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Heat & Hydration Strategies

�  There were 120 sports-related

deaths of young athletes in 2008-2009; 49 in 2010; and 39 in 2011

�  Approximately 8,000 children are treated in emergency rooms each day for sports-related injuries.

�  High school athletes, especially

males, are at the highest risk of suffering exertional heat illness requiring treatment in U.S. hospital emergency rooms.

�  31 high school football players died of heat stroke complications between 1995 and 2009. (more then the last 35 years) (?)

�  64.7 percent of football players sustaining a heat illness were either overweight or obese.

�  Exertional heat stroke has proven to be 100 percent survivable when immediately recognized and aggressively cooled on site.

�  Two-thirds of kids show up for practice significantly dehydrated

�  Only 42 percent of high schools have access to athletic training services.

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Study Finds Exertional Heat Illness Highest In High School Football Examining data for the period 2005 to 2011 obtained from the National High School

Sports-Related Injury Surveillance System, High School RIO

�  Estimated 51,943 EHI events occurred nationally

from 2005 – 2011 �  an estimated 9,000 high school athletes are treated

for exertional heat illness (EHI) annually

�  Most illness occur in August, after more than 2 hours of practice

�  75.2% of EHI events occurred during practice, 23.6%

during competition �  The EHI rate has decreased over the last 6 years

�  The highest EHI rates (per 100,000 athletic exposures) were reported, not surprisingly, in four warm-weather states: Florida (21.60), Alabama (17.92), Arizona (13.63), and Kentucky (13.08).

� 

Study Finds Exertional Heat Illness Highest In High

School Football Examining data for the period 2005 to 2011 obtained from the National High School Sports-Related Injury Surveillance System, High School RIO

�  Among football players, EHI occurred most frequently among offensive lineman (35.7%), defensive linemen (16.9%); and linebackers (9.7%);

�  The next-largest numbers of EHI events occurred in girls' volleyball (4.8%), girl's soccer (3.0%) and boys' wrestling (3.0%) (Cross Country)

�  The majority of EHI events occurred in August (60.3%), and, among these, most occurred during the pre-season (90.4%)

(Acclimatization)

�  The majority of EHI events involved varsity athletes (58.9%), followed by junior varsity (19.3%) and freshman (12.2%) athletes

Key Points �  Football highest risk (Cross

Country??) �  Majority of athletes come

to practice/competition dehydrated.

�  Possible high rate of EHI in Arizona.

�  High rate of EHI during Pre-season

�  All levels of competition are at risk. (F/JV/V)

�  Larger / Obese athletes highest risk.

�  Athletes should have a total of 6-7 minutes of rest every 30 minutes. (Dr. Casa)

�  80-90% of deaths occurs during the first 3-5 days of practice. (Dr. Casa)

�  Majority of deaths occur during the second practice. (Dr. Casa)

�  Prevention is the key!!! �  EHI 100% survivable

when treated correctly.

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Heat Prevention Checklist (NATA Position Statement: Exertional Heat Illnesses Sept 2002)

�  Pre-event preparation ◦  Encouraging Acclimatization ◦  Identified high risk athletes ◦  Educate Coaches / Athletes /

administrators / Parents (Meetings) ◦  Sweat rate calculations (KSI)

�  Checking hydration status ◦  Body weight before and after

activity ◦  Do athletes know how to assess

urine (Urine Color Charts) (Frequency / Color)

�  Environmental assessment ◦  Monitoring weather with WBGT (82

F) Black Extreme or hazardous????

�  Coaches’ and athletes’

responsibilities ◦  Ample rest/water break ◦  Recognize athletes in distress ◦  Control intensity of practice ◦  Modifications made when needed

�  Event management ◦  Adequate amounts of fluids

provided (Cold) ◦  Provide shade if possible

�  Treatment considerations ◦  EAP in place ◦  Know Signs & symptoms of heat

illness ◦  Accessible Cold tub / Large ice

towels

Korey Stringer Institute

Recommended acclimatization is first 10-14 days of practice!!!

