Exertional Heat Illness

Heat Information
http://www.nfhslearn.com/flash/Gat
orade_demo_v3_stream.aspx
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Heat illness is inherent to physical activity and
its occurrence increases with rising ambient
temperature and relative humidity.
Potential Signs and Symptoms to Recognize:
1.
2.
3.
4.

Heat (Muscle) Cramps
Fatigue
Profuse or NOT Sweating
Confusion
5. Lightheadedness
6. Dizziness
7. Nausea/Vomiting
If an athlete is displaying any of these signs or
symptoms remove from participation
immediately. Begin to cool & rehydrate as
quickly as possible and DO NOT let the athlete
return to participation.
Heat (muscle) Cramps:
Exercise-associated muscle (heat) cramps
represent a condition that presents during or
after intense exercise sessions as an acute,
painful, involuntary muscle contraction.
Proposed causes include fluid deficiencies
(dehydration), electrolyte imbalances,
neuromuscular fatigue or any combination
of these factors.
Treatment:
 Try to rehydrate orally, preferably
with electrolyte solution
 Apply ICE to the affected area
 Encourage athlete to counter
contract opposing muscle group
 Light stretching or massage is
permissible
 If cramps do not subside or if the
athlete is vomiting; the athlete may
need I.V. fluids
Heat Syncope - Orthostatic Dizziness:
• May occur when a person is exposed to high
environmental temperatures. Usually occurs
within the first five days of acclimatization,
before blood volume expands.
Treatment:
• Remove athlete from participation to a cooler
place
• Try to rehydrate orally; preferably use
electrolyte solution
• Monitor vital signs and cognitive status
Heat exhaustion or heat stroke
Treatment:
• Activate EAP and call 911
• Remove equipment and clothing
• Remove athlete from participation to
an air conditioned space if available
• Begin aggressive cooling (ice packs,
cold shower, cold water immersion)
• Try to rehydrate orally
• Monitor vital signs and cognitive
status
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Acclimatization is a must
If possible, arrange training for
the coolest part of the day or go
indoors.
Rest in the shade during breaks.
Remove excess clothing; take
advantage of wind, fans or cooling
devices to cool.
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Use minimal, loose-fitting clothing made from natural
fibers to promote heat loss.
Ensure players are fully hydrated prior to participation.
16-20 oz of fluid, 2 hours before and at least 8-10 oz every
15 minutes during is a must.
Drink properly formulated sports drinks to delay onset of
fatigue during exercise and to provide carbohydrates.
Especially important as muscles favor carbohydrate
metabolism in warm conditions.
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http://www.osaa.org/heatindex/
Under 95° Heat Index
100°- 104° Heat Index

All Sports

All Sports

Provide ample amounts of water. This
 Provide ample amounts of
means that water should always be
water. This means that water
available and athletes should be able to
should always be available and
take in as much water as they desire
athletes should be able to take in

Optional water breaks every 30 minutes
as much water as they desire.
for 10 minutes in duration
 Mandatory water breaks every

Watch/monitor athletes for necessary
30 minutes for 10 minutes in
action
duration

Check and record Heat Index during
 Watch/monitor athletes for
each break and make necessary
necessary action
modifications
 Check and record Heat Index
during each break and make
95°- 99° Heat Index
necessary modifications

All Sports
 Alter uniform by removing

Provide ample amounts of water. This
items if possible
means that water should always be
available and athletes should be able to
 Allow for changes to dry t-shirts
take in as much water as they desire
and shorts

Mandatory water breaks every 30
 Reduce time of outside activity
minutes for 10 minutes in duration

Contact sports and activities with

Watch/monitor athletes for necessary
additional equipment
action
 Helmets and other possible

Check and record Heat Index during
equipment removed if not
each break and make necessary
involved in contact or necessary
modifications
for safety

Contact sports and activities with additional
equipment

Helmets and other possible equipment
removed if not involved in contact
Above 104° Heat Index

