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What is exertional heat stroke (EHS)?
- Life-threatening medical emergency
- Body’s temperature is too high
- Left untreated, exertional heat stroke results in death due to organ damage across all body systems (liver, kidney, brain, etc.)
- Until medical help arrives, the key is to immediately lower elevated body temperature
- EHS is different from classic heat stroke, which usually effects children and the elderly during prolonged hot weather.
What is exertional heat stroke (EHS)?
- Life-threatening medical emergency
- Body’s temperature is too high
- Left untreated, exertional heat stroke results in death due to organ damage across all body systems (liver, kidney, brain, etc.)
- Until medical help arrives, the key is to immediately lower elevated body temperature
- EHS is different from classic heat stroke, which usually effects children and the elderly during prolonged hot weather.
Symptoms
Rectal temperature over 105 degrees (oral, axillary, tympanic, and temporal measurements are inaccurate and cannot be trusted).
And any or all of the following:
- Erratic pulse (strong and rapid or weak and rapid)
- Lack of coordination
- Collapse
- Low blood pressure
- Vomiting
- Headache
- Loss of consciousness and/or seizure
- Shock
- Irritability, confusion, disorientation
- Sweaty skin that may be red/flushed or pale
Risk factors
- Vigorous activity in hot/humid weather, usually lasting longer than an hour.
- Lack of heat acclimatization
- Poor physical fitness
- Dehydration
- Sleep deprivation
- Fever or illness
- “Warrior” mentality
- High pressure to perform
- Heavy equipment/uniform
Risk factors
- Vigorous activity in hot/humid weather, usually lasting longer than an hour.
- Lack of heat acclimatization
- Poor physical fitness
- Dehydration
- Sleep deprivation
- Fever or illness
- “Warrior” mentality
- High pressure to perform
- Heavy equipment/uniform
Treatment
Rapid and aggressive whole-body cooling is the key to survival of EHS. The goal is to lower core body temperature to less than 102.5 degrees Fahrenheit within 30 minutes of collapse.
- Remove all equipment and excess clothing.
- Cool the athlete as quickly as possible within 30 minutes via whole body ice water immersion (place them in a tub or other container with ice and water). Stir water and add ice throughout cooling process.
- If immersion is not possible take athlete to a shaded, cool area and use rotating cold, wet towels to cover as much of the body surface as possible. A cold shower is also an alternative if full body immersion is not available.
- Maintain airway, breathing and circulation.
- After cooling has been initiated, activate emergency medical system by calling 911
- Monitor vital signs such as rectal temperature, heart rate, respiratory rate, and blood pressure.
- Cease cooling when rectal temperature reaches 101-102˚F. Body temperature will decrease 1 degree for every 5 minutes athletes are in a cold tub. If rectal temperature is not available, DO NOT USE AN ALTERNATE METHOD (oral, tympanic, axillary, forehead sticker, etc.). These devices are not accurate and should never be used to assess an athlete exercising in the heat.
Content by Susan Yeargin Ph.D ATC
Emergency Action Plan
An Emergency Action Plan (EAP) is crucial for athletic associations to prevent heat-related injuries because these injuries can be life-threatening if not addressed promptly. An EAP outlines the steps to be taken in case of a medical emergency and ensures that everyone involved in the sport, including coaches, athletes, and support staff, is prepared to respond quickly and effectively to prevent further harm. The plan should include procedures for identifying and responding to signs of heat illness, as well as information about emergency medical services and how to access them. By implementing an EAP, athletic associations can help to minimize the risks associated with heat-related injuries and ensure the safety and well-being of their athletes.
Right-click below and choose “Save As…” to download a position statement on EAP development from the National Athletic Trainers Association:
(external link)
Refer to the page below for multiple EAP checklists and resources from the Korey Stringer Institute (Updated 2024):
(external link)
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