Active Voice: Exertional Heat Injury — What You Can Do to Prevent It
By CAPT Scott Pyne, M.D., FACSM

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

CAPT Scott Pyne, M.D., FACSM, is the Navy Surgeon Generalís Sports Medicine Specialty Leader and an Assistant Clinical Professor of Family Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In addition to directly supporting numerous military medical treatment facilities, he has served as team physician for the United States Naval Academy and medical director of the Marine Corps Marathon. His diverse professional interests include the medical management of exertional heat illness.

Ten years ago, the highly publicized exertional heat stroke death of Minnesota Vikingsí Korey Stringer rocked the athletic world and increased the attention placed on the prevention of similar tragedies. Exertional heat illness has been a well-known entity in military and occupational environments, but the science and systematic education, prevention and treatment strategy for athletes and those entrusted with their care has only recently been developed. The ACSM Position Stand on Exertional Heat Illness During Training and Competition is an excellent resource outlining prevention, identification and treatment recommendations for these conditions.

Regrettably, this summer has brought another wave of heat-related and heat-suspected deaths. While numerous contributing factors for the development of heat injury have been identified, by far the most common causative factor is an individualís degree of exertion relative to their bodyís ability to dissipate the heat generated with exercise. Each athleteís response to exertion in the heat is different and difficult to predict. Accordingly, caution should be paid to team, group and timed activities where peer, coach and leadership encouragement may lead to an individual overextending in the heat. Partnership between coaches, athletes, parents and medical staff is vital.

Acclimatization is an important factor in decreasing the risk of heat injury. Athletes require several days of graduated exercise sessions in the heat to prepare for full participation. This is particularly true for those whose leisure and occupational activities are predominantly in climate-controlled environments. Special attention is directed towards American football, responsible for the majority of deaths, where the size of the athletes and the properties of the uniform interfere with heat dissipation. NFL and NCAA football have both mandated an acclimatization period, but unfortunately many high school and recreational teams have not.

Before conducting activity in hot, humid environments a preventive strategy should be developed to include education, recognition and actions to be taken for individuals suspected of suffering from heat injury. Athletes at risk include those who are ill, dehydrated, taking certain medications, overweight, poorly conditioned or with sickle cell trait. Appropriate recognition and immediate on-site treatment are crucial in saving lives as the time of temperature elevation is related to the amount of damage incurred. Athletes who have difficulty keeping up, appear confused, vomit or collapse should raise concern for potential heat injury and should be removed from training. Diagnosis with a rectal temperature is recommended and initial treatment is as simple as stopping activity, removing constrictive clothing/uniforms, cooling with ice water immersion, shade, fanning and immediately notifying a higher level of medical care. Suspicion of exertional heat injury should also be conveyed to emergency medical personnel, so treatment can be continued without delay.

Prevention of all exertional heat injuries should be a common goal of athletic training and participation, but it is equally important to ensure prompt recognition and immediate treatment to prevent devastating injuries and tragic deaths.