New guidelines announced today in Indianapolis include an unusual policy for treating athletes with heat stroke. The National Athletic Trainers' Association (NATA) says victims of heat stroke should not be rushed to the hospital. NATA reports that cold water immersion is the most effective treatment for heat stroke.
A simple sideline ice water tub could be a life saver. Trainers say there should be one on every field when athletes are working out in the heat. When an athlete suffers from heat stroke, it's essential to get their core body temperature lowered quickly to avoid permanent organ or brain damage, or even death.
The National Athletic Trainers' Association Expo in Indianapolis released new heat and hydration guidelines for athletes. Most significant is the "cool first, transport second" policy for athletes suffering heat stroke, when core body temperature rises above 104 degrees.
"It's a complete paradigm shift in medicine," said Doug Casa, chief operation officer of the Korey Stringer Institute. "I mean what other medical condition do you say, 'I'm not going to send him to the hospital right away.' But what we understand with heat stroke is we have a very limited number of minutes to get their temperature under the critical threshold."
The Colts hit the practice fields in Anderson in less than a month. Training camp brings some of the hottest days of the summer and the danger of heat stroke.
"We report to camp July 23rd," said Colts offensive lineman Joe Reitz. "So on the 19th, the 20th, I'm really going to start pushing fluids, drinking as much water as I can, so I can be kind of 100 percent topped off in the gas tank so to speak. So that way you hit a couple hot days and you're losing some sweat, you're at your very highest level and it's not going to affect you as much."
NATA reports the best way to treat heat stroke is cold water immersion on site in the first 30 minutes after a heat stroke incident.
"You have to have cooling finish at the school before you put them in the ambulance to take them to the hospital," said Casa, "because you don't want to take him out of the tub while they're getting this great cooling and then put him in the ambulance where they can't continue that same cooling. So you want to absolutely utilize the on-site cooling modality, get them down to the 102-103 range, then you ship them to the hospital. That's your best chance of helping that person survive the heat stroke."
NATA also recommends a more gradual workload to start the football season.
"Indiana does not meet the minimum standards right now," said Casa. "One of the first things that the residents of Indiana should do is encourage the Indiana High School Athletic Association to meet the minimum standards for heat acclimatization so that there would be no two-a-days on the first five days, no successive days of two a days, phasing in the equipment over time."
But changes to the IHSAA by-laws adopted in May now require three days of non-contact drills when high school football practice starts August 4th. (By-law changes can be read below.)
"The Indiana Football Coaches Association spent countless hours in research and consultation with representatives of the football and medical communities to arrive at conditions that are appropriate for Indiana high school football players," said IHSAA commissioner Bobby Cox in an email. "It is unfortunate that individuals have made public statements without apparent research into the measures the IHSAA have implemented to promote the health and safety of our student athletes."
Heat stroke is the 3rd leading cause of sudden death in sports. But trainers say it is 100 percent preventable when it is recognized and treated correctly. Just a tub full of ice water can be the emergency response needed.
NATA Executive Summary Select Highlights: Exertional Heat Illnesses Position Statement
(full statement to be published in upcoming issue of the Journal of Athletic Training)
Prevention of Exertional Heat Illnesses:
Treatment of Exertional Heat Illnesses:
Specific recommendations for pre-season heat acclimatization protocol:
Recommendation of assessing rectal temperature if exertional heat stroke is suspected:
Best practices strongly advise the use of rectal temperature for the assessment of body temperature in a suspected exertional heat stroke patient. It is discouraged to use inaccurate devices such as oral, tympanic, etc.
Specific protocol for the treatment of exertional heat stroke:
The new guidelines suggest a specific step-by-step protocol for cold water immersion for the clinician to implement with an exertional heat stroke patient. This protocol is backed by research exhibiting a 100 percent survival rate when initiated quickly and properly.
Identification of approximate cooling rates for an exertional heat stroke patient:
While cooling rates may vary, the cooling rate for cold water immersion will be approximately 0.37°F/min. or about 1°F every three minutes when considering the entire immersion period for an exertional heat stroke patient. This provides an approximate treatment time for clinicians if rectal temperature monitoring is not possible during treatment.
Recommendation of "cool first, transport second":
The current document now states that a patient suspected of having exertional heat stroke must be cooled via cold water immersion for the full treatment time prior to being transported to a hospital; and that this must be stated in the school's emergency action plan.
A substantial revision of tables and figures have been amended to provide more clinically applicable information.
Removal of hyponatremia as an exertional heat illness:
Hyponatremia was removed from the current guidelines as this condition is not considered to be a true heat-related illness.
"Death from exertional heat stroke is 100 percent preventable when proper recognition and treatment protocols are implemented," concluded Casa. "Putting the right programs into place is essential to prevent and treat exertional heat illnesses and ensure appropriate care is in place."
The IHSAA Board of Directors approved multiple changes regarding the conduct of football practices and summer activities at their annual meeting in May. Rule 15-3.3 has been totally rewritten to include the following restrictions:
A School, and players from the School's football program, may participate in Football Activities (participation in any football related activities while wearing helmets or shoulder pads) under the following standards:
Furthermore, the Board approved substantive changes regarding the first week of authorized football practice and practice protocol throughout the season. Rule 54-4 now provides the following:
All organized football practices by players or teams shall be limited to the period beginning Monday of IHSAA calendar week 5 and terminating on the date the team is eliminated from the Football Tournament Series.
Football practices must adhere to the following: