By Aaron Collins

Although summer is in full swing, football season gears up with pre-season practice in just a few weeks. So naturally, thoughts of cool fall Friday nights come to mind. But for the players, the August practice regimen finds them on the field in temperatures that are anything but fall-like. Scorching San Joaquin Valley temperatures easily reach more than 100 degrees this time of year.

Old-school macho coaches’ attitudes about the heat might be best summed up by the adage “what doesn’t kill you makes you stronger.” But after heat-related illnesses that, in some cases, have resulted in players’ deaths, the new-school thinking is tending toward whatever keeps players alive and well—and keeps both coach and school district from getting sued by aggrieved parents.

Times have indeed changed, but more education is imperative, says Tulare District Hospital’s Benny Benzeevi, M.D., FACEP. “Some used to think that if you are fit enough or strong enough, you can take the heat. That is utterly false. No matter the physical shape, the body can only tolerate heat to a certain point, after which symptoms begin.

“We cannot educate enough, especially as heat strokes are preventable in most cases,” says Dr. Benzeevi. “For example, heat acclimation—being out in the heat for short intervals—over a period of days is essential before initiating sports-related exertion in hot weather.”

Warming Up

Dr. Benzeevi says it takes most healthy people about two weeks of 100 minutes per day exposure to hot weather to acclimate.  In addition, pre-exercise hydration with a carbohydrate/electrolyte sports drink two hours and again twenty minutes before exercise, and then every ten to twenty minutes during exercise, as well as after the exercise session, is essential for the athlete to remain appropriately hydrated.  Coaches should also be very aware of the early signs of heat exhaustion (the precursor to heat stroke), and immediately remove an athlete from the heat if she shows such signs.  It is critical that this message be reiterated, over and over again, says Benzeevi.

His emphasis is good news, considering that more people have died from extreme heat-related illness than from tornadoes, lightning, floods, and earthquakes combined over the last twenty-five years: 8,015 souls lost, most of which were preventable deaths, according to the Centers for Disease Control in Atlanta. So it’s time to recognize heat-related illness as the deadly serious problem it is.

Heat-related illnesses occur when the body cannot compensate quickly enough to adapt to a hot environment and properly cool itself through normal sweating. In certain conditions, perspiring just is not enough. Body temperature rises quickly, leading to potential brain and other vital organ damage.

Young and healthy athletic types are not invincible, especially in California’s Central Valley—one of the hottest summer regions in the U.S., whose temperatures promise to increase along with the Earth’s rising average temperature.

Air Conditioning Helps!

File this fact under “D” for Duh: Word has it that air conditioning helps avoid heat-related illness! But there is actually more to it than just the obvious. Research shows that time spent indoors with air conditioning seems to offer the body cumulative effects. In other words, someone who spends six hours cooling is better able to withstand the heat longer than someone who cools after forty-five minutes then enters the heat.

What to Look Out For

Heat Stroke is the loss of the body’s ability to regulate its own temperature: It can rise to 106 degrees rapidly as the sweating process fails, no longer able to cool the body. Heat stroke can result in permanent disability or rapid death if medical attention is not sought immediately.

The signals vary, but those to watch out for include throbbing headache; intense, rapid pulse; dizziness; confusion; red, hot, and dry skin; and an oral temperature above 103 degrees. Unconsciousness can follow any combination of the above.

Heat Exhaustion is a milder form of heat stroke, which is not to say it’s considerably more fun. Intense perspiration, dizziness, nausea or vomiting, fatigue and paleness are among the symptoms. And like heat stroke, heat exhaustion can make you faint or lose consciousness. Vague but rapid pulse and short, rapid breaths are also evident.

Heat Cramps result, it is believed, from low salt levels due to perspiration during strenuous activity. The cramps themselves can be a sign of heat exhaustion, so pay attention if these symptoms develop. These muscle spasms can occur in the body from arms to legs to the torso. If these occur, cease physical activity, get rest, and drink either water, clear juice, or a sports drink such as Gatorade. If symptoms do not improve within an hour, seek help—the condition can signal the onset of the more serious heat exhaustion or even heat stroke.

Sunburn, thankfully, seems to be on the wane as more people get the news of rising skin cancer rates. That real-deal ‘70s-era tan look is pretty much passé now (the spray-on variety aside). But people can still get caught somewhere unexpected without sunscreen. If you do, and the burns are not severe enough to warrant a hospital visit, apply ice to remove the sting, or soak in a cool bath. Ignore the old remedy of butter, salve, or ointment. Resist picking at any blisters that form; allow them to heal naturally.

Heat Rash is the least serious of the heat-related illnesses, and is more annoying discomfort than anything. Most common in young children, heat rash looks like reddish clusters of small pimples or blisters typically found on the upper chest, neck, groin, or crease of the arms. The best approach is prevention, by providing a cool dry place for kids. Powder is usually sufficient to ease any discomfort.

Avoid Trouble

Dr. Benzeevi says that Valley residents can avoid trouble if they follow these steps: Stay indoors and out of the sun during the day. Use your air conditioner—fans alone are not enough. If you do not have an air conditioner, go to a building that does. Drink plenty of fluids. Choose electrolyte-balanced sports drinks. Wear light-colored, loose clothing and a hat. Avoid caffeinated or alcoholic beverages, which cause dehydration. Also, take note of medications that can affect your heat tolerance. Finally, take frequent cold showers or baths.

Dr. Benzeevi says some factors can make it hard to determine if you’ve got a heat emergency. Alcohol consumption, obesity, having an illness with a fever during a heat wave, and lack of sleep can affect your heat tolerance. Drugs such as amphetamines, caffeine, and certain heart medications aggravate the effect of extreme heat.

Immediate Treatment

The person on the scene first can help, says Dr. Benzeevi. The first step in treating heat-related illness is recognizing it. Immediately get the person to a shaded, cool area.  Apply water to the patient and manually fan her to initiate and increase evaporation. If the victim is awake, begin rehydrating him with electrolyte-balanced fluids, if any are available. If a paramedic unit is available, they should initiate gradual IV hydration.  Finally, transport the patient to the nearest Emergency Department as soon as possible.

Vulnerable Elders

Athletes and outdoors enthusiasts are at greater risk than average people, and infants and children are vulnerable, but the most vulnerable group is the elderly, whose ability to withstand the effects of the heat diminish with age. They are at greater risk because people 65 and older respond to heat stress less efficiently, and they are less able to sense the signals of impending trouble in time to counteract them.

Complicating matters for them, American society is far less integrated with its elderly than are other cultures. The elderly, while enjoying the benefits of independence, may also go unmonitored for longer periods while the aged in other cultures often have extended family close at hand to offer protection in extreme weather circumstances. Home alone, they can more easily fall victim.

What can we do as a society to raise awareness that would minimize this vulnerability and look out for them?

Says Dr. Benzeevi: “Neighbors should check on neighbors, especially on elderly people who live alone. Families should consider bringing their elderly relatives to live with them during periods of heat waves. (We need) constant education to the public at large and to individuals most exposed to the heat: Agricultural workers, police officers, firefighters, paramedics, athletes, kids, etc.—that is key.”

The Future

As for medical advances on the horizon, Dr. Benzeevi says that research is being conducted on medications that increase the body’s production of heat shock proteins—natural proteins that protect cells against excessive heat exposure. In addition, some experimental suits are being tested that rapidly decrease the body’s core temperature.

That means that the most important tools still remain prevention and early recognition. Medical advances help, but it is still up to individuals to stay cool … and stay alive.

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