Environmental Environmental ConditionsConditions

Signs of DehydrationSigns of Dehydration

• ThirstThirst• Flushed SkinFlushed Skin• FatigueFatigue• Muscle CrampsMuscle Cramps• ApathyApathy• Dry Lips/MouthDry Lips/Mouth• Dark Colored UrineDark Colored Urine• Feeling WeakFeeling Weak

HydrationHydration• 2% drop in body water decreases performance2% drop in body water decreases performance

• 17-20 oz, 2 hrs prior17-20 oz, 2 hrs prior• 7-10 oz, 10-15 min. before7-10 oz, 10-15 min. before• 7-10 oz, every 10-20 min. during7-10 oz, every 10-20 min. during

• 16-24 oz, for every lb lost during 16-24 oz, for every lb lost during exerciseexercise

• Sports drinks vs water Sports drinks vs water • Activities lasting >1hr or >1 practice/dayActivities lasting >1hr or >1 practice/day

NATA Recommendation (Casa et al., 2000)NATA Recommendation (Casa et al., 2000)

Heat CrampsHeat Cramps• Sudden & Severe Muscle SpasmsSudden & Severe Muscle Spasms

• Due to excessive loss of water, Due to excessive loss of water, sodium & potassium sodium & potassium

• Combined with pain & fatigueCombined with pain & fatigue• Treatment: Treatment:

• StretchStretch• MassageMassage• Hydration w/ ElectrolytesHydration w/ Electrolytes

Heat ExhaustionHeat Exhaustion

Sx’s: Sx’s: • Mild Hyperthermia Mild Hyperthermia

(<104 degrees)(<104 degrees)• Pale, Cool, Clammy Pale, Cool, Clammy

SkinSkin• Rapid, Weak PulseRapid, Weak Pulse• Profuse SweatingProfuse Sweating• Loss of Coordination, Loss of Coordination,

DizzinessDizziness• Dilated PupilsDilated Pupils• Headache Headache • Nausea, VomitingNausea, Vomiting

Treatment:Treatment:• Cool, Shaded AreaCool, Shaded Area• Cool Body:Cool Body:

• Ice Bath, Ice or Ice Bath, Ice or Cold, Wet TowelsCold, Wet Towels

• Water & Water & ElectrolytesElectrolytes

• Monitor VitalsMonitor Vitals•Transport if no Transport if no

improvement seenimprovement seen

Heat Exhaustion Heat Exhaustion Becomes Life-Becomes Life-Threatening…Threatening…

• When there is:When there is: • VomitingVomiting• Altered ConsciousnessAltered Consciousness• DisorientationDisorientation• StaggeringStaggering• FaintingFainting• BelligerenceBelligerence

• Treatment:Treatment:• Remove excess clothing/equipmentRemove excess clothing/equipment• Immerse in cold water within first 10 minutesImmerse in cold water within first 10 minutes• Activate EMS…”Activate EMS…”cool first, transport second”cool first, transport second”• MonitorMonitor

Exertional Heat StrokeExertional Heat Stroke• Life-threatening Life-threatening

ConditionCondition

• Malfunction in Malfunction in brain’s temperature brain’s temperature control centercontrol center

• Characterized by Characterized by CNS abnormalities CNS abnormalities

• Differential Differential DiagnosisDiagnosis• Heat exhaustionHeat exhaustion• Exertional Exertional

hyponatremiahyponatremia• ConcussionConcussion

• Sx’s:Sx’s:• Hot, Flushed, Red SkinHot, Flushed, Red Skin

• Sweating 75%, Dec. Sweat 25%Sweating 75%, Dec. Sweat 25%• Very High Core Temp Very High Core Temp

(>104(>104oo))• Shallow, Fast BreathingShallow, Fast Breathing• Rapid, Strong PulseRapid, Strong Pulse• Decreased BPDecreased BP• Constricted PupilsConstricted Pupils• Vomiting/DiarrheaVomiting/Diarrhea• Altered Consciousness, Altered Consciousness,

ConfusionConfusion• Emotional Instability, Emotional Instability,

Irritated BehaviorIrritated Behavior• Possible SeizuresPossible Seizures• UnconsciousnessUnconsciousness• Cardiac or Respiratory ArrestCardiac or Respiratory Arrest

Heat Stroke TreatmentHeat Stroke Treatment• Immerse in cold water!!!Immerse in cold water!!!

• 35°-58°F35°-58°F• 100% survival rate if cooled in first 10 min100% survival rate if cooled in first 10 min• ““Cool first, transport second”Cool first, transport second”• If cold water immersion is not available:If cold water immersion is not available:

• Douse w/ cold water & fan w/ towel Douse w/ cold water & fan w/ towel OROR• Place in cold shower Place in cold shower OROR• Place ice on major arteries (neck, armpit, groin, Place ice on major arteries (neck, armpit, groin,

elbow, etc)elbow, etc)• Activate EMSActivate EMS• Remove excess clothing/equipmentRemove excess clothing/equipment• Monitor vitalsMonitor vitals

• Lower temp to 101°F prior to transport if possible Lower temp to 101°F prior to transport if possible (approximately 10-15min if not able to access core (approximately 10-15min if not able to access core temp)temp)

• Provide fluids if consciousProvide fluids if conscious

Heat Exhaustion vs Heat Heat Exhaustion vs Heat StrokeStroke

Preventing Heat Preventing Heat IllnessesIllnesses

• Monitor Weather and Adjust PracticeMonitor Weather and Adjust Practice• Acclimate AthletesAcclimate Athletes

