Athletes at risk: Knowing the dangers of heat stroke

exertional heat stroke athletes

For many young athletes, fall sports practices have already started. Whether it’s football two-a-days, soccer practices on a sweltering turf field, or cross country training in the late summer sun, the threat of heat exhaustion and heat stroke is prevalent across all sports.

It’s an important time for athletes and parents to be aware of the signs of heat illnesses, especially given that children and adolescents are more susceptible to heat stroke than adults. Younger athletes produce more heat during activity, sweat less, and adjust less rapidly to changes in environmental heat.

Certain sports also carry unique risks for heat stroke. The heavy equipment football players wear puts them at greater risk, as does the limited access to adequate hydration many long distance runners experience.

Dr. Michael Beasley, a Sports Medicine specialist at Boston Children’s Hospital, provides insight on how to recognize the signs of exertional heat stroke (EHS) and the best way to administer potentially life-saving treatment.

Recognizing heat stroke

Beasley describes heat stroke as “the end of the spectrum of heat illness, which can include heat edema, heat rash, heat cramps, and heat syncope (fainting) all before true heat stroke occurs.” True heat stroke occurs once the core body temperature becomes higher than 106°F.

Leading up to heat stroke, an athlete may begin to have abdominal and muscular cramps, as well as nausea, vomiting, headaches, dizziness, and difficulty breathing. “It’s commonly taught that heat stroke will come with lack of sweating,” says Beasley. “But patients with heat stroke may in fact sweat profusely, and sweating should not be used as a marker of severity or comfort in the setting of heat illness.”

On the field, the signs of EHS can be seen in the appearance of altered neurologic state, which may present as delirium, confusion, hallucinations, imbalance, and tremors. These symptoms may escalate to decerebrate or decorticate posturing — where the individual’s body becomes rigid and the arms are extended at their sides or flexed over their chest. This is a sign of severe neurological damage, and can result in a coma.

How EHS is treated

Successful treatment of heat stroke is heavily reliant on cooling an athlete down as quickly and efficiently as possible. The chances of neurological damage or even death increase with any delay in lowering the individual’s core body temperature. Beasley states that treatment of EHS “should absolutely be treated as a medical emergency.”

The cooling process is expedited by removing any restrictive clothing in order to increase evaporative cooling. Although cooling methods vary, evidence points to ice-water immersion as the most effective method for lowering core body temperature. An athlete experiencing heat stroke symptoms can also be splashed/sprayed with cold water and be covered with ice packs.

Athletes at risk

Certain young athletes may be more at risk of EHS than others. Typically, children and adolescents who are overweight, have chronic health issues, or play a sport that requires wearing heavy clothing or pads are at a higher risk.

With football, soccer, and field hockey seasons already starting, many athletes have been participating in summer practices, which can sometimes include two-a-days. Although the NCAA has banned two-a-day practices for Division I football players, many high school players have still been practicing twice a day in the summer heat.

“The highest numbers of heat stroke occur in youth football players, particularly in the month of August,” says Beasley. “The extended periods outside in hot temperatures, especially under pads and equipment, place these athletes at increased risk.”

Cross-country runners are also at a high risk for heat stroke, as their hydration is often limited during competition. Beasley stresses that acclimatization to heat is key in reducing the risk of EHS, as athletes who are not used to higher temperatures generally have a slower sweat response and thus are much more likely to suffer heat illness.

Regardless of the sport, parents and young athletes should ensure that they are educated and vigilant about the warning signs of heat stroke. If an athlete is suffering from heat illness, every moment counts. Fast recognition and an expedited effort to cool an athlete down could be the difference between healthy recovery and sustained neurological damage, or even death.

If any athlete seems to be suffering from heat illness, they should be brought to a physician as quickly as possible in order to be properly diagnosed and treated. But the first step in this process is knowing when an athlete may have EHS, and that starts with understanding how to recognize the signs.

Learn more about Boston Children’s Sports Medicine.