Heat stroke is not a common outcome of a football practice. But, it happens often enough that sports experts say anyone who’s involved with the sport needs to be aware of the danger, how to minimize it, and what to do if players suffer heat stroke, in spite of precautions they may have taken to prevent one.
Our coaches and trainers in Wetzel County are very concerned for our youth and do a great job. “The first week of football wasn’t too bad,” said Paden City High School Head Football Coach Brent Croasmun. “But, Monday was a killer. We had the kids bring their own water bottles. However, we still have what we call the ‘water wagon’ for the kids to use.”
Symptoms of a heat stroke include confusion, vomiting, slurred speech, and staggering, but they can also be more subtle – missed assignments on the field or slight personality alterations.
“While heat stroke can happen in any sport, it’s more common in football, especially when teams are getting ready for the season,” said Dr. Frederick Mueller, director of the National Center for Catastrophic Sport Injury Research at the University of North Carolina at Chapel Hill.
“It’s the hottest time of the year and the players are wearing all that equipment,” Mueller said. “And it’s not only the heat, it’s the humidity.” However, Valley Head Coach Tom West didn’t allow his players to wear pads on the hottest day of the year, last Monday. He also had the players go to the weight room when it began thundering.
Magnolia was the only area school that had two practices on Monday. In the afternoon, players worked on offensive and defensive schemes. However, there were six players who had some symptoms of heat stroke and were not permitted to practice.
Magnolia, like Paden City, has a water wagon full of cool water to drink, but they also have Gatorade right outside the locker room. Gatorade and similar drinks not only help hydrate the body, but they also replace potassium and other critical electrolytes that are lost through sweating.
In the decade ending in 2004, 24 young football players – 19 of them in high school, three in college, and two in the professional ranks – have died from heat stroke, according to the center’s figures.
The worst year ever was 1970, when eight players died. “Eight in one year is an amazing figure,” Dr. Mueller said.
That said, heat stroke deaths are entirely preventable, experts say.
Even something as simple as undressing the person and placing them in a kiddie pool filled with ice water can save a life, said Dr. Douglas Casa, director of athletic training education at the University of Connecticut.
“There’s 100 percent survival if you immerse a person in ice water,” Casa said.
Though cooling with ice water is recommended in young patients, another technique that can be used in the pre-hospital setting is evaporative cooling. This is done by placing an undressed person close to a large fan and spraying with tepid water.
The advantage of this technique is that it allows ready access to the patient in case of heart arrhythmia that requires defibrillation. During any type of active cooling, it is important to monitor rectal temperature to avoid what is known as iatrogenic hypothermia.
But better than treatment is preventing the heat stroke in the first place, Casa said. Simple measures that can reduce the risk include:
*Phasing in practices. Begin with light workouts with little equipment; avoid two-a-day sessions for the first few days; never have practices on successive days; and don’t run high-intensity practices in the first few days of training.
*Have plenty of cold drinking water available. Don’t rely on players to bring their own.
*Make sure that players know they can call a halt to practice if they feel sick.
*Schedule practices during the cooler parts of the day.
*Allow plenty of breaks and let players rest in the shade with helmets off.
Heat stroke is rare during actual games – probably because players have time to cool off on the sidelines, with their helmets off and with water readily available.Weigh-ins can help prevent heat stroke and related heat sicknesses such as heat cramps and heat exhaustion. Players should be weighed before and after football practices. Since the volume of sweat loss varies in each person, this is the most accurate way to determine how much fluid an individual has lost during practice and needs to replace.
To fully re-hydrate, the rule of thumb is to replace 150 percent of weight lost in fluids during the first two hours after sports and another 25-50 percent of the weight lost in the first six hours after sports to fully rehydrate.
“One of the keys to preventing dehydration, heat exhaustion, and heat strokes is to provide players cool down and fluid breaks in a shaded area at least every hour, or more frequently, depending on heat and humidity levels,” said Dr. Brian Gullett, an emergency department physician at Wetzel County “Each athlete should drink at least the recommended minimum amount of fluids before returning to practice.”
Gullett continued, “Sports drinks – not “energy” drinks – are recommended instead of water because they replace electrolytes and contain carbohydrates for energy. Make sure the water does not come from a hose lying on the ground as bacteria tends to breed in hoses. The water should also be free of lead. Fluids should never be restricted. Athletes should drink at least eight ounces of water before they begin practice.”
In addition, the coaching staff and trainers should closely monitor behavior and watch for signs and symptoms of heat stroke and heat exhaustion. A buddy system should be used, with players monitoring each other. If heat illness is suspected, the player should be removed immediately from practice.
If heat stroke is suspected, ice-water or cold-water immersion is the definitive treatment. If that is not feasible, the athlete should immediately and continually be doused with water, either from a hose or multiple water containers. In addition, they should be continually fanned and have wet cold towels applied to the head and neck until immersive cooling can occur or emergency medical personnel arrive.
“During breaks,” Gullett added, “athletes should be required to rehydrate to replace lost fluids. They also should have cool air blown on them during short rest periods and after practice.”
River High School Head Football Coach Mike Flannery echoed similar sentiments as the physicians and other coaches. “We monitor the boys, especially the ones that are not in shape yet. We also keep an eye on the ones who have asthma. We knew that Monday was going to be very hot, so we scheduled only one practice for the day.”
Gullett noted that eating peanut butter sandwiches before a practice is better for the body than is candy. He also advises athletes to use sun block to prevent sun burn.
Hundred, Paden City, and Valley teams have cool-pops available. “Cool-pops are okay to have,” Gullett said. “As long as they don’t contain a lot of sugar, it will cool the players down.”
Schools in the area are fortunate to have coaches and trainers that are concerned for the athletes and are very knowledgeable about the signs, symptoms, and treatment of dehydration.
Once the dehydration process starts, it can be difficult to reverse without medical intervention. My greatest hope is that the athletes themselves and their families understand the importance of drinking before, during, and after practices.
For all athletes and coaching staffs, keep up the good work and good luck to all during the season.