General Emergency Information
In the event of an emergency: Dial 911
1000 South Lee Hwy
Cleveland, TN 37311
The closest intersection to the school is Keith St SW and Grove Ave SW.
- Main Office (423) 476-0650
- Arena: Wellness Office (423) 476-0645
Emergency Contact Information:
- Cleveland Police Non-Emergency Number (423) 476-7511
- Bradley County Ambulance Service (423) 728-7010
- Bradley County Fire and Rescue (423) 728-7293
- Police Department (423) 476-1121
- Bradley County Sheriff (423) 476-0680
- Hospital: Sky Ridge Medical Center:
- Main: (423) 559-6000 Westside: (423) 339-4100
- Poison Control US (800) 222-1222
- Athletic Department
- Athletic Director: Turner Jackson (423) 595-4017
- Athletic Trainer: Keresa Steichen (206) 755-5830
- School Resource Officer: Julie Quinn (423) 593-5480
- Arena – South side (Main entrance)
- Portable AED (athletic trainer)
Emergency situations may arise at any time during athletic events. Expedient action must be taken in order to provide the best possible care during the emergency situation. The development and implementation of an emergency plan will help ensure that the best and quickest care will be provided.
Athletic departments have a duty to develop an emergency plan that will be implemented when necessary, therefore providing appropriate standards of emergency care. As athletic injuries may occur at any time and during any activity, the sports medicine team must be prepared. This preparation involves formulation of an emergency plan, proper coverage of events, maintenance of appropriate emergency equipment and supplies, utilization of appropriate emergency medical personnel, and continuing education in the area of emergency medicine and planning. Hopefully, through careful pre-participation physical screenings, adequate medical coverage, safe practice and training techniques and other safety avenues, some potential emergencies may be averted. However, accidents and injuries are inherent with sports participation, and proper preparation on the part of the sports medicine team should enable each; emergency situation to be managed appropriately.
Bradley Central High School has a written emergency plan that should be followed in the event of a medical emergency. All coaches should be familiar with this document and their role and responsibility in an emergency. Any questions should be directed to the head athletic trainer (or school administrator, in the absence of an athletic trainer).
An emergency is the need for Emergency Medical Services (EMS) to give further medical attention and/or transport an athlete to the hospital. It is important in these situations that coordination between the athletic trainer, coaches, administrators and student responders be effective. This guide is intended to delineate roles and outline the protocol to be followed should an emergency occur.
Situations when 911 should be called are:
– An athlete is not breathing
– An athlete has lost consciousness
– It is suspected that an athlete may have a neck or back injury
– An athlete has an open fracture (bone has punctured through the skin)
– Severe heat exhaustion or suspected heat stroke
– Severe bleeding that cannot be stopped
– Any other type of life threating injury
B. EMERGENCY PERSONNEL – Chain of Command
- Team Physician
- Certified Athletic Trainer
- Athletic Director
- Head Coach
- Assistant Coach
- School Resource Officer
- Sports Medicine Student Assistant
- Other Athletes
The highest person in the chain of command who is present at a scene will be the designated person in charge, or leader. That person is responsible for deciding whether or not to call 911, instructing others how they may be of help and will be the person who stays with the athlete until EMS arrives. However at any point in time if someone feels the need due to a life threating situation, they can call 911 it isn’t solely the responsibility of the emergency personnel.
Once it has been decided that EMS should be called, the following protocol should be followed:
C. EMERGENCY ACTION PLAN STEPS:
1. The highest person on the chain of command will be deemed the leader, they will first establish the scene as safe once this has been achieve they will stay with the athlete and monitor their condition while administering necessary first aid. If possible, someone else on the chain of command should also stay and assist. The front office or an administrator should be notified that there is an emergency situation on campus.
2. The highest person on the chain of command will make the call to EMS or will designate another person to make the call.
3. EMS/911 can be called from a cell phone or land line located in the main office, wellness office.
• Providing Information:
‐ Name, address, telephone number of the caller
‐ Nature of emergency (medical or non–‐medical*)
‐ Number of athletes
‐ Condition of athlete(s)
‐ First Aid treatment initiated by the first responder
‐ Specific directions as needed to locate the emergency scene
* DO NOT HANG UP UNTIL EMS HANGS UP FIRST.