All Sports
 Limit outside activity in practice and/or play.
 Watch/monitor athletes for necessary action
 Check and record Heat Index during each break and make necessary
modifications.
 Inside practices are limited to the following:
 Walk-throughs
 Weight training
 Meetings
 Provide ample amounts of water. This means that water should always be
available and athletes should be able to take in as much water as they desire.
 Mandatory water breaks every 20 minutes in a shaded area
 Contact sports will conduct practice in helmets and shoulder pads with the
option to remove one or both pieces of equipment as conditions change.
WBGT
Category
°F
1
<=79.9
2
80-84.9
3
85-87.9
4
88-89.9
5
=>90
WBGT
°C
<=26.6
26.7-29.3
29.4-31.0
31.1-32.1
=>32.2
Flag
color
No flag
Green
Yellow
Red
Black
1.
2.
3.
No limits, suggested breaks
for hydration every 30
minutes depending on
exertion.
No limits, must hydrate
every 30 minutes and at
least a 5 minute break in
shade with fans.
Limit strenuous activities to
a maximum of 20 minutes,
hydration and cool down
break in shade for at least 5
minutes.
4.
5.
Limit strenuous activities
to 20 minutes, hydration
and cool down break in
shade for 10 minutes.
Limit strenuous activities to
15 minutes, hydration and
cool down break in shade
for 10 minutes. Walkthroughs, weight training,
and meetings are suggested
if conditions continue to
worsen.


Hydration breaks at
least every 30 minutes
followed by the
recommended cool
down
Equipment worn for
practices will be
adjusted according to
Heat Index guidelines
which will be
monitored every break
period.

Canopies, fans/misters,
water coolers, Gatorade,
and ice towels will be
located adjacent to the
shaded area, all
hydration and cool
down breaks will be
taken there or in other
shaded areas


During practice make fluids readily available. Every
15 minutes athletes should consume 7 to 10 oz of
fluids. (DO NOT DENY WATER BREAKS)
Remember to calculate your rest/break sessions based
on temperature to humidity forecast. Provide some
sort of shade to allow the athletes to get out of direct
sun exposure.
Post-exercise hydration should aim to correct any
fluid loss accumulated during the practice or event.
Ideally completed within 2 hours, rehydration should
contain water to restore hydration status,
carbohydrates to replenish glycogen stores, and
electrolytes to speed rehydration.
 Urine

Color:
Urine color of a well hydrated
individual should be clear to slightly
tinted. If the urine output is the color
of “Apple Juice”, the individual is
dehydrated and should be rehydrated
before participating.
AM I HYDRATED? - Urine Color Chart
1
2
If urine matches 1, 2, or 3, you
are properly hydrated.
3
Continue to consume fluids at
the recommended amounts.
4
If your urine color is below the
RED line, you are DEHYDRATED
5
and at risk for cramping and/or a
heat illness!
6
YOU NEED TO DRINK
MORE WATER!
7
8

Weight Loss:
Weigh athletes prior to first practice. (DO NOT go by
weight listed on the athletes’ pre-participation physical)
 Weigh athletes pre- and post-practice.

+1 to -1 percent of total body wt. loss = Well Hydrated
2.
**-1 to -3 percent of total body wt. loss = Minimal
If an athlete has not recovered to less than -3% total body
weight, he is held out until he makes weight.
3. -3 to -5 percent of total body wt. loss = Significant
Notify Parents of potential hazards
1.
4.
> 5 percent of total body wt. loss = Serious Dehydration
Notify Parents and suggest taking to ER for IV fluids
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Educate athletes AND parents on effects of
dehydration on physical performance.
Inform athletes on how to monitor hydration
status.
Convince athletes to participate in hydration
protocols based on sweat rate, drinking
preferences, and personal responses to different
fluid quantities.
Encourage coaches to mandate rehydration during
practices and competitions, just as required other
drills and conditioning activities.
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ID at risk heavy sweaters
Have scale accessible to weigh before and
after practices, alert athlete and or parent if
an unusual amount of weight loss.
Provide optimal oral rehydration solution
(water, sport drinks, & electrolytes) before,
during, and after exercise.
Implement hydration protocol during all
practices and games, and adapt as needed.
Finally, encourage event scheduling and
rule modifications to minimize the risks
associated with exercise in the heat
•
•
The Golden Hour?
The Golden ½ Hour – the
first 30 minutes of heat
illness are the most crucial
for treatment!

