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
gclinton@ycs.wednet.edu
(360)458-7777