Bradley Central High School is located at: 1000 South Lee Hwy Cleveland, TN 37311
The closest intersection to the school is Keith St SW and Grove Ave SW.
4. Another person will be in charge of retrieving the emergency equipment from its designated location and returning to the leader as soon as possible. This can be a good job for a student trainer or coach.
5. The leader will send runners to all intersections between where the athlete is located and the School/venue-specific location to direct the ambulance to the athlete. The runners should stay in their positions and wave the ambulance through the proper turns to get to the athlete.
6. The leader will designate another person to attempt contact with the athlete’s parents. Emergency contact information can be found in the athletes physical form which coaches and athletic trainers should have with them at all times. If a parent is present they are to be located and brought to the area to be transported with EMS.
7. If transport is deemed necessary by EMS, the athlete will be taken Sky Ridge Medical Center: 2305 Chambliss Ave NW, Cleveland TN unless the parent requests otherwise.
D. ROLES OF THE EMERGENCY TEAM MEMBERS
First Responder Responsibilities
1. Assess athlete, if a student has collapsed and is not responsive, assume CPR
2. Identify person to activate Emergency Medical System (call 911or notify EMS if present).
3. Identify person to retrieve emergency equipment such as an AED or other first aid supplies if needed.
4. Lead/coordinate CPR efforts if appropriate until EMS personnel are present to assume care.
5. Identify person to direct EMS to the scene.
6. Identify person to do crowd control. Only persons involved in the care of the athlete should be present.
7. Identify person to contact parents. This person should retrieve students emergency information that all coaches are required to have on hand. They should also share this information with the person designated to call EMS.
Person activating Emergency Medical System responsibilities
1. Call 911 immediately.
2. Be prepared to give as much information as possible including:
a. Your name, address, telephone number of caller
b. Why you are calling (student collapsed while practicing football)
c. Condition of athlete (breathing, pulse, level of consciousness, etc)
d. Any treatment initiated by first responder
e. Location of athlete
f. Directions if needed.
g. Other information requested by dispatcher
3. After ending call, report back to FIRST RESPONDER that EMS has been called and is on the way.
Person retrieving Emergency Equipment responsibilities
1. Retrieve AED first and return to scene. Notify FIRST RESPONDER that the AED is present.
2. All teams have a first aid kit but additional supplies such as splints, slings can be obtained from the sidelines where the Athletic Trainers kit is located.
Person directing EMS to scene responsibilities: (Assistant Coach, Administrator, Athletic Director)
1. If more than one person is needed, request additional help.
2. Go to entrance of area. Be sure gates are open. If area is not easy to locate, you may want to have several people to get into strategic areas to “flag down” EMS personnel and direct them to the scene.
Person doing crowd control responsibilities: (SRO, Assistant Coach, Administrator, and Athletic Director)
1. Limit scene to necessary people. Move bystanders away from area.
2. If CPR is in progress, there will need to be several people available to do chest compressions, etc. Determine a couple of people trained in CPR that can assist with this. Have them stand to the side a few feet behind the person doing chest compressions.
3. If the parents/family are present, have someone stand with them for support. Do not try to remove the family but try to prevent them from hindering care.
Person that will contact the parent responsibilities: (Assistant Coach, Administrator, Athletic Director)
1. Obtain information to relay to parents. Emergency contact information and emergency treatment forms are kept in the training kit or head coaches bag.
2. Information needed to share may include:
a. Your name
b. Brief description of event leading to student’ emergency. (John collapsed during football practice)
c. Current condition (he is awake and talking)
d. Any treatment received
e. Other pertinent information. (EMS is here and has started an IV)
f. Which hospital the student will be transported to.
3. Be prepared to give parents directions to hospital if needed.
During home games, the home team ATC and the visiting ATC are responsible for their own teams but may assist the other ATC if needed. Since there is only one ATC on campus, all coaches are responsible for emergencies during practice and games until ATC, EMS, or doctor arrives on scene. The Head coach is in charge of contacting the Athletic Director, Athletic Trainer, and any other school administrator when an emergency situation has occurred. Each Coach should have a current CPR/AED and first aid certification and should be aware of how to perform the EAP when it is needed.
