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.

Exertional heat illness can affect athletes during high-intensity or long-duration exercise and result in withdrawal from activity or collapse during or soon after activity. These maladies include exercise associated muscle cramping, heat exhaustion, or exertional heatstroke. While certain individuals are more prone to collapse from exhaustion in the heat (i.e., not acclimatized, using certain medications, dehydrated, or recently ill), exertional heatstroke (EHS) can affect seemingly healthy athletes even when the environment is relatively cool. EHS is defined as a rectal temperature greater than 40 degrees C accompanied by symptoms or signs of organ system failure, most frequently central nervous system dysfunction. Early recognition and rapid cooling can reduce both the morbidity and mortality associated with EHS. The clinical changes associated with EHS can be subtle and easy to miss if coaches, medical personnel, and athletes do not maintain a high level of awareness and monitor at-risk athletes closely. Fatigue and exhaustion during exercise occur more rapidly as heat stress increases and are the most common causes of withdrawal from activity in hot conditions. When athletes collapse from exhaustion in hot conditions, the term heat exhaustion is often applied. In some cases, rectal temperature is the only discernable difference between severe heat exhaustion and EHS in on-site evaluations. Heat exhaustion will generally resolve with symptomatic care and oral fluid support. Exercise associated muscle cramping can occur with exhaustive work in any temperature range, but appears to be more prevalent in hot and humid conditions. Muscle cramping usually responds to rest and replacement of fluid and salt (sodium). Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping.

These guidelines are intended to provide relevant information on preventing sudden death in sports and to give specific recommendations for certified athletic trainers and others participating in athletic health care.

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...

This investigation evaluated the validity and sensitivity of urine color (Ucol), specific gravity (Usg), and osmolality (Uosm) as indices of hydration status, by comparing them to changes in body water. Nine highly trained males underwent a 42-hr protocol involving dehydration to 3.7% of body mass (Day 1, −2.64 kg), cycling to exhaustion (Day 2, −5.2% of body mass, −3.68 kg), and oral rehydration for 21 hr. The ranges of mean (across time) blood and urine values were Ucol, 1-7; Usg, 1.004-1.029; U08m, 117-1,081 mOsm • kg−1; and plasma osmolality (Posm), 280-298 mOsm ⋅ kg−1. Urine color tracked changes in body water as effectively as (or better than) Uosm, Usg, urine volume, Posm, plasma sodium, and plasma total protein. We concluded that (a) Ucol, Uosm, and Usg are valid indices of hydration status, and (b) marked dehydration, exercise, and rehydration had little effect on the validity and sensitivity of these indices.