Signs, Symptoms, and Treatment of Heat Stroke in Athletes
By Dr. Katie Kennedy, DPT
Risk factors of heat stroke
- Hot environment
- Lack of fitness
- Lack of adaption to exercise in heat
- Clothing which does not allow evaporation of sweat
- Strenuous exercise
- Lack of sleep
- Illness, especially any that involves vomiting, diarrhea, and/or fever
- Use of diuretics, emetics, laxatives, or alcohol prior to or during exercise
- Use of medications that cause dehydration - be aware of side effects of all medications you use
Initial symptoms of heat stroke
- Emotional instability or irrational behavior, including irritability, confusion, apathy, belligerence, and/or giddiness
- Fatigue disproportionate to level of physical activity
- Chills and goose bumps
- Difficulty breathing
- Hyperventilating to shed heat (just as a dog pants) - this can cause tingling fingers followed by fainting
- Incoordination and staggering — "running like a puppet on a string"
- collapse with seizure and/or coma
- TIMING IS OF THE ESSENCE! When core temperature is very high, body and brain cells begin to die from the heat.
- Immediately cool the athlete’s trunk.
- Dump the athlete into an ice-water tub. Submerge the trunk — shoulders to hip joints. Research suggests ice-water immersion cools runners twice as fast as air exposure while wrapped in wet towels.
- Ice bath or apply cold wet towels.
- COOL FIRST, TRANSPORT 2ND (to ER) - Most athletes will recover if quickly cooled (Holschen, 2018).
- Provide shade, ice water, and misting fans for rest breaks
- As the temperature rises, reduce practice pace and duration and increase rest breaks
- Have players sit in cold tubs after practice
- Hold practices earlier and later, with more time between — time for rest, recovery, and cooling
- Acclimation to heat: A week or two of moderate physical activity in the heat, say jogging 30-45 minutes a day, can jump-start heat acclimation
- Pacing of exercise
- Rest breaks
Athletes at risk of heat stroke may benefit from pre-cooling before workouts. A half hour in a cold bath will reduce core temperature and increase the buffer against heat stroke. Using cold towels or splashing cold water on face, head, and neck provides a psychological boost but little physiological benefit.
- Agonizing tableaus of endurance were seen at the 1984 Los Angeles Olympic Games and the 1995 Hawaii Ironman Triathlon.In Los Angeles, marathoner Gabriela Andersen - Scheiss, not trained for heat, entered the stadium dazed and wobbling. In a final lap that seemed to last forever, she waved off help and collapsed at the finish. In Hawaii, seven-time winner Paula Newby-Fraser, losing her lead, skipped aid stations late in the run and collapsed near the end. After rest, cooling, and hydration, she was able to walk to the finish (Eichner, 1998).
- In July of 2018, University of Maryland football player Jordan McNair died of heatstroke after an intense workout in 80-degree heat (Hahn, 2018).