The Raider Who Went Down at 38 °C
At the district inter-school kabaddi tournament in Nagpur in the second week of May, the afternoon match starts at 11:30 a.m. with the temperature at 38 °C and humidity around 70 %. Rohan, 15, the team's main raider, ate only a banana at 7 a.m., travelled 40 km by bus, and drank about 500 mL of water before the match. He has already completed three raids in the first half. Between raids he complains of a severe headache, feels giddy, and has a painful cramp in his right calf. His skin feels cool and moist, he is sweating heavily, his pulse is about 110 per minute and his breathing is fast. A senior player gives him a salt tablet with a glass of water and tells him to keep playing because he is the team's best raider. The coach is unsure whether to send him back on the mat or to send him to the hospital.
1. Identify Rohan's most likely condition and justify it using three observations from the case. Explain how you ruled out heat stroke and low blood sugar.
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Most likely condition: heat exhaustion with dehydration and electrolyte loss.
The signs fit a picture of fluid and salt depletion plus heat strain:
- Cool, moist skin with heavy sweating - the body is still cooling itself, so this is heat exhaustion, not heat stroke.
- Pulse ~110/min, fast breathing, giddiness and headache - these point to reduced circulating blood volume.
- Painful calf cramp after three raids at 38 °C / 70 % humidity - heavy sweating has cost him sodium and chloride, and his fluid intake (500 mL) was far below his losses.
Why not heat stroke? Heat stroke shows hot, dry skin, body temperature above about 40 °C, confusion, convulsions or unconsciousness. Rohan is conscious, talking and sweating. If any of those signs had appeared, it would be an emergency: call for an ambulance immediately, cool him while waiting, do not delay for ORS.
Why not low blood sugar alone? He did eat very little (one banana since 7 a.m.), and hunger, sweating and dizziness overlap. But hypoglycaemia improves within minutes of sugar, does not usually cause calf cramps, and gives shakiness and confusion rather than cool moist skin from heat load. Blood sugar may be contributing, so the first drink should contain both sugar and salt.
The safe approach: treat as heat exhaustion now, and refer to hospital if he does not clearly improve within 30 minutes.
2. List the first-aid steps you would take, in the order you would take them, and state with reasons whether the salt tablet was the right choice.
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Order of action:
- Stop play at once and remove him from the mat - continuing exertion is the biggest danger.
- Move to shade or a ventilated room; lie him down with legs slightly raised to improve blood flow to the brain.
- Loosen clothing, remove shoes and any pads; fan him and place wet cloths on the forehead, neck and armpits.
- Check and record pulse, breathing, temperature and level of consciousness every 10 minutes.
- Give a measured oral rehydration solution in small sips - about 100–150 mL every 10–15 minutes - only if he is fully alert and not vomiting. If ORS is not available, use the home solution: 1 litre clean water + 6 level teaspoons sugar + half a level teaspoon salt.
- Do not let him return to play today. Arrange transport home with an adult, and refer to hospital if he vomits, becomes drowsy or confused, or is not better in 30 minutes.
The salt tablet was the wrong choice. A dry salt tablet with water gives a strong salt load with no sugar, no measured concentration, and often causes stomach irritation and nausea, which makes dehydration worse. Sports drinks and ORS are balanced for both salt and glucose, and glucose also helps water absorption. The senior player's intention was good but the method can harm.
Note for the coach: a player who is giddy, cramping and has a fast pulse is not 'being brave' by continuing - the risk of collapse is high.
3. State the conditions Rohan must meet before he is allowed to play the next day's match, and give three preventive measures the coach should have applied before the 11:30 a.m. match.
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Return-to-play conditions (all must be met, not just 'he says he is fine'):
- No headache, giddiness or cramp at rest and after 10 minutes of easy walking or light passing.
- Normal pulse and breathing for his age, and normal body temperature.
- Passing pale yellow urine, and able to eat a normal meal and drink without nausea.
- A doctor's clearance if he needed hospital treatment, and no repeat symptoms during the warm-up.
- Ideally, reduced raid load on return (fewer raids, more rest between them).
Three preventive measures the coach should have applied:
- Food and fluid timing - a proper carbohydrate meal 2–3 hours before play (not one banana), about 400–600 mL of water 2 hours before, and 150–250 mL every 15–20 minutes during play; ORS when sweating heavily for more than an hour.
- Schedule and environment - request that matches not be played at the hottest part of the day, provide shade, chilled water and wet towels at the court, and allow rolling substitutions.
- Heat acclimatisation and monitoring - gradual exposure to heat over the 10–14 days before the tournament, and weighing players before and after play; a loss of more than 2 % of body mass means the player was already under-hydrated and must be replaced.
Adding a cool-down and a check by the school first-aider after each match would have caught his condition earlier.