In states that have passed heat acclimatization guidelines, there have been ZERO deaths in high

school athletics!!  �  States / Entity’s (Adopted

Guidelines) NCAA National Football League Arizona Arkansas Connecticut Florida Georgia Iowa Mississippi Missouri New Jersey North Carolina Texas Utah

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Heat Acclimatization

Acclimatization Protocol �  ACCLIMITIZATION �  This can be accomplished by gradually increasing the

duration and intensity over 10 days of supervised activity ◦  Begins the first day of AIA permissive week. ◦  Practices will be conducted - �  5:00pm – Start practice with pad

modifications � Morning practices must meet safe competition

protocol, and be concluded by 10am. ◦  Practices that involve physical activity, must not exceed

3 Hours

Acclimatization Protocol

�  Educate coaches, athletes, and parents regarding heat illness and hydration ◦  The Athletic Trainer will provide

guidelines for heat illness and proper hydration

�  Coaches must ensure: ◦  Each athlete is allowed water at

anytime ◦  Planned water breaks on practice

schedule ◦  Allow athletes a minimum of 3

minutes during planned water breaks, to reduce metabolic heat production and encourage evaporative cooling

�  ***Remove helmets during breaks

◦  Cross Country (Recommendations) �  Alternating Days of

Morning Practices/Indoors and Afternoon/After school reduced running distance (ON CAMPUS) �  Example : �  M, W, F – Morning

Practices �  T, Th -- After School

reduced

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Environment Assessment

Wet Bulb Glob Temperature WBGT Dry Bulb (DB) - Shielded from direct sunlight - reads actual air temperature.

Wet Bulb (WB) - will read varying temperatures depending on the rate of evaporation. Rate of evaporation varies with the humidity level.

Black Globe (BG) - With black copper sheath over bulb - A temperature measurement of the intensity of the sun.

Kestrel 4600 Heat Stress Tracker General Heat Index Checker WBGT 8778

 

Environment Assessment Exertional Heat Illness during Training and Competition (American College of Sports Medicine Position Statement 2007)

SAFE COMPETITION PROTOCOL (After Acclimatization) Below Danger Zone WBGT (86 and below) �  Practice/competition as normal ◦  Full pads ◦  Regular running schedule (football, cross country) ◦  Water breaks every 15 minutes or as needed by the

individual

Environment Assessment Exertional Heat Illness during Training and Competition (American College of Sports Medicine Position Statement 2007)

Danger Zone WBGT (87 – 89) �  Practice/competition with modifications. ◦  Reduced amount of equipment worn and/or adjust start time until

readings return Below Danger Zone �  Start practice without Pads �  Medical staff will inform coaches of practice modifications �  Recommended modifications: �  Half Pads can be used for contact drills (Helmet and

Shoulder Pads) �  Reduce intensity �  Reduced conditioning, without pads �  Water breaks every 10 – 15 minutes or as needed by the

individual ◦  Reduced running schedule – (Cross country practice on campus with

reduced running schedule)

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Environment Assessment Exertional Heat Illness during Training and Competition (American College of Sports Medicine Position Statement 2007)

Critical Zone WBGT (90 and above) ◦  Practices modified (No Helmet / Pads, and no running);

competition postponed or cancelled / rescheduled ◦  Adjust start time until readings return Below Critical Zone

– recommendation: � Practice moved indoors � Practice or competition moved to a later date or time

Hydration Strategies

�  Education ◦  Athletes, Coaches, Parents ◦  Hydrate all day ◦  Athletes carry fluids with them at school (Rules) ◦  Athletes monitor hydration status

�  Urine color / frequency �  Calculate sweat rates ◦  Exercise performance is impaired by a fluid loss of 2%of body

weight ◦  By the time this thirst drive is felt the athlete is already in

a state of dehydration ◦  Drink every water break ◦  For recovery, supplement with a carbohydrate drink that contains

some sodium to aid in replenishment of glycogen stores and electrolytes (Good Nutrition)

Fluid Distribution �  Resources ◦  AzATA.net – Resources �  Guidelines for the Safe Handling of

Drinking Water, Ice, and Dispensers at Athletic Facilities

�  Proper sanitization �  Fluid Temperature (Cold) ◦  Fluid temperature influences the amount

consumed. �  Competitions ◦  At 6-8% carbohydrate concentration,

sports drinks can be absorbed 30% faster than water.

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Thank you!