Prepare ice water
immersion
On the field or in a tent,
half-fill tub or wading pool
with water and ice (before
use, check water source to
see how quickly tub fills).
 Stock tank can be filled
with ice and cold water
before an event or have tub
half-filled with water and
coolers of ice next to tub to
prevent keeping tub cold
throughout the day.

Ice should cover the
surface of the water
 If the athlete collapses
near an athletic training
room, a whirlpool tub
or cold shower may be
used.

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

Cover as much of the
body as possible with ice
water while cooling
If full body coverage is not
possible, cover the torso
as much as possible
Keep the athlete’s head
and neck above water, an
assistant may hold the
victim under the armpits
with towel or sheet
wrapped across the chest
and under the arms.


Place an ice/wet towel
over head and neck while
body is being cooled in
tub
Use a water temperature
below 60ºF
•Vigorously circulate water
During cooling, water should be
continuously circulated or stirred
to improve the water-to-skin
temperature gradient, which
optimizes cooling. Have an
assistant stir the water during
cooling.
Continue medical assessment
• Vital signs should be monitored at
regular intervals.
• It may be helpful for an assistant to
stand nearby in case the athlete
becomes combative.
• Other assistants may be needed to lift
or roll the athlete if vomiting occurs.

Cooling duration
Continue cooling until the
patient’s rectal temperature
lowers to 39ºC (102ºF)
 If rectal temperature cannot be
measured and cold water
immersion is administered, cool
for 10-15 minutes and then
transport to a medical facility
(1°F/3 minutes)
 If rectal thermometer is not being
used because of lack of proper
medical help, remove from water
after shivering begins, a natural
reaction of the body to warm
itself


Patient transfer

Remove the patient from
the immersion tub only
after rectal temperature
reaches 39ºC (102ºF) and
then transfer to the
nearest medical facility via
EMS as quickly as
possible
Football Pre‐season Regulations
1. Football practice may begin on Monday of
week #5.
2. Schools cannot have consecutive days of
“two‐a‐day” practices.
3. Three days of conditioning with only
football helmets and shorts are mandatory
before full pads are worn.
4. Thursday of week #5 is the first permissible
practice with full equipment.(August 4)
5. Student athletes shall not engage in more than
three hours of practice activities on those days
during which one practice is conducted.
6. Student athletes shall not engage in more than
five hours of practice activities on those days
when more than one practice is conducted.
7. The maximum length of any single practice
session is three hours.
8. On days when more than one practice is
conducted, there shall be, at a minimum, one hour
of rest/recovery time between the end of one
practice and the beginning of the next practice.
What Counts
WHAT DOESN”T COUNT
Actual on field/court practice
Meetings
Sport specific skill instruction
Weight training
Mandatory conditioning
Film Study
Voluntary Conditioning
Water breaks
Rest breaks
Injury treatment
No activities (including meetings, weight training, and film study) can occur
during the one hour
rest/recovery time between the end of one practice and the beginning of the next
practice (on days
when more than one practice is scheduled). This time is exclusively for students
to rest/recover for
the following practice session.


Weigh in and out
 Weigh in before and
after practice and
chart to keep records
for coaching staff and
athlete
Water breaks

every 15 – 20 minutes in
shade, depending on
weather and intensity of
practice

Cold water emersion
after practice
 After practice wading
pools are setup up
with water and ice for
athletes to cool down
their core
temperature
 This aids in healing of
leg muscles and
alleviates cramping
later

Water available at all times during practice


Heat Index Calculator


Water bottles will be available to all groups for
drinks between reps or plays
Take readings every water break and adjust
schedule and equipment as indicated by reading
and chart
Gatorade after practice

