EXERTIONAL HEAT STROKE
Recommendations
Prevention
1. In conjunction with preseason screening, athletes should be questioned about risk factors for heat illness or a history of heat illness. Evidence Category: C
2. Special considerations and modifications are needed for those wearing protective equipment during periods of high environmental stress. Evidence Category: B
3. Athletes should be acclimatized to the heat gradually over a period of 7 to 14 days. Evidence Category: B
4. Athletes should maintain a consistent level of euhydration and replace fluids lost through sweat during games and practices. Athletes should have free access to readily available fluids at all times, not only during designated breaks. Evidence Category: B
5. The sports medicine staff must educate relevant personnel (eg, coaches, administrators, security guards, EMS staff, athletes) about preventing exertional heat stroke (EHS) and the policies and procedures that are to be followed in the event of an incident. Signs and symptoms of
a medical emergency should also be reviewed. Evidence Category: C
Recognition
6. The 2 main criteria for diagnosis of EHS are (l) core body temperature of greater than 104[degrees] to 105[degrees]F (40.0[degrees] to 40.5[degrees]C) taken via a rectal thermometer soon after collapse and (2) CNS dysfunction (including disorientation, confusion, dizziness, vomiting, diarrhea, loss of balance, staggering, irritability, irrational or unusual behavior, apathy, aggressiveness, hysteria, delirium, collapse, loss of consciousness, and coma). Evidence Category: B
7. Rectal temperature and gastrointestinal temperature (if available) are the only methods proven valid for accurate temperature measurement in a patient with EHS. Inferior temperature assessment devices should not be relied on in the absence of a valid device. Evidence Category: B
Treatment
8. Core body temperature must be reduced to less than 102[degrees]F (38.9[degrees]C) as soon as possible to...