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Gary Clinton MS, AT/C, AT/L Sports Medicine Instructor Yelm HS WCTSMA President If a patient is suspected of Exertional Heat Stroke, what should be the first action taken in treatment of the condition? A) Drive them to the hospital by parent/yourself. B) Contact EMS and wait for them to arrive. Don’t move athlete. C) Get them a bottle of water and put ice towels on them. D) Apply Biofreeze to the entire body. E) Contact EMS, but place athlete in cold water immersion and stir the water aggressively before transport. Isaiah Laurencin- FL, Exertional Sickling Tyquan Xavier Brantley- SC, Exertional Sickling Lewis Ogloba- PA, Asthma led to Cardiac Arrest DJ Searcy- GA, Heat related Forrest Jones- GA, Heat stroke Montel Williams- AR, Exertional Sickling Sam Dickson- PA, (Congenital)Coronary Artery Al Smith, Jr.- TX, unknown, 2nd day of FB practice Latrell Dunbar-MS, Cardiac Event Candace Ortiz- TX, unknown Angela Gettis- CA, Cardiac Event David Stinson, head coach Pleasure Ridge Park HS criminally charged in death of 15 year old, Aug. 20th 2008. All coaches present, AD who was present, and Principal were named in a separate civil lawsuit. “Reckless Homicide”- When a person fails to perceive a risk that a reasonable person in that situation would have seen. Another player that day also collapsed and spent 2 days in the hospital. Coach alleged to have withheld water and continued practice with a heat index of 94. Coach “would run the players until someone quit the team”. It took 15 minutes to call 911. Coach Stinson was on paid administrative leave, reassigned, no longer coaches. Community & school district torn apart. Coach Stinson was acquitted of criminal charges. Civil suit was settled out of court for 1.75 million dollars. Focuses on two issues in HS Football Concussions Heat Stroke Arkansas, 2010 Two heat stroke scenarios 1 died (Tyler Davenport) 1 lived (Will James) What was the difference in care? Frontline- “No one should die of Heatstroke” A set of guidelines that safely prepares athletes for competition. Released by the NATA in 2009 for Secondary Schools. NFHS “A guide to Heat Acclimatization & Heat Illness Prevention” released this summer. 7 components of plan released by NFHS this summer. 100% of heat related deaths are preventable!! WIAA currently has no guidelines? Korey Stringer Institute is pushing for all 50 states to adopt guidelines for all high schools. NCAA has had guidelines in place since 2003. One collegiate death in August since inception! Acclimatization is not “conditioning” No more than 1 practice per day. No longer than 3 hours 1 hour max. ( walk thru) permitted after 3 hours minimum rest. Football: Days 1 & 2 Helmets only Days 3-5 Helmets & shoulder pads only Double practice days followed by a single On single days, 1 walk thru permitted w/3 hrs rest. Rest day doesn’t count towards 14 day total. Doubles don’t exceed 3 hours for each. Not to exceed 5 hours total. All activities included as practice time: conditioning, walk thru, weight room, etc. Recommend certified AT onsite for all practices. Area of Practice Modification Practices 1-5 Days 1-2 # of Practices Permitted Per Day Equipment Maximum Duration of Single Practice Session Permitted Walk Through Time Contact Days 3-5 1 Helmets only Practices 6-14 2, only every other day Helmets & Shoulder Pads 3 hours Full Equipment 3 hours (a total maximum of 5 hours on double session days) 1 hour (but must be separated from practice for 3 continuous hours) No Contact Contact only with blocking sleds/dummies Full, 100% live contact drills NOTE: warm-up, stretching, cool-down, walk-through, conditioning, and weightroom activities are Included as part of practice time Secondary School Guidelines Preseason Heat-Acclimatization Guidelines for Secondary School Athletics. Journal of Athletic Training. 2009;44(3):332-333. National Athletic Trainers Association American College of Sports Medicine Gatorade Sports Science Institute National Strength and Conditioning Association US Army Research Institute for Environmental Medicine American Orthopaedic Society for Sports Medicine American Medical Society for Sports Medicine American Academy of Pediatrics Korey Stringer Institute is doing extensive research “New Jersey, first to adopt heat guidelines” From 1995 through 2008, 39 football players died of heatstroke. Second most common cause of death for high school athletes, after spinal cord injury. WA has guidelines but is Currently 7 states classified by KSI as deficient. meeting guidelines EAP’s in place Earlier AM full gear practices Shells for later PM practices, install Emphasize pre-practice hydration Efficient hydration available Athlete differences Discourage supplements, caffeine & stimulants Lower intensity & increase breaks whenever necessary Heat exhaustion symptoms include: Paleness Cramping Heavy sweating Fainting or nausea Fast