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n September 2015 the National Athletic Trainers’ Association published their latest position statement built upon scientifically based, peer reviewed research by a team of authors who are experts on the subject of exertional heat illnesses. The objective of the statement is to “present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation” to help certified athletic trainers and other health care providers. The primary goal of the recommendations is athlete health and safety during performance in hot/humid conditions. The following commentary presents highlights of the Position Statement. Casa D, DeMartini J, Yeargin S, et al. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. Journal of Athletic Training (Allen Press). September 2015;50(9):986-1000.

Exertional Heat Illnesses (EHIs) identified within the paper include Exerciseassociated muscle cramps (EACMs), Heat syncope, Heat exhaustion, Exertional heat injury, and Exertional heat stroke (EHS). Keeping in mind that individual responses to environmental conditions and exertion may differ, highlights of the recommendations for Prevention, Recognition, Treatment, and Return to Activity include, but are not limited to the following (consult the full document for detailed recommendations): Prevention • Conduct a thorough physician supervised preparticipation medical screening to identify at-risk athletes. • Acclimatize athletes gradually over 7-14 days. • Individuals should maintain euhydration and appropriately replace fluids lost through sweat during and after training and competition and should have access to fluids on an as-need basis. Encourage sodium replacement. 22

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• Educate relevant personal on prevention and recognition of EHI and particularly EHS.


• Effects of heat are cumulative. Encourage athletes to sleep in a cool environment, eat a balanced diet and properly hydrate before, during and after exercise.

• EAMC – visible cramping in part or all of the muscle or muscle groups, localized pain, dehydration, thirst, sweating, or fatigue. Tend to be short in duration and mild in severity, but some may severely impact performance and require further medical attention.

• Policies on preseason heat acclimatization and event guidelines for hot, humid weather conditions should be developed based upon type of activity and temperature.

• Heat Syncope – brief episode of fainting associated with dizziness, tunnel vision, pale or sweaty skin, and a decreased pulse rate while standing in the heat or after intense exercise.

• Identify high-risk athletes and monitor during stressful environmental conditions taking preventative measures.

• Exertional Heat Exhaustion – excessive fatigue, fainting, or collapse with minor cognitive changes (eg, headache, dizziness, confusion). More serious symptoms may indicate EHS.

• Match rest breaks and work-to-rest ratios to environmental conditions and intensity of activity. • Supplemental sodium ingestion and fluid monitoring or neuromuscular reeducation may help prevent EACMs.


• Exertional Heat Stroke (EHS) – CNS dysfunction and a core body temperature greater than 40.5°C (105°F). Core body temperature may be below this level with EHS still present, immediate treatment is vital if EHS is suspected.

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