Helpful Steps to Prevent Heat Illness

“Summertime and the livin’ is easy. The fish are jumpin’ and the cotton is high.”
~George Gershwin

This quote always reminds me of a romanticized summer full of lazy days and gentle breezes blowing in from the shore. Here in South Georgia, we are lucky to experience that day just once or twice a year. Summer days in Georgia are hot. Most often, they are a sticky, wet, wool blanket kind of hot. Days that cause the air conditioner salesman to celebrate and the repair man to curse. The heat in the South is abrasive and overwhelming due to the high temps and high humidity. My advice to those among you who have a choice about whether or not to go out in the heat is simple: don’t! To those of you who have to work or choose to play outside in the dog days of summer, the following precautions can’t be stated strongly enough. Unless you are a Cicada buzzing in a tall pine tree, you are constantly flirting with heat illness, and it is not a condition to be taken lightly.

Dangers of heat illness

EMTs strap football player to stretcher.

First off, the dangers of heat illness to your health cannot be over emphasized. In recent years, several professional and college athletes have succumbed to heat stroke. Between 1995-2009 there have been 31 deaths in the United States due to heat injury in high school football alone. These are athletes in peak physical condition, folks, so you can imagine how easy it would be for all of us weekend warriors to experience it. High school athletes, especially males, are at the highest risk of suffering exertional heat illness. Heat injury is preventable with a basic understanding of the causes, degrees of heat illness, signs and symptoms, and prevention strategies necessary to avoid it.

Cause of heat illness

To understand how to prevent heat illness (and why my dog digs a huge hole in the summer under my azaleas), it is best to understand how our bodies process high temperatures. Heat can act on the body or dissipate from the body in four ways: conduction, convection, radiation and evaporation. Conduction is just direct contact with something. Convection is loss of heat as air passes over the skin. Radiation is direct sunlight. Evaporation is removal of heat from the body by perspiration.

Normally evaporation, most commonly through sweating, allows for great heat exchange and maintains the body’s temperature. In the South, however, the sun is relentless, the wind is absent and the humidity averages greater than 85 percent. This trifecta leads to the body’s inability to cool itself because of an ironic circumstance: with increased heat during exercise, our body sweats to cool down, yet perspiration does not evaporate in the humid air. It just sits on the skin, essentially trapping the heat in our pores.

Bring down the heat

Heat illness can run the gamut from mild heat cramps to heat stroke, a true medical emergency. Decades ago, when my wife and I had just begun dating, she called my parents’ house, and my father told her that I was unable to come to the phone due to the fact that I was writhing around on the floor. After a robust game of tennis in the middle of July, I had come home and collapsed with heat exhaustion. Luckily, my parents knew how to handle it and soon brought my body temperature down with cold packs and lots of hydration. Not everyone who suffers such an episode will have the knowledge or opportunity to recover as easily as I did. The common denominator with all heat illness is the body’s inability to keep itself at a safe temperature. Recognizing the early signs of heat illness will keep it from progressing into a situation that can rapidly become dangerous.

Early signs of heat illness

Crowd of runners beginning a 5K.

Mild heat illness usually manifests itself as heat cramps. This can be painful cramping in the stomach, arm or leg muscles caused by not properly replacing fluid and electrolytes during intense exercise. Most people have experienced this type of episode and know to find a way to cool down and hydrate before their body temperature escalates further.

Moderate heat illness, which can manifest itself as a loss of consciousness or heat exhaustion, is also brought on by intense exercise in the heat without proper fluid replacement, but the biggest difference is that instead of just cramping, the individual starts to exhibit systemic signs and symptoms such as weakness, fatigue, fainting, dizziness, nausea and vomiting. Core body temperatures in someone with moderate heat distress can reach up to 104 degrees.

Severe heat injury, often called heat stroke, is a medical emergency when the core body temp is greater than 104 degrees and can lead to organ failure and death. Heat stroke is usually preceded by a person’s inability to sweat, nausea, vomiting, confusion and seizures.

Provide immediate treatment

The steps of treatment for all the different levels of heat illness are to immediately remove the stricken person to a cool, shaded area, remove tight clothing, give fluids if the patient is conscious, soak in an ice bath (which is extremely important for moderate to severe exertional heat illness), and reassess frequently. With severe heat injury, 911 should be called immediately, but the aforementioned treatment protocol should be initiated while waiting for EMS.

Steps to prevent heat illness

Coach squirting water in young athlete's mouth.Prevention is the key to heat illness. With a little common sense, an athlete’s risk of heat injury can be greatly reduced.

  1. Camel Up, as I like to say. Keeping well hydrated cannot begin right before the athletic event. In the hot summer, athletes should be constantly drinking water and electrolyte replacement, such as Gatorade and Powerade. Stay away from caffeinated drinks as they can promote dehydration and drinks with high sugar content as they can cause stomach cramps. A general recommendation is to drink 24 ounces of fluid two hours before an event and an extra eight ounces 20 minutes before the event.
  2. Proper clothing. These days, great technical fabrics wick the perspiration away from the body and are highly recommended.
  3. Acclimate. It can take a few weeks for the body to acclimatize to the heat. During this initial period, take frequent breaks, try to exercise earlier in the morning or later in the afternoon, and stay out of the direct sunlight. Gradually increase activity over 10 to 14 days.
  4. Weigh yourself. Normally if time permits, regular food and fluid intake will restore hydration status, however, if the athlete is exercising for multiple days in a row, monitoring hydration status is important for performance and preventing chronic dehydration. Even mild dehydration of three to five percent body weight can significantly affect an athlete’s performance. By weighing before and after a workout, the athlete can replenish fluid loss by drinking around 1.5L of fluid for every kilogram of body weight loss.

I hope everyone has a great summer, and be careful.

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