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Heat and Hydration protocols for The Strongsville Football League

     The environment, equipment and intensity can place athletes at risk of heat illness. Heat illnesses represent conditions resulting from heat stress, which can be imposed by a number of factors but usually result from the environment or the body creating this heat load itself. Heat illnesses can range from minor to severe, and in particular, exertional heat stroke is a life-threatening emergency.

PREVENTION

These are a few ways to help prevent the occurrence of various exertional heat illnesses.

1. Have athletes undergo a period of HEAT ACCLIMATIZATION

2. Encourage athletes to ARRIVE AT PRACTICE HYDRATED

3. Allow athletes UNLIMITED ACCESS TO HYDRATION during activity

4. MODIFY PRACTICE when environmental conditions become extreme, (allowing additional rest/hydration breaks, reducing the intensity of practice, reducing the time of practice and reducing the equipment worn during practice).

5. Practice at an INTENSITY THAT IS APPROPRIATE for the fitness level

6. Encourage athletes to SPEAK UP WHEN NOT FEELING WELL - create a culture where this is considered smart.

 

HEAT ACCLIMATIZATION

Use the model below to get players acclimated to the heat.

The following are important for understanding the heat acclimatization model:

1. Use good judgment. The times listed below are maximum practice times as you acclimate to the heat. Conditions may warrant shorter practice times and intensity.

2. Practice is defined as time on the football field (including warm-up, stretching, break time, cool down and any conditioning time), and it should never exceed three hours.

3. During the first five days, practices should be limited to two hours.

4. A walkthrough is defined as time dedicated to reviewing plays and field positions and should not exceed one hour.

5. Heat acclimatization days should be continuous if possible, meaning few days off. However, if your practice schedule is only a few days a week, then remember that the days between your practices (the days off) do not count toward acclimatization days. It will take longer to acclimatize in situations such as this.

Practice Days 1-2

-Practices permitted per day:1

-Equipment:Helmets only

-Max duration of single practice session:2 hours

-Permitted walkthrough time, (not included as practice time): 1 hour (but must be separated from practice for 3 continuous hours).

-Contact:No contact

Practice Days 3-5

-Practices permitted per day:1

-Equipment:Helmets and shoulder pads.

-Max duration of single practice session:3 hours.

-Permitted walkthrough time, (not included as practice time): 1 hour (but must be separated from practice for 3 continuous hours).

-Contact:Contact only with blocking sleds/dummies.

Practice Days 6-14

-Practices permitted per day:2, only every other day

-Equipment:Full equipment

-Max duration of single practice session:3 hours (a total maximum of 5 hours on double session days)

-Permitted walkthrough time, (not included as practice time): 1 hour (but must be separated from practice for 3 continuous hours).

-Contact:Full, 100% live

 

WHEN ATHLETES SHOULD HYDRATE

-Sports drinks contain electrolytes, sugar and water, which give athletes important nutrients during exercise. While water is appropriate during all types of exercise, sports drinks are recommended for use during intense exercise that is greater than 60 minutes or during intense exercise in the heat.

Before Exercise

-Hydrate with 16-24 ounces of water or a sports drink.

During Exercise

-Have unlimited access to water during exercise/activity.

-Be able to drink as much as they want.

-Be able to drink for the entire break period if they wish.

-Access to sports drinks when exercise is greater than 60 minutes or if exercise is going to be intense and in the heat. To achieve this, it’s recommended that all exercise sessions should have predetermined breaks approximately every 15 minutes. The timing and length of breaks should be dependent on the environmental conditions. While athletes may be encouraged or even required to bring their own fluids, as a coach, always make sure extra fluids are available for those who have forgotten or need to refill their water bottles.

 

-***Below are different levels of heat stress on the body, and SFL protocols to treat them. 

 

HEAT EXHAUSTION

RECOGNITION

-The inability to continue exercise in the heat from either weakness or exhaustion.

May feel hot, tired, sweating a lot, weak, dizzy and don’t feel able to continue exercise.

CAUSES

-Excessive fluid losses or electrolyte losses.

-Dehydration causes less blood to be available for the working muscles and the skin to give off heat.

TREATMENT

-Remove the athlete from activity and put them in a shaded/cool area.

-Lay the athletes on the ground and raise their legs about 12 inches.

-Replenish lost fluids.

-Moderate cooling methods such as ice towels, misting fans, or cold water immersion.

 

HEAT CRAMPS

RECOGNITION

-Painful, localized muscle cramps and may feel like they are "wandering" throughout the cramping muscle.

-Usually visible, and the muscle will feel hard.

CAUSES

-Combination of fatigue, dehydration and electrolyte losses through sweat.

-Lack of heat acclimatization and poor fitness.

TREATMENT

-Rehydration with water and sport drinks.

-Some light stretching or massage with ice on the cramping muscle.

 

HEAT SYNCOPE

RECOGNITION

-Refers to a fainting or lightheadedness episode.

CAUSES

-Lack of heat acclimatization and poor fitness.

-Blood pools in the lower extremities reducing the heart's ability to provide enough circulation.

