Heat Injury Can Be Prevented

We were trying to penetrate a stubborn defence in a crucial tournament match on a warm 37ºC afternoon. Even pitch-side by the bench was really uncomfortable, a test of heat endurance in burning feet & soaked shirts.

Entering the 4th quarter and leading by 2 goals, one of our younger & fitter utility player was losing steam and focus and subbed out. Flushed face & perspiring profusely, she felt faint & was hyperventilating as she neared the bench. Alarmed, we quickly got her shaded, doused her with water & ice-packs while loosening her clothing & continuously talking to her to keep her attention to calm her breathing. After a full, tensed 10 minutes (and 3 points later); her heart-rate, breathing & awareness recovered.

Two days later the news reported the death of a young Singaporean son, succumbing to heat stroke during military training. The danger of heat injury is clear and present, and everyone needs to understand & know how to deal with it.

The two events above, prompted this write-up to cover some causes of heat stroke in sports and share tips on recognition, prevention, and treatment. Hopefully this helps you be mentally & physically prepared if need be.

Early warning signs & onset of heat injury
• Irritability
• Confusion
• Lack of interets
• Hostility/aggression
• Unstable emotions
• Erratic/irrational behaviour
• Lack of focus
•Fatigue

When it might be too late to recover the athlete
• Clouded judgement
• Nausea
• Vomiting
• Cold intolerance
• Paradoxical chills
• Goosebumps / Hair standing on end sensation
• Hyperventilation (body stressing to shed heat)
• Tingling sensation in fingers (prelude to collapsing)

Steps to take
• Cool first, transport later. (Heat injury can cause serious organ damage)
• Cooling must be immediate & continued during CPR if patient has collapsed.
• Best to do ice / cold water immersion (or ice bucket treatment!)
• OR cold press with ice packs/cold towels
• Important areas neck, head, temples, under-arms & groin
• If hyperventilating, keep calm & count & focus on slow deliberate breathing.
(DO NOT use a paper bag to breathe into, according to popular “culture”)
• Seek emergency medical attention.

Exertional heat stroke (EHS) should be preventable, but heat illness can advance very quickly especially in team-sports and track & field athletes, and early warning signs of heat stroke can be subtle. Early diagnosis and proper therapy however, can save lives. 

Over-motivation & persistent game focus can overheat athletes who do too much too fast, or when trying to endure too long. In evasion games, the warrior mentality is a red flag. The most industrious & those playing to prove a point may overlook the swift onset of heat exhaustion overtaking them.

Heat stress the day before; one which was exhausting &/or dehydrating, is the main trigger for heat stroke victims. Thus adequate hydration, nutrient & electrolyte replenishment & proper rest/sleep is paramount. However, diuretics and alcohol is also a major aggravating factor.

Acclimatise & get “heat-fit”. In warmer seasons, constant hydration bouts will trigger the body to hold water & salt better and increase blood volume. Thus more blood can be pumped at lower heart rates. Acclimatised athletes also naturally perspire sooner & greater, over a wider body area to stay cool. 

Dehydrating just 2% of your body weight impairs performance, increases heart rate & decreases cardio vascular output. You lose muscle power, endurance, focus & the body heats up quicker. Taking into account an athlete can perspire an alarming 1 to 2 litres within an hour, dehydration can and will hit you like a train out of nowhere. Grab a sports drink; potassium & electrolytes aids quick rehydration..

Team wear, protective gear & compression apparel can at times be insulating. Padded gear, helmets & such inhibits perspiration evaporation slowing body temperature cool-off. Look out for one another on the pitch, especially your goalies.

Be aware, take note of the preventive measures & look out for athletes around you. On that note, be First-Aid, CPR & AED trained! You’d never know when you will be that samaritan who saves a soul! Train, don't strain! Start low & build slow…

Cheers!
Live Life, Live Sports

References & credits  
E. Randy Eichner, M.D.
Professor of Medicine