Cool First, Transport Second

By Desmond Crooks, MD / Eugene Emeralds | July 30, 2017 12:58 PM ET

While current day coaches do watch for the signs and symptoms, heat stroke remains one of the leading causes of sudden death in summer sports activities.

Heat stroke can occur when the body core temperature reaches 40C (104F) or higher. Remember the mantra "Cool first, transport second" since this is a good reminder of your potentially life-saving response.

 

Can a player (or a fan) be too hot? What should you do about it? When is it dangerous? Read on to find out.

While current day coaches do watch for the signs and symptoms, heat stroke remains one of the leading causes of sudden death in summer sports activities.

Heat stroke can occur when the body core temperature reaches 40C (104F) or higher. Remember the mantra "Cool first, transport second" since this is a good reminder of your potentially life-saving response.

The cause of heat stroke can be from athletic exertion, but this condition can also occur at rest. Under normal circumstances, a healthy adult can withstand core body temperatures of 40C (104 degrees Fahrenheit) for about 30 minutes prior to cell damage starting, but the very young and the aged may develop heat stroke in as little as 15 minutes. Vehicular heat stroke can be fatal to a child left in a hot car. Older adults with heart problems are often unable to compensate for the added heat stress and are at particularly high risk for developing heat stroke.

What kinds of things would you see? Heat stroke victims may be confused, show aggressive behavior, pass out or demonstrate seizure activity. Physical findings can include a fast heart beat, rapid breathing and they may not be sweating anymore.

Other contributing factors increasing risk for heat stroke include caffeine or alcohol use. Both contribute to dehydration. Unfortunately, there is evidence that it is common for people to be chronically dehydrated. Athletes too - studies have shown that ballplayers often show up for practice already dehydrated. Overdressing (pads and gear, for instance) creates additional risk, but is a requirement of some activities and occupations.

Normally, we compensate for added heat stress through evaporative cooling - we sweat! But if the body temperature goes too high, the body is eventually unable to compensate enough and cell damage starts. Proteins denature, cell membranes become leaky and the cells can no longer function normally.

As the title of this article suggests, there isn't any time to lose. Cooling the patient first is the priority. Get the patient away from the heat source. This may be easier said than done, as a true heat stroke victim may be confused and combative (and possibly much bigger than you!) It's important to get their gear off and expose the surface area so you can get water on them. Conditions in the field will vary, and may include raiding the ice chests for cold water and cubes, packing it around their armpits, groin and neck. Water bottles poured on the patient or water from a hose are all helpful. Fanning air across the victim helps cool them faster.

The important thing is to get them cooled off. Paramedics will be able to monitor vital signs, but treatment should start as soon as the condition is suspected. Anyone with heat stroke will definitely need a transport to the hospital.

As we've discussed, heat stroke is a medical emergency. Heat exhaustion is not, but can lead to heat stroke if left untreated. The patient with heat exhaustion is not confused or neurologically abnormal, but will complain of cramps, headache, nausea and lightheadedness. Typically, they are sweating profusely. Like heat stroke, it is imperative to get the patient out of the heat. They will be dehydrated so rehydration is a cornerstone of treatment. Remove their heavy or tight clothing. Cooling the victim with water (spraying or sponging) and adding a fan will help remove body heat.  

Considerably more benign, heat cramps occur after exercise. The loss of salts, fluids and electrolytes cause painful cramps, usually in the larger muscle groups. Their vital signs are typically normal, including temperature. Give them fluids, including those with electrolytes. Rest and gentle stretching is advised. Heat cramps should resolve quickly, and medical care should be pursued if symptoms persist.

Stay well out there!

 

 

This story was not subject to the approval of the National Association of Professional Baseball Leagues or its clubs.

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