or shallow breathing Dizziness The pulse rate is fast and weak. Core body temperature below 104 degrees Heatstroke symptoms include both physical and neurological manifestations—a fast pulse and extremely high temperature (above 104 degrees) coupled with confusion or hallucination. NFHS recommends taking WBGT at location People may experience nausea, fatigue, vomiting, diarrhea, loss of balance, irritability, irrational or unusual behavior, apathy, hysteria, and headaches, as well as dizziness and disorientation. With NEHS, the body stops or decreases sweat production so the skin feels hot and dry. With EHS, the body can still produce sweat, so the skin can be moist though the core temperature remains just as high. Sometimes, there will be no clear evidence of a problem until the athlete collapses. Is the only valid measure of body temperature. Can only be measured rectally or with an ingestible thermometer (Gastrointestinal). What if I don’t have/don’t want to measure temperature rectally? Common sense: Signs & Symptoms Fast pulse Confusion Nausea Disorientation Altered level of Consciousness Irrational/Unusual Behavior Dizziness Loss of Balance Activate EAP Call 911, but… Cool the body rapidly, before transport Remove from heat Cold water immersion If not available: Douse with cold water Ice bags/towels, rotate : 3 mins. Put in any available water source Goal is to get body temperature below 102 degrees within 30 minutes. Water temperature between 35-59 degrees. Ice always visible on surface Continuously stirred. Cooling rate in general is 1 degree: 3 minutes. Basic guideline: Water temp of 38-42 degree 10-15 minutes of immersion time Affects athletes with Sickle Cell Trait Muscle Cramping Tenderness Pain Inability to catch breath Swelling Fatigue Weakness Longer periods of recovery within conditioning Excluded from performance tests Timed mile run & serial sprints Adjust work-rest cycles during hotter days Emphasize hydration Don’t work out if feeling ill Control asthma Have supplemental oxygen available Study of hydration 1. Proper pre practice hydration ½ given water ½ withheld water No significant difference in core temperature! 2. Start practice dehydrated ½ given water ½ withheld water Significant difference in core temperature Emphasis needs to be on effective hydration by the athlete! 10 Most common conditions with treatment and Emergency Action Plans included. Asthma Exertional Hyponatremia Catastrophic Brain Exertional Sickling Injuries Cervical Spine injuries Diabetes Exertional Heat Stroke Lightning Head-down contact Sudden Cardiac Arrest If a patient is suspected of Exertional Heat Stroke, what should be the 1st action taken in treatment of the condition? A) Drive them to the hospital by parent/yourself. B) Contact EMS and wait for them to arrive. Don’t move athlete. C) Get them a bottle of water and put ice towels on them. D) Apply Biofreeze to the entire body. E) Contact EMS, but place athlete in cold water immersion and stir the water aggressively before transport. Korey Stringer Institute, www.ksi.uconn.edu EAP’s CWI guidelines Exertional Heat Stroke survival kit Rectal Probes & thermometers Hydration kits Hot weather practice procedures outline State athletic association guidelines Binkley HM, Beckett J, Casa DJ, Kleiner DM, Plummer PE. National Athletic Trainers’ Association position statement: exertional heat illnesses. J Athletic Training. 2002; 37(3):329–343. Casa DJ, Guskiewicz KM, Anderson SA, Courson RW, Heck JF, Jimenez CC, McDermott BP, Miller MG, Stearns RL, Swartz EE, Walsh KM. National Athletic Trainers’ Association position statement: preventing sudden death in sports. J Athletic Training. 2011; 47(1):96–118. Casa DJ, McDermott BM, Lee EC, Yeargin SW, Armstrong LE, Maresh CM. Cold-water immersion: The gold standard for exertional heat stroke treatment. Exercise and Sports Science Reviews. 2007; 35(3):141149. Heatstroke. eMedicine website. http://emedicine.medscape.com/article/166320-overview. Updated September 2009 Mueller FO, Colgate B. Annual survey of football injury research 1931– 2008. The American Football Coaches Association, the National Collegiate Athletic Association, and the National Federation of State High School Associations. www.unc.edu/depts/nccsi/FootballAnnual.pdf. No sweat: Recognizing and preventing heat-related illnesses . CMA Today. 2010; 43(4) July/August. Understanding heat-related illness: symptoms. WebMD. http://www.webmd.com/a-to-z-guides/understanding-heat-relatedillness-symptoms. Yeargin SW, Casa DJ, Judelson DA, McDermott BP, Ganio MS, Lee EC, Lopez RM, Stearns RL, Anderson JM, Armstrong LE, Kraemer WJ, Maresh CM. Thermoregulatory Responses and Hydration Practices in Heat-Acclimatized Adolescents During Preseason High School Football. J Athletic Training. 2010; 45(2): 136–146. Gary Clinton MS, AT/C, AT/L Sports Medicine Instructor Yelm HS WCTSMA President [email protected] (360)458-7777