Purpose

The following policy on fluid replacement, rehydration, prevention, and heat illness has been developed in accordance with the National Athletic Trainers Association Fluid Replacement Position Statement (2017), the NATA Exertional Heat Illness Position Statement (2015), recommendations from the Korey Stringer Institute, and Kansas State High School Activities Association guidelines. This policy is intended to protect the health of student athletes participating in both indoor and outdoor sports.

Rationale of Fluid Replacement

When participating in hot humid environments, student athletes may become deprived of essential fluids, carbohydrates, and electrolytes, leading to dehydration and possibly heat illness. Dehydration can occur with as little as a 1-2% drop in body weight due to loss of fluids. Student athletes who are not properly hydrated prior to the start of physical activity can notice signs of dehydration in as little as an hour or sooner. Dehydration places student athletes at risk for heat related illness such as heat cramps, heat exhaustion, and heat stroke.

Signs and Symptoms of Dehydration

Signs and symptoms include:

• Thirst
• Irritability
• General discomfort
• Headache
• Weakness
• Dizziness
• Nausea
• Cramps
• Chills
• Vomiting
• Decreased performance

Rehydration Guidelines

It is the expectation of the Olathe School District athletic department that all athletes have freely accessible water during practice, regardless of temperature. The athletic trainer, coaches, and other staff will promote consumption of water during practices and games.

Prior to Exercise

• 17-20 fluid ounces should be consumed two to three hours prior to exercise.
• 7-10 fluid ounces should be consumed 10-20 minutes prior to exercise.

During Exercise

• 7-10 fluid ounces should be consumed every 10-20 minutes during exercise.
• Student athletes should drink prior to becoming thirsty.

After Exercise

• Fluids should be replaced within two hours of the end of physical activity.
• 20-24 fluid ounces should be encouraged for every pound of weight lost.

Definition of Heat Illness

Heat illness is closely associated with physical activity and its occurrence increases with a rise in temperature and relative humidity. It is usually classified in four categories: heat syncope, heat cramps, heat exhaustion, and heat stroke. Although most often occurring in hot, humid weather, heat illness can also occur with the absence of both heat and humidity.

Heat Syncope

• It occurs during high heat and humidity due to inadequate blood flow to the brain, resulting in loss of consciousness.
• Signs and symptoms include loss of consciousness or fainting, light-headedness, fatigue, pale/clammy skin.

Heat Cramps

• It occurs during or after intense exercise as an acute, painful and involuntary muscle contraction.
• Causes may include dehydration, electrolyte imbalances, neuromuscular fatigue or a combination of factors.
• Signs and symptoms: dehydration, thirst, transient muscle cramps, and fatigue.

Heat Exhaustion

• It occurs most frequently in hot, humid conditions and causes an inability to continue to exercise.
• It may be caused by dehydration, heavy sweating, sodium loss, and energy depletion.
• Signs and symptoms: fast and weak pulse, persistent muscle cramps, urge to defecate, weakness, fainting, nausea, decreased urine-output, cool and clammy skin, diarrhea, core body temperature between 97-104℉

Heat Stroke

• It occurs when the core temperature is elevated at greater than 104°F and central nervous system dysfunction.
• This is caused by the body's inability to cool itself due to environmental conditions and due to heat production which overwhelms the body’s temperature regulation system.
• Signs and symptoms: fast heart rate, low blood pressure, sweating, skin may be hot and dry, hyperventilation, altered mental status, vomiting, diarrhea, seizures, central nervous system changes, altered consciousness.
• Life threatening if not promptly recognized and treated!

Prevention of Heat Illness Guidelines

• Pre-participation examinations should ask if a student athlete has a history of heat illness.
• Athletic trainers and coaching staff will encourage water consumption during practices and will be aware of signs and symptoms of heat illness and how to intervene.
• Student athletes will follow acclimatization guidelines outlined in the KSHSAA position statement.
• An athletic director or athletic trainer will use a wet-bulb globe temperature to determine what “zone” the site is in and the need for any practice modifications or terminations. If conditions change significantly after the initial WBGT is taken, then it will be reassessed. Ideally, these readings are taken at the practice site.
• Cold immersion tubs will be ready anytime the weather is above 80°F. If no tub is available, a tarp or other device with ice and water for filling is adequate.

Activty Guidelines

If the WBGT is less than 79.9°F (green zone):

• Normal activity; no restriction to student-athletes' access to water.

If the WBGT is 80°-84.6°F (zone 1, yellow):

• Fatigue is possible with prolonged exposure and/or physical activity.
• Monitor at-risk athletes closely.
• Minimum three rest/hydration breaks per hour. Break length minimum four minutes.
• Cold tubs prepared and ready (recommended).

If the WBGT is 84.7°-87.7°F (zone 2, orange):

• Heat cramps or heat exhaustion is possible.
• Two-hour maximum length of practice
• For football, helmets and shoulder pads only. No protective equipment when conditioning.
• Minimum four rest/hydration breaks per hour. Break length minimum four minutes.
• Cold tubs prepared and ready.

If the WBGT is 87.8°-89.7°F (zone 3, red):

• Heat cramps or heat exhaustion are likely; heatstroke is possible.
• One hour maximum length of practice.
• No protective equipment to be worn.
• No conditioning.
• Rest/hydration breaks must total 20 minutes.
• Cold tubs prepared and ready.

If the WBGT is 89.8°F or greater (black zone):

• No outdoor activities or use of un-air conditioned facilities will be permitted.

Treatment of Heat Illness

Heat Syncope

• Move the student-athlete to a cool area and elevate the legs above the heart.
• Have the athlete drink water if conscious.
• Monitor airway, breathing and circulation.
• No return to play until evaluated by a medical professional.

Heat Cramps

• Remove the student-athlete from play and replace lost fluids.
• Begin mild stretching and massage of the contracted area.
• The student-athlete can return to play once cramping has ceased and fluids have been replaced.

Heat Exhaustion

• Move the student-athlete to a cool area and assess cognitive function and vital signs.
• Remove excess clothing and equipment, start fluid replacement, and cool the student-athlete with fans, ice towels on their extremities and in their armpit and groin.
• If possible, assess core body temperature utilizing a rectal thermometer.
• The student-athlete should not return to activity for 24-48 hours.
• If signs and symptoms aren’t improving, activate emergency medical services.

Heat Stroke

• Activate emergency medical services and the emergency action plan.
• Assess vital signs and, if possible, core body temperature using a rectal thermometer.
• Remove excess clothing and equipment and place in a cold water immersion tank (50°F) until the core temperature is 101-102°F.
  • Make sure to circulate water.
• Cool first, transport second!
• Must be cleared by a physician before returning to activity.

Heat stroke has a 100% survival rate if proper cooling is initiated within 10 minutes of collapse.