Heat stroke is preventable through careful observation, ability for immediate cooling

Knowing the symptoms and how to administer prompt treatment can make all the difference.

Heat illness is preventable and even treatable if recognized early enough. Common sense and the immediate ability to cool a victim down could be the deciding factors.

“We know that exertional heat stroke leads to the third highest number of deaths in our athletic populations,” Carrie A. Jaworski, MD, FACSM, said at the American Orthopaedic Society for Sports Medicine annual meeting. “We know that in the past 50 years there have been approximately 100 deaths related to heat. More importantly, since 1995, we have had 39 heat-related deaths.”

Jaworski also pointed out that the majority of deaths were among high school students, which led her to focus on younger athletes.

Signs of heat illness

Jaworski stressed that there were two factors present in 100% of all fatal cases: a physical effort unmatched to physical fitness, and inadequate medical triage.

To prevent heat stroke, it is important to consider which student-athletes are at risk and recognize the early signs as they are happening. Those at risk, Jaworski said, include the young, the old, the unacclimated, the fatigued and those with chronic illnesses. Coaches and physicians should also be on the lookout for students on medication.

“Also at risk are the very unfit: those who showed up to camp out of shape or obviously haven’t done their offseason workouts,” she added. “There are always a couple of those on each team.”

The spectrum of the disease runs wide, and heat cramps or heat exhaustion must be treated immediately to avoid possible progression into a more serious affliction.

Heat exhaustion can be confused with heat stroke, but the most important factor is that heat stroke sets in when the body reaches a core temperature higher than 104°F, Jaworski said.

Symptoms of heat exhaustion include profuse sweating, mild dehydration, nausea, dizziness and possibly even mild confusion or lack of coordination. Because several of these symptoms can also be the early signs of heat stroke, immediate treatment is critical.

“Remember, though, that you don’t have to first see heat exhaustion,” she added. “It can often go right into heat stroke.”

Immediate treatment

Heat stroke is present when the core temperature has climbed above 104°F and the patient has an altered mental status. When cases of heat stroke occur, the most crucial factor is not how high the core temperature gets but how long it remains elevated above a critical level of 106°F.

“The morbidity and mortality of the person is directly proportional to how quickly you can cool them,” Jaworski said. “It does not matter how high their temperature gets, but how quickly you can get that temperature down.”

Since time is the most important factor, treatment must be immediate. The key to immediate treatment is the assumption that present symptoms are heat stroke and nothing else. Cooling can be done with ice water tub immersion. Also important are the protection of the airway, the administering of oxygen to compensate for increased O₂ consumption, and the discontinuation of cooling once a rectal thermometer reading dips below 102°F.

Recognition and prevention

According to Jaworski, the prevention of heat illness comes down to a number of factors. A policy and plan must be in place to ensure a baseline for safety. In addition to temperature- and humidity-based assessments, coaches and trainers should rely on medical staff to make the determination of adverse conditions so practices can be modified or canceled accordingly.

While prevention is imperative, staff must be aware not to rely on athletes who say they are okay. Poor performance, vomiting, or a change in behavior are all indications that heat illness is setting in.

“The take-home message here is that heat stroke is preventable, and there are lots of things we can do to educate our coaches and athletes,” Jaworski concluded. “The biggest two things to remember for prevention are to acclimate to the climate and to hydrate.” — by Robert Press

Reference:

• Jaworski CA. Exertional heat stroke: Why do deaths continue? Presented at the American Orthopaedic Society for Sports Medicine 2009 Annual Meeting. July 9-12, 2009. Keystone, Colo.

• Carrie A. Jaworski, MD, FACSM, is an assistant professor of family and community medicine at the Feinberg School of Medicine at Northwestern University. She can be reached at Northwestern University — Athletics, 1501 Central St., Evanston, IL 60208; 847-491-8866; e-mail: c-jaworski@northwestern.edu.