body temperature above 105 degrees.
• Rectal temperature is the only method of obtaining an immediate and accurate measurement of core body temperature in an exercising individual.
• The goal for any exertional heatstroke victim is to lower core body temperature to less than 102.5 degrees within 30 minutes of collapse.
• Cold water immersion is the most effective way to treat a patient with exertional heat stroke. The water should be 35-59 degrees and continuously stirred to maximize cooling.