Medical records such as physicals and emergency contact information for an athlete is located in a locked filling cabinet in the Athletic Training Room. The head coach is responsible for having a copy of their athlete’s medical records with them at all times. In the absences of a parent a copy of the athletes medical records should accompany them to the hospital.
E. EMERGENCY EQUIPMENT
Emergency equipment could include: spine boards and straps, automated external defibrillators (AEDs), AED pads, AED batteries, splinting equipment, helmet removal equipment (trainers angle, electrical screw driver) and their batteries, etc.
Personnel should be familiar with the function and operation of each type of emergency equipment. Equipment should be in good operating condition, and personnel must be trained in advance to use it properly. Emergency equipment should be checked on a regular basis and use rehearsed by emergency personnel. The emergency equipment available should be appropriate for the level of training for the emergency medical providers.
- EMT Present: signal to the EMT that assistants is needed, they will have the needed emergency equipment (spine board, cervical collar, AED, splints, etc.)
- ATC Present: AED, trainers angle, smaller splints, bandages and dressings will be on the sidelines of the field (no spine board, cervical collar, large splints)
- ATC NOT Present: AED (locate nearest AED) and whatever medical supplies each sport has in their possession
Location of AED’s
1. Arena: Located on the Wall of the main entrance to the arena.
2. Portable AED: Is located with the ATC, it is kept in the training room.
*Coaches should take note of the closest AED to their practice and game locations.
D. MEDICAL EMERGENCY TRANSPORTATION
Emphasis is placed on having an ambulance on site at high risk sporting events, such as football, gymnastics, track and field meets, etc. In the event that an ambulance is on site, there should be a designated location with rapid access to the site and cleared route for entering/exiting the venue. In the event that an ambulance is not on site, the medical personnel should be aware of average EMS response time for the athletic venue and distance from the venue to local hospitals. Care must be taken to ensure that the activity areas are supervised should the emergency care provider leave the site.
- Any emergency situation where there is impairment in loss of consciousness (LOC), airway, breathing, or circulation (ABCs) or there is a neurovascular compromise should be considered a “load and go” situation and emphasis placed on rapid evaluation, treatment, and proper transportation.
In order to provide the best possible care for Bradley Central athletes it is highly encouraged to send athletes to Sky Ridge Medical Center. Since insurance coverage varies among athletes, parents may decide how their athlete is cared for and where they are cared for. Parents are the primary person to accompany student to hospital. If parents are not around, assistant coach will accompany athlete to hospital along with their physical and consent form. Emergency care providers should refrain from transporting unstable athletes in inappropriate vehicles.
E. VENUE DIRECTIONS (CORRESPONDS TO NUMBERS ON THE MAP)
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. As you approach the security gate the soccer field is located on the left hand side directly in front of the main office.
Jim Smiddy Arena (Basketball/Volleyball/wrestling):
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. Follow the road past the soccer field on the left and the security gate, you will see a large building straight in front, this is the main entrance of the gymnasium. You can continue on this road to reach the east entrance of the gym.
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. Follow the road straight passing the security gate on your right, and the main office on your left. You will follow the road to the right passing the gym. The wrestling building is located behind the gym. You will turn left into the parking lot and the entrance to the wrestling room is located at the west side of the building.
Bear Stadium Jimmy Lovell Field:
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. Follow the road straight passing the security gate on your right, and the main office on your left. You will follow the road to the right passing the gym. Take the first available right, into a parking lot located in front of the football stadium. Following the road passed a gate, you will veer to the left, continue until you see a gate entrance to the football field on the left, pull through the gate.
Football practice Field:
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. Follow the road straight passing the security gate, on your right and the main office on your left. You will follow the road to the right passing the gym. You will pass the gymnasium as well as the wrestling building on your left. You will veer to your left and will see the entrance to the baseball stadium which is located to the west of the football stadium. Turn right in to the entrance of the baseball stadium, where you will see the football practice field on your right. It is located behind the football stadium.
