Heat illness

Heat Illness

Image result for heat cramps
 
New England weather varies greatly between the four different seasons.  The frigidly cold temperatures of winter with snow and ice are a stark contrast to the hot and humid summer months.  Currently in the middle of summer, New England has been battling scorching high temperatures during the month of July.
 
As Tactical Athletes are required to work in any and every weather condition, they are both particularly susceptible to sustaining heat illnesses themselves, if not treating the general public suffering from these conditions.  There are four general classifications of heat illness:
·       Heat cramps:  Muscle cramping caused by exercising and/or working in high temperatures, with inadequate replacement of fluids and/or electrolytes.
o   Signs/symptoms:  Muscle pain, spasm, contraction.
o   Treatment:  Stop activity, rehydrate, electrolyte replacement, gentle stretching of the affected muscles.  If prolonged heat cramping occurs, seek medical treatment. 

·       Hyponatremia:  Decreased levels of blood sodium levels.  During vigorous activities, Athletes sweat.  Sweat consists of water and electrolytes.  Both water and electrolytes need to be replaced by the Athlete.  If fluid levels are replaced, but electrolytes (sodium is an electrolyte) are not also replaced an imbalance of blood sodium levels occur. 
o   Signs/symptoms:  Headache, mental confusion, nausea, vomiting, extremity edema, excessive water consumption.
o   Treatment:  Electrolyte replacement.  For severe symptoms consult a physician.

·       Heat exhaustion:  Classified as a moderate illness caused by completing strenuous physical activity in hot and humid environments.  This condition is characterized by decreased cardiac output. 
o   Signs/symptoms:  Dizziness, diarrhea, depleted energy, decreased coordination, fainting, headache, nausea, vomiting, profuse sweating, pale skin, stomach cramps, core temperature <104°F/40°C, central nervous system dysfunction. 
o   Treatment
§  Immediately remove from activity
§  Seek a cool and shaded environment
§  Remove excess clothing and equipment
§  Lay down with legs elevated above the heart
§  Rehydrate with oral fluids and/or IV normal saline
§  Place ice packs behind the back of the neck, under the arms, in the groin, and behind the knees
§  Monitor vital signs
§  Transport to an emergency medical facility
o   Return to activity:  Follow-up with a physician, consult a Certified Athletic Trainer on proper return to activity guidelines. 

·       Exertional heat stroke:  Identified as the most severe heat illness.  This condition is an elevated core body temperature 104°F/40°C, caused by strenuous physical activity in increased environmental temperatures.  When the core body temperature reaches these high levels, there is central nervous system abnormalities and organ system failure.  If not identified and treated quickly, this condition is life threatening and potentially fatal. 
o   Signs/symptoms:  Altered consciousness, confusion, combativeness, decreased blood pressure, decreased mental acuity, diarrhea, dizziness, headache, increased breathing rate, irrational behavior, nausea, vomiting, hot and wet or dry skin (individual may have stopped sweating), weakness, seizures, core temperature 104°F/40°C, central nervous system dysfunction, organ failure. 
o   Treatment
§  Immediately remove from activity
§  Remove excess clothing and equipment
§  Whole body cooling performed as quickly as possible.  This is best achieved through cold water immersion.  If cold water immersion is not possible, place the individual under cold, running water or place ice packs behind the back of the neck, under the arms, in the groin, and behind the knees.  The individual’s core body temperature must be cooled as quickly as possible to limit organ damage. 
§  Monitor vital signs
§  Start an IV of normal saline
§  Once the core body temperature has decreased to 101°F - 102°F, the individual should be immediately transported to an emergency medical facility.
o   Return to activity:  Follow-up with a physician, physician clearance to return to physical activity, consult a Certified Athletic Trainer on proper return to activity guidelines.
Image result for heat cramps

Ways to prevent heat illness:
·         Stay well hydrated before, during, and after strenuous activity
·         Take multiple rest breaks during strenuous activity if possible
·         Acclimatize to the heat
·         Practice good nutrition
·         Get enough sleep
·         Regularly exercise
·         Limit excessive caffeine, drug, and alcohol intake in warmer weather
·         Stop physical activity if signs or symptoms of heat illness occur
·         Look out for your fellow Tactical Athletes

Heat illnesses are serious medical conditions.  If not properly identified and treated, serious organ damage can occur, which may be fatal.  Heat illnesses can be avoided if the proper steps are taken.  As Tactical Athletes, you need to be aware of your surroundings and limit your risk factors.  All Tactical Athletes’ work as part of a team, it is important to look out for each other. 

By:  J. Scott, DPT, ATC

Sources:
The National Athletic Trainers’ Association position statement on Heat Illness
The Centers for Disease Control Heat-related illness

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