Chris Stewart was looking forward to starting on the Douglass High School Trojans football team this year. Instead of basking in the roar of the crowd, the 17-year-old honor student had 500 people attend his funeral yesterday. The 6-foot 1-inch, 291-pound lineman, died of heat stroke last week after a football practice in temperatures of 95 degrees. His death, like all heat deaths during football practices, was preventable.
-- Michael Smith in "medpage Today," 2005.
In a few weeks, tens of thousands of young men and women will flood athletic fields across the United States. Some will be 6 years old, experiencing for the first time the indoctrination of August football practice, while others will be vying for starting positions at Division I colleges. What they all have in common, however, is the risk of heat-related illnesses that range from simple cramps to heat stroke and even death. Although we have a better understanding of heat stroke since Chris Stewart died, each year young athletes die unnecessarily due to preventable heat-related illnesses.
Heat-related illnesses are ten times more frequent in high school football players than in any other sport. Each August -- the hottest and most humid month of the year -- players pour onto the fields to practice for hours at a time. Furthermore, after two months of summer break, many players are not at their peak physical fitness.
The national spotlight on childhood obesity is reinforced by a recent study that reported that 47.1 percent of high school football players are obese or overweight. When you add in the early preseason heat, humidity and lack of conditioning, it is not surprising that 83.6 percent of heat-related illnesses occur during practice sessions, as game situations provide more opportunities to rest between plays and drink fluids. The National Athletic Trainers Association (NATA) published guidelines to prevent heat-related illnesses, but only 42 percent of the 18,753 public and private high schools have a certified trainer. Start counting all the youth and middle school programs that have never seen a trainer and you can start to see the magnitude of the problem. The majority of our young athletes lack expert supervision and are at risk.
What Causes Heat Stroke?
It takes a delicate balancing act to keep our body temperatures at a nice, comfortable 98.6°F. But, the number we focus on for heat-related illness is your "core body temperature" -- the temperature deep inside our bodies. In the center of your brain, a tiny area called the hypothalamus acts as the body's thermostat, constantly sending signals to the spinal cord, blood vessels, skin and sweat glands to make the necessary adjustments to keep our bodies in a safe temperature zone. Under normal conditions, the brain does a terrific job of adjusting to hot climates, but with excessive heat and humidity, lack of fluids or excessive sweating, it loses its ability to adequately regulate the body's temperature.
Elevated body temperature or hyperthermia occurs when the body accumulates heat faster than it can get rid of it. Under normal conditions, sweating transfers the body heat through evaporation, but this becomes more difficult as the humidity increases. When you exercise, you generate heat at a rate 15-20 times greater than when you are relaxed, drink in hand, watching your favorite team on the television. Combine heat, humidity and exercise, and your body temperature may start to soar.
Heat stroke occurs when the core body temperature exceeds 104° F. A person may rapidly progress from experiencing mild symptoms such as dizziness, cramps and headaches to more severe symptoms like confusion, nausea and vomiting. The key transition point from heat-related illness to heat stroke is the presence of central nervous system problems like confusion.
An Ounce of Prevention
Heat-related illnesses are totally preventable. We cannot change the fact that the preseason occurs during the hottest and most humid time of the year, when participants are the least physically fit. We also cannot change that children are particularly at risk because they acclimate more slowly, have less of a thirst response and sweat less than adults. NATA and the American College of Sports Medicine have issued guidelines for training and sports activities. Exercise and training in the heat should include:
• 10-14 days of acclimatization at the beginning of the preseason with graded exercise.
• A "buddy system" so that athletes can monitor each other for signs of heat-related illness.
• A gradual increase in the equipment worn, building up to full uniforms. Practicing in light colored, loose fitting clothing with only helmets and shoulder pads does not significantly increase heat gain.
• The identification of unfit players who are then conditioned more slowly.
• Fluid intake of 8-10 ounces every 10-20 minutes -- even if individuals are not thirsty --because once a person is behind in fluids it is impossible to catch up with oral intake alone.
• Prohibiting players from exercising with a fever, viral illness, respiratory infection, diarrhea or vomiting.
Tips for Parents
Athletes and sports participants often do not realize that their temperature is rising and that they are at risk for heat stroke. Combine this with the athletes' motivation to perform and the coaches desire to get the most out of their players, and we have a potentially dangerous situation. Parents should attend their children's practices to see if they are getting adequate physical and water breaks. They should ask the coach or trainer how they handle heat stroke and what equipment (rectal thermometers and cold water immersion tanks) they have available to treat it.
We all feel that we should know basic CPR in case a loved one or a friend needs it. Knowing how to prevent heat stroke may save the life of someone you love.
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