TREATMENT

-Lay the athlete on the ground and raise their legs about 12 inches.

-This helps blood go back to the heart to normalize blood pressure.

 

Exertional Heat Stroke

-How to Respond to an Exertional Heat Stroke Emergency:

1)Initial response. Once exertional heat stroke is suspected, prepare to cool the patient and contact

emergency medical services (EMS).

2)Prepare for ice water immersion. On the field or in a temporary medical tent, half-fill the tub or wading pool with water and ice (before an emergency, check the water source to see how quickly it fills the immersion tub).

a) The stock tank can be filled with ice and cold water before an event(or have tub half-filled with water and three to four coolers of ice next to tub; this prevents having to keep tub cold throughout the day.

b) Ice should cover the surface of the water at all times.

c) If the athlete collapses near an athletic training room,a whirlpool tub or cold shower maybe used.

3) Determine vital signs. Just before immersing the heat-stroke patient, take vital signs.

a) Assess core body temperature with a rectal thermistor(thermistorimplies flexible thermometer that stays in during cooling and allows for continuous monitoring of temperature during immersion therapy).

b) Check airway, breathing, pulse, and blood pressure.

c) Assess the level of central nervous system dysfunction.

4)Begin ice water immersion. Place the athlete in the ice water immersion tub. Medical staff, volunteers, and teammates may be needed to assist with a smooth and safe entry and exit.

5)Total body coverage. Cover as much of the body as possible with ice water while cooling.

a) If full body coverage is not possible due to the containerʼs size, cover the torso as much as

possible.

b) To keep the athleteʼs head and neck above water, an assistant may hold the victim under the axillae – armpits – with a towel or sheet wrapped across the chest and under the arms.

c) Place an ice/wet towel over the head and neck while body is being cooled in tub.

d) Use a water temperature under 15C(under 60 degree F).

6)Vigorously circulate water. During cooling, water should be continuously circulated or stirred to enhance the water-to-skin temperature gradient, which optimizes cooling. Have an assistant stir the water during cooling.

7)Continue medical assessment. Vital signs should be monitored at regular intervals.

a) It may be helpful for an assistant to stand nearby in case the athlete becomes combative.

b) Other assistants may be needed to lift or roll the athlete if vomiting occurs.

8)Fluid administration. If a qualified medical professional is available, an intravenous fluid line can be placed for hydration and support of cardiovascular function.

a) Rest the arm to be used on the side of the water immersion tub.

9)Cooling duration. Continue cooling until the patientʼs rectal temperature lowers to 39oC (102oF)

a)** If rectal temperature can not be measured and coldwater immersion is indicated,cool for10-15 minutes and then transport to a medical facility.

b) An approximate estimate of cooling via cold water immersion is 1oC for every five minutes and 1oF every 3 minutes (if the water is aggressively stirred). This means, the cooling rate will be slower initially, and increase the longer the person is in the tub. For example, if someone is in the tub for 15 minutes they would cool approximately 3oC or 5oF during that time.

10)Patient transfer. Remove the patient from the immersion tub only after rectal temperature reaches 39oC (102oF) and then transfer to the nearest medical facility via EMS as quickly as possible.

11)Cooling is the primary goal before transport. If appropriate medical staff is available on-site (team physician or athletic trainer); an aggressive cooling modality is readily available (i.e., Cold water immersion, ice/wet towel rotation, high flow cold water dousing); and no other emergency medical services are needed besides the rapid lowering of temperature, then always follow the “cool-first, transport second” doctrine.

-**If cold water immersion is not available or feasible given the constraints of the task being performed, then cool via the best available means. A good (although not optimal) highly portable alternative is a cooler filled with ice, water, and 12 towels. Place six ice/wet towels all over body and leave on for 2-3 minutes, then place those back in cooler and put the six others on the patient. Continue this rotation every 2-3 minutes. Another alternative when a tub is not available is cold water dousing from a locker room shower or from a hose.

 

When can the individual return to activity?

After an EHS episode occurs, there may be physiological changes, such as heat tolerance, that are temporarily, and occasionally, permanently compromised. Long-term complications and morbidity are directly related to the time that the core body temperature remained above the critical threshold. To safely return an athlete to full participation following an EHS, a specific return-to-play (RTP) strategy should be implemented. The following guidelines are recommended for RTP:

 

Physician clearance prior to return to physical activity. The athlete must be asymptomatic and lab tests must be normal.

The length of recovery time is primarily dictated by the severity of the incident.

The athlete should avoid exercise for at least one (1) week after the incident.

The athlete should begin a gradual RTP protocol in which they are under the direct supervision of an appropriate health-care professional such as an athletic trainer or physician.

The type and length of the RTP program may vary among individuals, but a general program may include:

Easy-to-moderate exercise in a climate-controlled environment for several days, followed by strenuous exercise in a climate-controlled environment for several days

Easy-to-moderate exercise in the heat for several days, followed by strenuous exercise in the heat for several days

If applicable to the individuals sport: easy-to-moderate exercise in the heat with equipment for several days, followed by strenuous exercise in the heat with equipment for several days.