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. Follow the road straight passing the security gate, on your right and the main office on your left. You will follow the road to the right passing the gym. You will pass the gymnasium as well as the wrestling building on your left. You will veer to your left and will see the entrance to the baseball stadium which is located to the west of the football stadium.
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. Go straight till you pass the security gate on your right, turn immediately left passing the main office, and at the stop sign turn right. Soon after the right the road will “T” again take a left and you will see the tennis courts on your left.
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. Go straight till you pass the security gate on your right, turn immediately left passing the front of the school. At the stop sign turn right, there will be a large parking lot on you left continue straight until the road T’s. Turn left and you will see the softball field located straight in front of you.
- Directions from the front entrance of the school: enter the school through the main entrance on S Lee Hwy. Once you pass the security gate on your right turn left this will take you passed the front of the school. At the stop sign turn right, there will be a large parking lot on you left continue straight until the road T’s.
Turn left and you will see the track on your right on a slight hill.
Other Related Emergency Situations
- For other emergencies (poisoning, fire, bomb threats, violent or criminal behavior, etc.) refer to the school emergency action plan checklist and follow instructions.
- In the event of someone suffering from Poisoning:
1. Check scene to make sure it is safe
2. Remove victim from source of Poison
3. Check for life threatening situation
4. If victim is conscious, ask questions to get more information.
5. Look for poison container and take it with you to telephone
6. Call Poison Control Center or 911
7. Give care according to directions of PCC or 911.
8. Find out what type of poison did the victim ingest
9. How much poison did victim ingest?
10. When did the poisoning take place?
In the event of a FIRE:
1. Evacuate building immediately by following nearest exit sign.
2. Exit in a calm and orderly fashion through nearest fire exit.
3. Call 911
4. If smoke is present, crawl low to escape.
5. If you cannot escape, stay in room, stuff door cracks and vents with wet towels or clothes.
6. Call 911 and let dispatcher know your location
In the event of another emergency situation:
In the case of a bomb threat:
- Don’t touch any suspicious objects—report them to the police. Depending on the instructions given by authorities, leave the building with your belongings or immediately take cover. Leave the doors and windows open, and don’t touch the light switches.
- When leaving the building, don’t use the elevators—only use the stairs. Upon reaching the exit, get as far away from the building as possible and obey the police or other authorities who have responded to the call.
In the case of a shooter:
- You have three options: 1. flee the scene if it is safe, 2. go into a lock down, or 3. take action against the shooter.
- Run away from the threat if you can, as fast as you can and never run in a straight line.
- If you are in a classroom/studio/shop the senior employee/faculty member should immediately lock students and themselves in the room (if possible), and cover any windows or openings that have a direct line of sight into adjacent hallways. Keep everyone together.
- If you are in the hallway seek shelter in the nearest securable room, lock the room and cover the windows.
- If you are at an outdoor unsecured area, seek shelter in the nearest building, locate a securable room, lock yourself in the room and close off the windows.
- Never arbitrarily activate a building alarm to evacuate a building unless directed to do so by Campus Safety, as this may alert the intruder of pending response activities, and worsen the situation
The designated weather watcher is the athletic trainer, athletic director, school administer.
- Heat issues are not usually a problem in this area except during summer pre-season practice and spring football, especially during football.
- Cold conditions can also become an issue. If the situation does arise where weather conditions might affect athletes, ATC will keep track of weather conditions via psychomotor or if one is not available ATC will refer to weather conditions by use of internet websites such as weather.com or local news website. ATC will follow the NATA Position Statement: Exertional Heat Illnesses as a reference for determining attire, extent of practices, signs and symptoms, prevention, and treatment of heat injuries and illnesses.
In case of a tornado:
- Advise everyone to leave the area. DO NOT advise them to return to their cars. Advise them to report to the hallways in the school which is the assigned area of the school used for severe weather drills. Taking cover in the doorways and away from windows, or objects. If it is after school hours have them report to the gymnasium.
In case of an earthquake:
- Everyone inside the school will immediately drop, cover, and hold on. If necessary, move only a few steps to a nearby safe place avoiding windows. Stay indoors until the shaking stops and you’re sure it’s safe to exit. If inside the school, expect the fire alarms and maybe sprinklers to go off during a quake. If you are outdoors, find a clear spot away from buildings, trees, and power lines and drop to the ground. Once the shaking stops check yourself and others for injuries. Expect aftershocks and each time you feel one, drop, cover, and hold on. Get everyone out if your home is unsafe. Someone should also call 911 to inform them of situation.
