New Developments in Treatment of Heat-Related Illnesses
Every year during the summer months, outdoor athletics are plagued with heat-related illnesses. These illnesses range anywhere from the more common cases of muscle cramps and dehydration, to the more life threatening conditions of exertional hyponatremia, heat exhaustion and heat stroke. However, current research has proven that with the implementation of up to date guidelines for both preventative and acute care, a significant number of these cases can be successfully treated and even prevented. The purpose of this article is to outline the reasons why the recent task force was created, how their new guideline were developed and present three of the principal guidelines that were determined by the Inter-Association Task Force on Exertional Heat Illnesses.
The dangers and risks associated with exercise in the heat are well documented; however policies and procedures to prevent, recognize and treat heat-related illnesses have not been adequately distributed and implemented. This led to the inception of the Inter-Association Task Force on Exertional Heat Illnesses and their desire to establish a comprehensive consensus statement.
Over a period of four months, representatives from 18 leading medical, nutritional and sports medicine-related organizations collaborated to identify a consensus statement which would be uniform throughout all medical professions. The goal of the panel was twofold: 1. to create a unified statement that would address the basic issues related to the prevention, recognition and treatment of heat-related illnesses and 2. to offer guidelines that would increase widespread awareness of safety standards (2). This would in turn reduce risks for both professional and recreational athletes alike while establishing a continuity of care among medical professionals.
The committee, through establishing a consensus statement, has given precise recommendations that can now uniformly apply to all athletic arenas. Furthermore, the new format of this statement is easily understood and accessible to all athletic stakeholders. First, through the relationship with a certified athletic trainer (or other medical personnel) this information can be obtained and appropriately distributed. Secondly, the NATA has posted the consensus statement in its entirety on their website: www.nata.org . With the introduction of this statement heightened awareness of homogeneous preventative and acute treatment strategies will:
• Encourage increased and accurate education regarding heat illnesses for athletes, coaches, parents and medical staff
• Provide and increase medical services onsite at various events
• Ensure that preparticipation physical examinations have been completed, which include specific questions regarding fluid intake, weight changes during activity, medication and supplement use and history of cramping/heat illnesses
• Assure that medical staffs have authority to alter work/rest ratios, practice schedules, amounts of equipment and withdrawal of individuals from participation in sports, based on heat conditions and/or athletes’ medical conditions (2).
The National Athletic Trainers’ Association (NATA) released a positional statement regarding Exertional Heat Illnesses in 2002 (1). This statement served as the working framework in the development of the consensus statement. While the scaffolding remains relatively unchanged, there have been significant adaptations made to the original statement. These three principle guidelines are based on new research and contemporary knowledge.
While preventative strategies are always preferred, protocols for the acute treatment of exertional heat illnesses must not be overlooked. Previously, cold water immersion for the treatment of exertional heat stroke was determined to be somewhat precarious. The extreme temperature change was associated with the potential of inducing fatal consequences. However, with ongoing research the whole-body immersion bath is now considered vital to optimizing treatment and avoiding fatal consequences (1-3). Furthermore, it is also recommended to cool the individual first and transport second if adequate rapid cooling and medical supervision are available (2).
When facing the conditions of exertional heat stroke and heat exhaustion, core body temperature is a major distinguishing factor. Ideally, the most accurate measure of core body temperature is through the use of a rectal thermometer (1, 3, 4). Rectal temperature is an invaluable tool for medical personnel through the cooling process of an athlete. Appropriate steps must be taken to ensure adequate body cooling and regulated by the rectal thermometer.
Further recommendations introduced by the Task Force apply to the hydration of athletes in avoiding, recognizing and treating conditions of muscle cramps, dehydration and exertional hyponatremia. These conditions can be characterized by some form of hydration irregularity. This irregularity could be fluid/electrolyte imbalances, elevated body weight loses, or excessive fluid consumption, to name a few. Experts advise that medical personnel take a proactive role in assessing their athletes pre-exercise, event and post-participation baseline body weight measures (2). The acquisition of this information allows the staff to calculate an individual’s approximate loss or gain in total body weight, and allow for proper rehydration of the athlete during the treatment phase. Furthermore, many return to play considerations have criteria based on the athlete reaching and maintaining “normal” hydration status (individually based). The Sweat Rate Calculation (2) is one example of monitoring an athlete’s hydration:
Sweat rate = pre-exercise body weight – post-exercise body weight + fluid intake – urine volume / exercise time in hours)
When using this formula to calculate sweat rate, it is recommended that a representative range of environmental conditions, practices and competitions be taken into consideration (2). It is also important to get the athlete involved during this process. Encourage them to take an active role in their hydration status by making them aware of their body’s changes during practice and competition. Inform them of their results to this equation, therefore, equipping the athlete with immediate feedback about their daily drinking habits and a future plan to combat dehydration conditions.
In summary, the application of these new guidelines will increase awareness among athletic stakeholders, increase knowledge in prevention of exertional heat-related illnesses, and optimize the acute treatment of all heat-related illnesses. Therefore, resulting in a decreased number of exertional heat-related cases every year and minimizing the negative and even fatal consequences of these conditions. The introduction of this consensus statement will also establish a long desired continuity of care among all medical professionals in the prevention, recognition, evaluation and treatment of exertional heat-related illnesses.
Binkley, Helen M., et al. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. J Athl Train., Vol. 37(3) pp. 329-343, 2002
Casa, Douglas J, PhD, ATC, FACSM, et al. Inter-Association Task Force on Exertional Heat Illnesses Consensus Statement; 2003
Casa, DJ, Roberts WO. Considerations for The Medical Staff in Preventing, Identifying and Treating Exertional Heat Illnesses. In: Armstrong LE, ed. Exertional Heat Illnesses. Champaign, IL: Human Kinetics; 2003.
Roberts WO. Assessing Core Temperature in Collapsed Athletes: What’s the Best Method? Physician Sportsmed. , Vol. 22(8) pp. 49-55, 1994
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