Exertional Heat Stroke at August Football Practice
During August football conditioning, the heat index is 104°F and humidity is 70%. A 16-year-old lineman collapses after a series of sprints. He is confused, answers questions slowly, and stumbles when helped to stand. His skin is hot and dry; rectal temperature is 105.8°F. The coach wants to move him to the shade, give him cold water, and wait for his parents. A student athletic trainer has a cold-water immersion tub available but has never used it. The school has an emergency action plan, but the athletic trainer is off-site and 911 response time is estimated at 12 minutes. The health science teacher is asked to advise the coach while waiting. The athlete weighs 240 pounds and has no known chronic illness.
1. Differentiate heat exhaustion from exertional heat stroke using the presentation, and state the immediate priority actions.
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Exertional heat stroke is the working diagnosis. The key signs are altered mental status-confusion, slow answers, stumbling-and a rectal temperature of 105.8°F (about 41°C) after exertion in heat. Heat exhaustion typically presents with heavy sweating, weakness, dizziness, headache, nausea, and a temperature below about 104°F, with normal mental status. Hot dry skin is not required; athletes may still be sweating.
Immediate priority: call 911 and begin cold-water immersion. Do not wait for parents or transport. Remove equipment and clothing, support airway, breathing, and circulation, and place the athlete in the tub with ice water while shielding the head. If immersion is not immediately available, use cold towels, ice packs to the neck, armpits, and groin, and fanning. Do not give fluids by mouth while he is confused because of aspiration risk. Monitor and record temperature and mental status. Cooling should continue until the temperature is near 101–102°F or the athlete is alert. The 12-minute EMS response makes on-site cooling essential.
2. The coach wants to know when the athlete can return to play and how to prevent recurrence. What guidance should the health teacher give?
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No same-day return to play. Exertional heat stroke is a medical emergency, and return requires physician clearance and a gradual, individualized progression. The coach should not let the athlete practice the next day even if he feels better.
Prevention: implement a heat-acclimatization plan over 7–14 days, with progressive duration and intensity; schedule practices outside the hottest part of the day; use wet-bulb globe temperature or heat index to modify work-to-rest ratios; provide unlimited water and shade; use a trained spotter and an emergency action plan; have a cold-water immersion tub and trained staff at every practice. Check medications and supplements, and screen for sickle cell trait and other conditions. Teach athletes to report symptoms and to buddy-check each other.
The teacher should give the coach a written emergency plan, not just advice. Document the incident, review it with the athletic director, and ensure the athletic trainer is present for future conditioning sessions. Return to play should follow a written, stepwise protocol supervised by a physician.