- Over the past century, lightning has consistently been 1 of the top 3 causes of weather-related deaths in this country. It kills approximately 100 people and injures hundreds more each year. Lightning is an enormous and widespread danger to the physically active population, due in part to the prevalence of thunderstorms in the afternoon to early evening during the late spring to early fall.
- The National Athletic Trainers’ Association recommends a proactive approach to lightning safety, including the implementation of a lightning-safety policy that identifies safe locations for shelter from the lightning hazard. Further components of this policy are monitoring local weather forecasts, designating a weather watcher and establishing a chain of command.
- Additionally, a flash-to-bang count of 30 seconds or more should be used as a minimal determinant of when to suspend activities. Waiting 30 minutes or more after the last flash of lightning or sound of thunder is recommended before athletic or recreational activities are resumed.
- Lightning safety strategies include avoiding shelter under trees, shelter made from metal avoiding open fields and spaces, and suspending the use of landline telephones during thunderstorms.
GUIDELINES FOR BCHS
- The game official, athletic trainer, athletic director, principal or assistant principal will make the official call to remove individuals from the game field.
- The athletic trainer, athletic director, principal or assistant principal will make the call to remove individuals from practice fields.
- Spectators will also be instructed to leave the area and seek shelter until the danger has passed.
- At least thirty minutes time will be given for the storm to pass.
- The athletic trainer, athletic director, coach or an assistant coach will be the designated weather watcher, actively looking for signs of threatening weather.
- The athletic trainer, athletic director or coach will monitor weather through the use of a Sky Scan, local forecast, or www.weather.com.
CRITERIA FOR SUSPENDING ACTIVITIES
The criteria for postponement and resumption of activities will be the thirty second flash-to-bang method. After the first flash (lightning) seen, a count will commence. Counting is ceased when the associated thunder (bang) is heard. If the count is less than or equal to 30, activity should be stopped and individuals should be moved to a safe shelter. When this count is divided by 5, the resulting number will determine the distance in miles from the venue.
SAFE SHELTERS AT BCHS
- Outdoor venues:
- Advise everyone to leave the area. Ask those who can to return to their vehicles. If they do not have a vehicle, the arena is the assigned area in the school they can report too.
- The athletes can return to their locker rooms. As a last resort the team can return to the bus making sure all windows and doors are closed.
- Avoid objects made of metal (bleachers, fences, etc.)
CARE FOR LIGHTNING VICTIMS
- Survey scene for safety
- Activate EMS (call 911)
- Only move victim if necessary. (May need to move to safe shelter)
- Refer to Emergency Action Plan (EAP) for further guidance
HEAT, HUMIDITY AND HYDRATION GUIDELINES
During summer, early fall and late spring high temperatures and high humidity can be present. It is important that we are aware of the dangers of this situation to prevent heat illness. Many cases of exertional heat illness are preventable and can be successfully treated if such conditions are properly recognized and appropriate care is given in a timely manner.
Bradley Central High School will follow both the recommendations made by TSSAA and the National Athletic Trainers Association. Athletic Trainer and Coaching staff(s) have the authority to alter work/rest ratios, practice schedules, amounts of equipment and withdrawal of individuals from participation in sports, based on heat conditions and/or athletes’ medical conditions as long as they exceed these recommendations and guidelines listed.
GUIDELINES FOR HYDRATION
Appropriate hydration before, during and after exercise is important for all athletes. Dehydration can compromise the athlete’s performance and increase the risk of heat illness. The American College of Sports Medicine recommends the following guidelines for hydration:
- Drink 16 ounces of fluid at least an hour before exercise
- Drink another 8-16 ounces 15 minutes before exercise
- During exercise, drink 4-16 ounces of fluid every 15-20 minutes
- After exercise, drink 24 ounces of fluid for every pound lost during exercise to achieve normal fluid status within 6 hours.
