Heat stroke advice for sports trainers and coaches

Background

Heat stroke is an uncommon but life threatening complication of grossly elevated body temperature with exercise in heat stressed settings. Whilst heat stroke risk can be minimised by the use of predictive tools (e.g. Sports Medicine Australia’s UV Illness and Heat Guide), the risk cannot be fully eliminated.

Risk is highest with: high temperatures and/or high humidity and/or vigorous activity.

Symptoms and signs

In a heat stressed setting always suspect heat stroke if an athlete becomes acutely unwell or collapses, especially if they don’t recover promptly on lying flat with the legs elevated. Whilst there are many possible causes of such an acute illness or collapse, heat stroke is one of the most important.

The first signs of heat stroke show in the function of the brain and the nervous system.

Look for any of: confusion, incoherent speech, abnormal walking, coma or seizures.

The athlete’s skin may feel dry and hot, or sweaty—so the feel of the skin is not a useful sign. Similarly, on-field temperature measurement is unreliable, so don’t use this to rule in or rule out heat stroke.

First aid

If an ill athlete in a heat-stressed setting hasn’t rapidly responded to lying flat in the shade, there is no downside to assuming heat stroke is the problem and starting first aid.

Early recognition and rapid first aid cooling are the keys to recovery from heat stroke.

Actions to take in this order are:

• STRIP the athlete of as much clothing as possible
• SOAK with any available water
• FAN vigorously by whatever means possible—improvise e.g. use a clipboard, bin lid.

When available, cool or ice water immersion is the most effective cooling means possible:

• IMMERSE the athlete up to the neck in a cool or ice bath OR
• COVER all of the body with ice water soaked towels that are changed frequently as an alternative if a bath isn’t available but ice is
• CALL 000 to summon emergency services, but do so once you are certain first aid cooling is being implemented.

Remember it is early recognition and first aid in heat stroke that is critical to save a life.