Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes. The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses.

Objective: To present recommendations for the prevention, recognition, and treatment of exertional heat illnesses and to describe the relevant physiology of thermoregulation.Background: Certified athletic trainers evaluate and treat heat-related injuries during athletic activity in ''safe'' and highrisk environments. While the recognition of heat illness has improved, the subtle signs and symptoms associated with heat illness are often overlooked, resulting in more serious problems for affected athletes. The recommendations presented here provide athletic trainers and allied health providers with an integrated scientific and practical approach to the prevention, recognition, and treatment of heat illnesses. These recommendations can be modified based on the environmental conditions of the site, the specific sport, and individual considerations to maximize safety and performance.Recommendations: Certified athletic trainers and other allied health providers should use these recommendations to establish on-site emergency plans for their venues and athletes. The primary goal of athlete safety is addressed through the prevention and recognition of heat-related illnesses and a welldeveloped plan to evaluate and treat affected athletes. Even with a heat-illness prevention plan that includes medical screening, acclimatization, conditioning, environmental monitoring, and suitable practice adjustments, heat illness can and does occur. Athletic trainers and other allied health providers must be prepared to respond in an expedient manner to alleviate symptoms and minimize morbidity and mortality.Key Words: heat cramps, heat syncope, heat exhaustion, heat stroke, hyponatremia, dehydration, exercise, heat tolerance H eat illness is inherent to physical activity and its incidence increases with rising ambient temperature and relative humidity. Athletes who begin training in the late summer (eg, football, soccer, and cross-country athletes) experience exertional heat-related illness more often than athletes who begin training during the winter and spring. [1][2][3][4][5] Although the hot conditions associated with late summer provide a simple explanation for this difference, we need to understand what makes certain athletes more susceptible and how these illnesses can be prevented. PURPOSEThis position statement provides recommendations that will enable certified athletic trainers (ATCs) and other allied health providers to (1) identify and implement preventive strategies that can reduce heat-related illnesses in sports, (2) characterize factors associated with the early detection of heat illness, (3) provide on-site first aid and emergency management of athletes with heat illnesses, (4) determine appropriate return-toplay procedures, (5) understand thermoregulation and physiologic responses to heat, and (6) recognize groups with special concerns related to heat exposure. ORGANIZATIONThis position statement is organized as follows:1. Definitions of exertional heat illnesses, including exerciseassociated muscle (heat) cramps, he...

CWI was found to effectively treat all cases of EHS observed in this study. CWI provided similar treatment outcomes in all patients, with no significant differences noted on the basis of initial Tr, age, or sex. On the basis of the 100% survival rate from EHS in this large cohort, it is recommended that immediate (on site) CWI be implemented for the treatment of EHS.

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Because of the environmental conditions and race duration, the Falmouth Road Race provides a unique setting for a high incidence of EHS. A clear relationship exists between environmental stress, especially as measured by Tamb and HI, and the occurrence of EHS or other EHI. Proper prevention and treatment strategies should be used during periods of high environmental temperatures as the likelihood of runners experiencing EHS is exacerbated in these harsh conditions.

Hyperthermia is common among athletes and in a variety of environments. The purpose of this study was to evaluate the effectiveness of cooling methods on core body temperature, heart rate (HR), and perceptual readings in individuals after exercise. Sixteen subjects (age: 24 ± 6 years, height: 182 ± 7 cm, weight: 74.03 ± 9.17 kg, and body fat: 17.08 ± 6.23%) completed 10 exercise sessions in warm conditions (WBGT: 26.64 ± 4.71°C) followed by body cooling by 10 different methods. Cooling methods included cold water immersion (CWI), shade, Port-a-Cool® (FAN), Emergency Cold Containment System® (ECCS), Rehab. Hood® (HOOD), Game Ready Active Cooling Vest™ (GRV), Nike Ice Vest™ (NIV), ice buckets (IBs), and ice towels (IT). These cooling modes were compared with a control (SUN). Rectal temperature (T(re)), HR, thermal sensation, thirst sensation, and a 56-question Environmental Symptoms Questionnaire (ESQ) were used to assess physiological and perceptual data. Average T(re) after exercise across all trials was 38.73 ± 0.12°C. After 10 minutes of cooling, CWI (-0.65 ± 0.29°C), ECCS (-0.68 ± 0.24°C), and IB (-0.74 ± 0.34°C) had significantly (p < 0.006) greater decreases in T(re) compared with that in SUN (-0.42 ± 0.15°C). The HR after 10 minutes of cooling was significantly (p < 0.006) lower for CWI (82 ± 15 b·min(-1)), ECCS (87 ± 14 b·min(-1)), and IT (84 ± 15 b·min(-1)) when compared with SUN (101 ± 15 b·min(-1)). The thermal sensation between modalities was all significantly (p < 0.006) lower (CWI: 1.5 ± 0.5; Fan: 3.0 ± 1.0; ECCS: 4.5 ± 1.0; Hood: 4.5 ± 0.5; GRV: 4.0 ± 0.5; NIV: 4.5 ± 1.0; IB: 4.0 ± 1.0; IT: 3.0 ± 1.0) when compared with SUN (5.5 ± 0.5), except for Shade (5.0 ± 1.0). There were no significant differences (p > 0.006) in thirst sensation between modalities. The ESQ scores were significantly (p < 0.006) lower for CWI (1 ± 6), Fan (4 ± 5), and IT (3 ± 8) compared with that for SUN (13 ± 12). In conclusion, when athletes experience mild hyperthermia, CWI, ECCS, and IB resulted in a significantly greater decrease in T(re). These cooling strategies are recommended to decrease T(re) during a brief recovery period between exercise bouts.

The purpose of this study was to evaluate physical demands of football players during preseason practices in the heat. Furthermore, we sought to compare how physical demands differ between positions and playing status. Male National Collegiate Athletic Association Division 1 football players (n = 49) participated in 9 practice sessions (142 ± 16 minutes per session; wet bulb globe temperature (WBGT) 28.75 ± 2.11°C) over 8 days. Heart rate (HR) and global positioning system data were recorded throughout the entirety of each practice to determine the distance covered (DC), velocity (V), maximal HR (HRmax), and average HR (HRavg). The subjects were divided into 2 groups: linemen (L) (N = 25; age: 22 ± 1 years, weight: 126 ± 16 kg, height: 190 ± 4 cm,) vs. nonlinemen (NL) (N = 24; age: 21 ± 1 years, weight: 91 ± 11 kg, height: 183 ± 8 cm) and starters (S) (N = 17; age: 21 ± 1 years, weight: 118 ± 21 kg, height: 190 ± 7 cm) vs. nonstarters (NS) (N = 32; age: 20 ± 1 years, weight: 105 ± 22 kg, height: 185 ± 7 cm) for statistical analysis. The DC (3,532 ± 943 vs. 2,573 ± 489 m; p = 0.001) and HRmax (201 ± 9 vs. 194 ± 11 b·min(-1); p = 0.025) were significantly greater in NL compared with that in L. In addition, NL spent more time (p < 0.0001) and covered more distance (p = 0.002) at higher velocities than L did. Differences between S vs. NS were observed (p = 0.008, p = 0.031), with S obtaining higher velocities than NS did. Given the demands of their playing positions, NL were required to cover more distance at higher velocities, resulting in a greater HRmax than that of L. Therefore, it appears that L engage in more isometric work than NL do. In addition, the players exposed to similar practice demands provide similar work output during preseason practice sessions regardless of their playing status.

Hypohydration during exercise in the heat impairs neuromuscular control. These findings suggest that physical activity in the heat while dehydrated may affect parameters associated with a higher risk of injury.