- All fluids should try and be served cold to promote gastric emptying.
WHAT TO DRINK DURING EXERCISES
Water-For most exercising athletes, the ideal fluid for pre-hydration and re-hydration is water. Water is quickly absorbed, well tolerated, an excellent thirst quencher and cost effective.
Traditional Sports Drinks-with appropriate carbohydrates and sodium may prove beneficial in some situations and for some individuals.
- Situations that may benefit
- Prolonged continuous activity of greater than 45 minutes
- Extremely intense exercise with risk of heat injury
- Extremely hot and humid conditions
- Individuals that may benefit
- Poor hydration prior to participation
- Increased sweat rate
- Poor caloric intake prior to participation
- Poor acclimation to heat and humidity
GUIDELINES FOR PRACTICES
Outdoor practice– The TSSAA Heat policy will prohibit schools from practicing or competing when the heat index at the location of the activity is in excess of 104 degrees Fahrenheit this includes all athletic teams and extracurricular organizations (band, ROTC, etc.).
TSSAA Heat Policy Modifications for Heat Index 95°-104°
TSSAA Heat Policy – Modifications for Golf Competitions and Practice
Players should have immediate access to water regardless of their location on the course. Water bottles should be kept with players at all times. Pace of play should be so that players are resting at least one minute for every three minutes that they are walking. The time taken between shots and the transition time on the tee-box between holes can be considered resting time.
TSSAA Heat Policy – Modifications for Soccer Competition
The referee shall stop the game for a heat time-out lasting no less than five minutes during the first and second half. The time-out will be called at the first logical time to stop play after the 20 minute mark of each half.
TSSAA Heat Policy – Modifications for Football Competition
Officials shall stop the game for a heat time-out at the first dead ball after the halfway point of each quarter. If either team has possession of the ball inside the other team’s twenty yard line, officials may delay this time out until either the offensive team scores or the ball is turned over.
TSSAA Heat Policy – Modifications for Cross Country Competition
Athletes should have access to unlimited water before and after competition. Athletes should be monitored closely for signs of heat illness following the conclusion of the competition. Athletes should be encouraged to re-hydrate and seek shade as soon as the competition is complete.
TSSAA Heat Policy – Modifications for Track and Field Competition
Athletes should have access to unlimited water before, during and after competition. Athletes should be monitored closely for signs of heat illness during the competition. No mandatory stoppage of play required unless the heat index exceeds 104°. Athletes should re-hydrate and seek shade at each available opportunity during the competition.
TSSAA Heat Policy – Modifications for Baseball Competition
Athletes should have access to unlimited water before, during and after competition in the dugout area. No mandatory stoppage of play required unless the heat index exceeds 104°.
TSSAA Heat Policy – Modifications for Softball Competition
Athletes should have access to unlimited water before, during and after competition in the dugout area. No mandatory stoppage of play required unless the heat index exceeds 104°.
TSSAA Heat Policy – Modifications for Tennis Competition
Athletes should have access to unlimited water before, during and after competition. No mandatory stoppage of play required unless the heat index exceeds 104°. Regular periods of rest between games and/or sets should be long enough to maintain a ratio of 1 minute of rest for every 3 minutes played.
2. Indoor practice– All athletic teams and extracurricular organizations (band, ROTC, etc.) may practice indoor at any time as long as the practice area is air conditioned or practice area is equipped with fans to keep the temperature below 95-104 degrees during the practice session.
3. Games/Scrimmages- The Bradley Central Office, school principals, and school athletic directors, athletic trainer will us the TSSAA heat and humidity guidelines as well as temperature and weather forecasts and predictions to make decisions on all games and scrimmages.
4. TSSAA Heat and Humidity Guidelines– Coaches should observe these guidelines at all times.
5. Scheduling practice– factors such as time of day, intensity of practice, equipment worn and environmental conditions should be considered.
6. Water should be made available in unlimited amounts and at any time during practice.
7. Designated breaks should be scheduled during practice.
Symptoms and Treatment Strategies for Exertional Heat Illnesses
When athletes do not replenish lost fluids, they become dehydrated. Dehydration occurs when your body loses too much fluid. This can happen when you stop drinking water or lose large amounts of fluid through diarrhea, vomiting, sweating, or exercise.