10 gallons mixed for athletes after practice


Have parent meetings for necessary activities.
We will disseminate information we have to
parents on, proper hydration, nutrition, and
rest. Let them know the protocols that we are
using are accepted and safe for their athletes.
R:\Athletic EAP\Hydration Campaign Printed Information.pdf
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Have canopies, misters, tents, and fans set up
for a break area
We will have water and Gatorade available at
all breaks
Athletes will take off shoulder pads and
helmets during water and cool down breaks to
aid in getting core temps down
Have cold water emersion tank at break station
with water in it and ice ready if needed
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We will be having a Supplemental Instruction Program (SIP) this
year for students who do not have a 2.0 or higher grade point
average.
I will be having meetings with the parents of those students who
qualify.
Monday and Wednesday from 3:30-5:10
Two tardies of up to 5 minutes will be allowed.
 Must remain in SIP for an additional 20 minutes
During semester student is enrolled: (Immediate Suspension)
 No unexcused absences
 No out of school suspension
 No criminal convictions

Maintain Eligibility



Pass 4 academic courses and earn a minimum of 2.0
GPA (Out of SIP)
Pass 4 Academic courses and show improvement of
at least one tenth of one point in his/her GPA after
first semester of SIP. Student is in SIP for the next
semester but must make a 2.0 to remain eligible.
The rule restricts a student to a maximum of two
consecutive semesters in the SIP any time a student’s
GPA falls below a 2.0 for the previous semester.
The Arkansas Activities Association Board of Directors has adopted the following
guidelines for dealing with a concussed student athlete:
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1. No athlete should return to play or practice on the same day of a concussion.
2. Any athlete suspected of having a concussion should be evaluated by an
appropriate health-care professional that day (MD, DO, Nurse Practitioner,
Certified Athletic Trainer, or Physician Assistant).
3. Any athlete with a concussion should be medically cleared by an appropriate
health-care professional prior to resuming participation in any practice or
competition.
4. After medical clearance, return to play should follow a step-wise protocol with
provisions for delayed return to play based upon the return of any signs or
symptoms.
Any athlete who exhibits signs, symptoms, or behaviors consistent with a
concussion (such as loss of consciousness, headache, dizziness, confusion, or
balance problems) shall be immediately removed from the contest and shall not
return to play until cleared by an appropriate health-care professional.
Behavior or signs observed
indicative of a possible concussion:

Loss of consciousness

Appears dazed or stunned

Appears confused

Forgets plays

Unsure of game, score or
opponent

Moves clumsily

Answers questions slowly

Shows behavior or personality
changes

Cannot recall events prior to or
after the injury
Symptoms reported by a player
indicative of a possible
concussion:

Headache

Nausea

Balance problems or
dizziness

Double or fuzzy vision

Sensitivity to light or noise

Feeling sluggish

Feeling foggy or groggy

Concentration or memory
problems

Confusion
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Athletes MUST wash their hands prior to any athletic participation.
Athletes should have all cuts and scrapes covered prior to participation. After participation clean the
wound and recover.
DO NOT allow athletes to share water bottles, towels, razors, or athletic equipment. (use cups
disposable drinks, individual towels or disposable towels, and make sure athletes are wearing the
equipment that was issued to them.
Make alcohol based hand sanitizer available during practice and games.
Athletes MUST take showers after practice and games.
Disinfect ALL balls used in practice or games by spraying with Lysol.
Clean locker rooms, meeting areas, in-door workout facilities, courts, and cheerleading mats weekly
with an FDA approved solution that targets MRSA (wrestling mats should be cleaned daily)
If you have turf in your indoor facility check with manufacturer to see which disinfectants are
recommended.
Wash all soft good items daily (towels, practice gear, etc.)
Specific equipment for each sport should be cleaned weekly (volleyball knee pads, football
equipment, catcher’s gear, etc.
Weight rooms should be equipped with disinfecting wipes and hand sanitizer (wipe down weights
after each use, encourage athletes to clean hands, cover and tears on weight benches, athletes should
wear shirts while working out)
Any athlete with signs and symptoms of an infection should be isolated from the rest of the team
immediately and referred to a licensed health care professional, such as a school nurse, certified
athletic trainer, or physician