• 7-10 days to adjust to high heat & humidity7-10 days to adjust to high heat & humidity• Short practices, moderate activity levels, Short practices, moderate activity levels,

water breaks every 15-20 minuteswater breaks every 15-20 minutes

• Lighter Clothing & Less EquipmentLighter Clothing & Less Equipment• Identify & Monitor Susceptible AthletesIdentify & Monitor Susceptible Athletes

• Overweight, young/old, under conditioned, Overweight, young/old, under conditioned, sicksick

• Enforce Proper HydrationEnforce Proper Hydration• Encourage Athletes to get 6-8hrs of Encourage Athletes to get 6-8hrs of

sleep in a cool environmentsleep in a cool environment

FrostbiteFrostbite• 11stst Degree: Degree: Red, flushed, white or gray skin Red, flushed, white or gray skin• 22ndnd Degree: Degree: Firm, white and waxy skin Firm, white and waxy skin

• Blisters and purple tint may appear when area Blisters and purple tint may appear when area is warmedis warmed

• 33rdrd Degree: Degree: Blisters, bluish skin, cold and Blisters, bluish skin, cold and stiffstiff

• Treatment:Treatment:• Warm areaWarm area• Remove wet clothingRemove wet clothing• MonitorMonitor• Soak in warm (100-105Soak in warm (100-105oo) water) water• EMS (3EMS (3rdrd degree) degree)

• Do NOT rub or massageDo NOT rub or massage• Do NOT apply ice Do NOT apply ice • Do NOT allow frostbitten tissue to refreezeDo NOT allow frostbitten tissue to refreeze

Severe FrostbiteSevere Frostbite

HypothermiaHypothermia• Body temp drops <95Body temp drops <95oo

• Signs:Signs:• Irritability, drowsiness, lethargyIrritability, drowsiness, lethargy• Loss of coordinationLoss of coordination• Loss of sensationLoss of sensation• Shivering (stops when severe)Shivering (stops when severe)• Slow irregular pulseSlow irregular pulse• Dilated pupils (severe)Dilated pupils (severe)• Mild confusion to unconsciousnessMild confusion to unconsciousness• Respiratory arrest (severe)Respiratory arrest (severe)

• Treatment:Treatment:• Warm areaWarm area• EMSEMS• Remove cold/wet clothingRemove cold/wet clothing• Wrap in blanketsWrap in blankets• MonitorMonitor• Warm Fluids (if conscious)Warm Fluids (if conscious)

Preventing Preventing HypothermiaHypothermia

• Proper ClothingProper Clothing• Keep ActiveKeep Active• Monitor Wind ChillMonitor Wind Chill• Monitor at-risk athletesMonitor at-risk athletes• Proper HydrationProper Hydration

• Exp: 18 NY HS FB Players (2011) transported & Exp: 18 NY HS FB Players (2011) transported & 22ndnd half of game canceled (20° w/ wind chill) half of game canceled (20° w/ wind chill)

LightningLightning•Lightning can strike from as far as

10 miles away.

•If thunder is heard or lightning is seen, stop play immediately and move all athletes into the school using the nearest entrance.•“When Thunder Roars, Go Indoors!”

•Wait 30 min until the last flash of lightning or thunder is heard before resuming play.

Flash to BangFlash to Bang• If you observe If you observe

lightning, count lightning, count the number of sec. the number of sec. until you hear until you hear thunder. Divide # thunder. Divide # of sec by 5 to get of sec by 5 to get the distance in the distance in miles. miles.

• Lightning can Lightning can strike from more strike from more than 10 miles than 10 miles awayaway

Thunder is Heard

Lightening Distance

5 sec after flash 1 mile away

10 sec after flash

2 miles away

15 sec after flash

3 miles away

20 sec after flash

4 miles away

25 sec after flash

5 miles away

30 sec after flash

6 miles away

35 sec after flash

7 miles away

40 sec after flash

8 miles away

Alternative Shelter(s)Alternative Shelter(s)

Acceptable ShelterAcceptable Shelter• Bus Bus • VehiclesVehicles• Non-metal, Non-metal,

enclosed enclosed outbuilding (i.e. outbuilding (i.e. equipment storage equipment storage building)building)

Not Acceptable ShelterNot Acceptable Shelter

• DugoutsDugouts• Under TreesUnder Trees• Open Sided Open Sided

Shelters (i.e. picnic Shelters (i.e. picnic shelter)shelter)

• TentTent• ANYWHERE ANYWHERE

OUTSIDE!!OUTSIDE!!

These actions may These actions may slightlyslightly reduce your risk of being struck reduce your risk of being struck

by lightning: by lightning: • Avoid open fields, the top of a hill or a Avoid open fields, the top of a hill or a

ridge top. ridge top.

• Stay away from tall, isolated trees. If you Stay away from tall, isolated trees. If you are in a forest, stay near a lower stand of are in a forest, stay near a lower stand of trees. trees.

• If you are camping in an open area, set up If you are camping in an open area, set up camp in a valley, ravine or other low area. camp in a valley, ravine or other low area.

• Stay away from water, wet items, and Stay away from water, wet items, and metal objects (such as fences and poles). metal objects (such as fences and poles).

Inside Safety TipsInside Safety Tips

• Stay off corded phones. Cell phones & Stay off corded phones. Cell phones & cordless phones are ok.cordless phones are ok.

• Don't touch electrical equipment or Don't touch electrical equipment or cords. cords.

• Avoid plumbing. Do not wash your Avoid plumbing. Do not wash your hands, take a shower or wash dishes. hands, take a shower or wash dishes.

• Stay away from windows and doors, Stay away from windows and doors, and stay off porches.and stay off porches.

• Do not lie on concrete floors or lean Do not lie on concrete floors or lean against concrete walls.against concrete walls.