Signs and Symptoms:
- Being irritable or cranky
- Seeming bored or disinterested
- Excessive fatigue
- Not able to run as fast or play as well as usual
- Move athlete to a cool environment and rehydrate.
- Maintain normal hydration (as indicated by baseline body weight).
- Begin exercise sessions properly hydrated. Any fluid deficits should be replaced within 1 to 2 hours after exercise is complete.
- Hydrate with a sports drink like Gatorade, which contains carbohydrates and electrolytes (sodium and potassium) before and during exercise is optimal to replace losses and provide energy.
- Hydrate throughout sports practice to minimize dehydration and maximize performance.
- Seek medical attention to replace fluids via an intravenous line if athlete is nauseated or vomiting.
- If degree of dehydration is minor and the athlete is symptom free, continued participation is acceptable with appropriate re-hydration.
B. HEAT EXHAUSTION
Heat exhaustion is a moderate illness characterized by the inability to sustain adequate cardiac output, resulting from strenuous physical exercise and environmental heat stress.
Signs and Symptoms:
- Athlete finds it hard or impossible to keep playing
- Loss of coordination, dizziness or fainting
- Profuse sweating or pale skin
- Headache, nausea, vomiting or diarrhea
- Stomach/intestinal cramps or persistent muscle cramps
- Remove athlete from play and immediately move to shaded or air-conditioned area.
- Remove excess clothing and equipment.
- Cool athlete until rectal temperature is approximately 101°F (38.3°C)
- Have athlete lie comfortably with legs propped above heart level.
- If athlete is not nauseated, vomiting or experiencing any CNS dysfunction, rehydrate orally with chilled water or sports drink. If athlete is unable to take oral fluids, seek medical attention to implement intravenous infusion of normal saline.
- Monitor heart rate, blood pressure, respiratory rate, core temperature and CNS status.
- Transport to an emergency facility if rapid improvement is not noted with prescribed treatment.
- Athlete should be symptom free and fully hydrated; recommend physician clearance; rule out underlying condition that predisposed him/her for continue problems; and avoid intense practice in heat until at least the next day.
C. HEAT CRAMPS
Muscle cramps are not well understood. Heat cramps are often present in athletes who perform strenuous exercise in the heat. Conversely, cramps also occur in the absence of warm or hot conditions, which is common in ice hockey players.
Signs and Symptoms:
- Intense pain (not associated with pulling or straining a muscle)
- Persistent muscle contractions that continue during and after exercise
- Reestablish normal hydration status and replace some sodium losses with a sports drink or water
- Some additional sodium may be needed (especially in those with a history of heat cramps) earlier in the activity.
- Light stretching, relaxation and massage of the involved muscle may help acute pain of a muscle cramp.
- Athletes should be assessed to determine if they can perform at the level needed for successful participation.
D. EXERTIONAL HEAT STROKE
A severe illness characterized by central nervous system (CNS) abnormalities and potentially tissue damage resulting from elevated body temperatures induced by strenuous physical exercise and increased environmental heat stress.
Signs and Symptoms:
- Increase in core body temperature, usually above 104°F/40°C (rectal temperature) when athlete falls ill
- Central nervous system dysfunction, such as altered consciousness, seizures, confusion, emotional instability, irrational behavior or decreased mental acuity
- Nausea, vomiting or diarrhea
- Headache, dizziness or weakness
- Hot and wet or dry skin
- Increased heart rate, decreased blood pressure or fast breathing
- Activate Emergency Medical System (call 911)
- Aggressive and immediate whole-body cooling is the key to optimizing treatment. The duration and degree of hyperthermia may determine adverse outcomes. If untreated, hyperthermia-induced physiological changes resulting in fatal consequences may occur within vital organ systems (muscle, heart, brain, etc.). Due to superior cooling rates, immediate whole-body cooling (cold water immersion), is the best treatment for EHS and should be initiated within minutes post-incident. It is recommended to cool first and transport second if onsite rapid cooling and adequate medical supervision are available.
The athlete’s physician should devise a careful return-to-play strategy that can be implemented with the assistance of a qualified ATC.