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Preventing Heat-Related Illness

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The reports of sport-related heat illness cases among athletes are increasing, and they occur at all times of the year. Heatstroke caused by excess exertion can be a seriously life threatening, even fatal event, and should be taken seriously by coaches, health facilities, instructors and exercise enthusiasts. Heat-related illness in sports can happen to anyone, including young healthy athletes as well as the young men and women who fight for this country’s freedom, our soldiers.  

The importance of having the knowledge of how and who to call for assistance in the event of a heat-related illness is personal to me. I have a dear friend whose son suffered an untimely death due to the heat and lack of knowledgeable coaching personnel and equipment nearby. Parents, coaches and group exercise instructors need to be particularly aware of the risk factors for heat-related illnesses, as they are responsible for ensuring that the risk of heatstroke is minimized during training, games and classes.

There are several heat-related illnesses such as heat exhaustion, heat syncope and exertional heat stroke. Let’s review the signs and symptoms associated with each of these conditions, as well as the depth of risk to the victim.

Heat-related illnesses occur when the body’s temperature control system is overloaded, and “heat related illnesses can range from mild discomfort to death” (Johnson, Haskvitz, Brehm, 2009, p.48). Coaches, athletic trainers, strength and conditioning coaches, support staff and athletes should be aware of the warning signs and call for help when needed. Muscle cramps, fatigue, dizziness, nausea, mild confusion, fainting, disorientation, psychotic behavior and physical collapse are some of the signs and symptoms of heat-related illnesses.

Cramping muscles are usually a result of fatigue and historically have been believed to be a result of dehydration and/or loss of electrolytes, although science has yet to determine whether or not this is true. However, an endurance athlete training long and hard in a heated environment can reach a level of fatigue that will lead to muscle cramps.

Heat exhaustion may result in signs and symptoms such as fatigue, dizziness, nausea and mild confusion. Although not as dangerous as heat stroke, these symptoms are good indication that the athlete has lost excessive amounts of fluid and has a loss of blood flow to the muscle and skin. Their body is losing the ability to control its temperature. 

There is also a concern with heat syncope. Heat syncope is usually a result of the loss of blood flow to the heart and brain, and lightheadedness and fainting may result. A reduction in blood flow to a person’s brain can alter their ability to remain in control of their actions.

But it is external heat stroke (EHS) is the most serious heat-related illness. It can, if not treated immediately and properly, lead to death. Recognition of EHS is the key to survival. The victim of EHS may present psychotic behavior, lose balance, collapse, become unconscious and have a body temperature that is in excess of 104 degrees. Cooling the athlete immediately should be first course of action. Complications related to EHS may include, “hepatic failure, renal (kidney) failure, disseminated intravascular coagulation, rhabdomyolysis, and the adult respiratory distress syndrome” (Yuval, 2004, p.184). Every athletic and/or sport facility should have in place a policy and procedures that will emphasize how to handle the greatest risk, EHS.

Coaches and athletic trainers are typically the first professionals present and on site when an emergency occurs, so it is therefore imperative that they are confident in taking the best course of action to prevent, recognize and treat causes of sudden death.

The National Standards for Sport Coaches recommend that all coaching educators, athletic administrators, athletes and even their families adhere to Domain 2, under Safety and Injury Prevention, Standards 9 & 10. 

To summarize these recommendations, as coaches and instructors we should be able to implement an already established Emergency Action Plan (EAP) that requires us to recognize, access and act upon an emergent situation by reaching out to first responders and utilize all resources available to quickly take action.

Policies should include a requirement to have an AED (Automatic External Defibrillator) on site during all trainings, games, classes and recreational activities. These policies may also require that all those responsible and involved with the safety of our athletes to be not only CPR certified but also AED certified. 

Eight key areas to identify and plan for to avoid and treat heart-related illness:

  1. Emergency personnel typically include team physicians, emergency medical technicians, certified athletic trainers, student athletic trainers, coaches, team managers and any support staff necessary for intended sport.
  2. Emergency communication should include a phone tree list of names and numbers to call for all relevant parties necessary. In the event cell service is lost, location of landline should be available for ALL venues (home or away).
  3. Emergency equipment such as spine boards, straps, automated external defibrillators (AEDs), AED pads, AED batteries, thermistor (rectal thermometer), cooling packs (and/or ice), splinting equipment, etc. should be available.
  4. The roles of first responders should be to establish a safe scene and administer immediate care to the athlete, to active Emergency Medical Response (EMS) if necessary, retrieve appropriate equipment and direct EMS to the scene. 
  5. Medical transportation (trauma unit) should be contacted for dispatch for any apparent heat exertion or sports-related collapse to transport victim to hospital.
  6. Venue/facility map should include major street names, highlighted entrance routes/gates to venue and all major buildings.  
  7. Most importantly, an updated policy Emergency Action Plan should include on its venue map notations of all locations containing AEDs.
  8. All Medical Staff on and off site involved in the care of our athletes must provide proper and authentic certification of their qualifications.

“Despite the National Trainer’s Association position statement on exertional heat illnesses, untimely preventable deaths continue to occur in young athletes. Some of these deaths are cardiac related and yet despite state laws on cardiac arrest and defibrillator (AED), devices in public domains, colleges and university athletic facilities may not have these AEDs readily available. This omission may be due to the misunderstanding that young athletes are not susceptible to sudden life threatening events. This notion however suggests discrimination of sorts due to age and athletic prowess. Currently, the NCAA states that exertional heat stroke is the third leading cause of on the field death in athletes” (Ciancola, 2012).

A comparison of the policies of NCAA and the High School Level when heat is a factor during practice times created by the Korey Stringer Institute at UConn can be viewed by clicking on following link

Planning Ahead
Practice and games are not the only scenarios where a heat-related illness can strike and result in sudden death. As educators in the fitness field, we need to do our due diligence in informing active students and staff about the risks of exertion in high temperatures.

If you have a chance, I highly recommend you take a look at the Real-Time Registry of Sudden Death in Sport and Physical Activity by going to the Korey Stringer Institute’s web site—you may be surprised to see victims young and old. 

Our responsibility as educators is not limited just those we teach or coach. We should be concerned with and ensure the safety of all recreational athletes and spectators as well.

Be safe and stay cool!


Ciancola, M., (2012). Letter to CT State Legislature and Public Health Committee.

Heled, Y., Rav-Acha, M., Shani, Y., Epstein, Y., & Moran, D. (2004). The "golden hour" for heatstroke treatment. Military Medicine, 169(3), 184-186.

Johnson, J., Haskvitz, E., Brehm, B., (2009) “Applied sports medicine for coaches”. Philadelphia, PA: Lippincott, Williams & Wilkins.

Korey Stringer Institute. (n/d). Information for athletic trainers. Retrieved from:

National Association for Sport and Physical Education. (2006). Quality coaches, quality sports: National standards for sport coaches (2nd ed.). Reston, VA: Author

Author: Donna Minotti

Donna Minotti is a health and wellness coordinator for Covidien, and Adjunct Faculty Member at Quinnipiac University. She will receive her Masters in Athletic Coaching Education at the end of August 2013 and has been a proud member of the Master Instructor Team since 2007.

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