Athletes and heat stroke: Prevention and treatment

exertional heat stroke

In the midst of some of the hottest months of summer, young athletes are just beginning practice sessions for fall sports. During this time, it’s important for athletes, coaches and trainers to be adequately prepared for the heat — and for physicians to be prepared to treat heat illnesses.

Children and adolescents are more susceptible to heat stroke than adults, as they adjust more slowly to changes in environmental heat, produce more heat during activity and sweat less. Young athletes are also less likely to take breaks and rest while exercising or participating in sports, and may not adequately hydrate.

Michael Beasley, MD, a sports medicine specialist at Boston Children’s Hospital, provides insight into how exertional heat stroke (EHS) can be monitored and treated in young athletes.

Recognizing the signs

Beasley describes heat stroke as “the end of the spectrum of heat illness, which can include heat edema, heat rash, heat cramps and heat syncope all before true heat stroke occurs.” True heat stroke occurs when the core body temperature becomes higher than 106 degrees, and is associated with neurologic dysfunction.

On the field, the signs of EHS can be seen in the appearance of altered neurologic status, which may present as delirium, confusion, hallucinations, imbalance and tremors. These symptoms may escalate to decerebrate or decorticate posturing — signs of significant brain damage — and could result in a coma.

Leading up to heat stroke, an athlete may begin to have abdominal and muscular cramps, as well as nausea, emesis (vomiting), headaches, dizziness and difficulty breathing. “It’s commonly taught that heat stroke will come with lack of sweating, or anhidrosis,” adds Beasley. “But patients with heat stroke may in fact sweat profusely, and sweating should not be used as a marker of severity or comfort in the setting of heat illness.”

A physician can diagnose EHS through additional symptoms once a patient has been brought to the hospital. Beasley explains that the most telling sign of heat stroke is elevated body temperature, which should ideally be taken as a core temperature (rectal) rather than peripheral (axillary/oral). Patients with EHS often have tachycardia, but may have either normal or low blood pressure, although they can also have wide pulse pressure.

Treating EHS

Morbidity and mortality significantly increase with any delay in lowering a patient’s core body temperature. Beginning the cooling process is the primary treatment — which Beasley says “should absolutely be treated as a medical emergency.”

Restrictive clothing should be removed to increase evaporative cooling. However, cooling methods do vary. “Evidence supports ice-water immersion as the likely most-effective method for lowering temperature rapidly,” says Beasley. If this treatment isn’t an option, additional methods include placing ice packs in the axilla, on the neck and groin, and splashing/spraying the patient with cold water. Having a fan blow on the patient during these treatments can also help increase evaporation and expedite the cooling process.

Beasley also adds, “any primary aspects of resuscitation, including breathing and circulation assistance, should be in the midst of cooling.”

Athletes at risk

The highest numbers of heat stroke occur in youth football players, particularly in the month of August.

Certain young athletes may be more at risk of EHS than others. Typically, children and adolescents who are overweight, have chronic health issues, or play a sport that requires wearing heavy clothing or pads are at a higher risk.

With football, soccer and field hockey seasons on the horizon, many athletes are participating in summer practices, which can sometimes include two-a-day practices. Although the NCAA has banned two-a-day practices for Division I football players, many high school players will still be practicing twice a day in the summer heat.

“The highest numbers of heat stroke occur in youth football players, particularly in the month of August,” says Beasley. “The extended periods outside in hot temperatures, especially under pads and equipment, place these athletes at increased risk.” While trainers and coaches can help reduce the risk by encouraging practices without pads and contact, EHS is still a source of concern given the heat and length of many practices.

Distance runners are also at a high risk for heat stroke, as their hydration is often limited during competition. Beasley stresses that acclimatization to heat is key in reducing the risk of EHS, as athletes who are not used to higher temperatures generally have a slower sweat response and thus are much more likely to suffer heat illness.

As summer practices begin for many young athletes, it becomes more important than ever to be aware of the signs of exertional heat stroke, and know how to properly treat an athlete who is suffering from heat illness. The consequences of severe heat stroke can include significant neurological damage as well as death.

With the beginning of the sports season also comes preseason physicals for athletes. During these assessments, physicians can inform their patients (and parents) on how to recognize signs of heat stroke and remind them to remain well-hydrated and well-rested.

Keeping young athletes healthy on the field is always the goal, Beasley says. And sometimes that means knowing when to take them off it.

Learn more about Boston Children’s Sports Medicine.