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...

Objective: To assess existing original research addressing the efficiency of whole-body cooling modalities in the treatment of exertional hyperthermia.Data Sources: During April 2007, we searched MEDLINE, EMBASE, Scopus, SportDiscus, CINAHL, and Cochrane Reviews databases as well as ProQuest for theses and dissertations to identify research studies evaluating whole-body cooling treatments without limits.

Context: When assessing exercise hyperthermia outdoors, the validity of certain commonly used body temperature measuring devices has been questioned. A controlled laboratory environment is generally less influenced by environmental factors (eg, ambient temperature, solar radiation, wind) than an outdoor setting. The validity of these temperature measuring devices in a controlled environment may be more acceptable.Objective: To assess the validity and reliability of commonly used temperature devices compared with rectal temperature in individuals exercising in a controlled, high environmental temperature indoor setting and then resting in a cool environment.Design: Time series study. Setting: Laboratory environmental chamber (temperature 5 36.4 6 1.26C [97.5 6 2.166F], relative humidity 5 52%) and cool laboratory (temperature 5 approximately 23.36C [74.06F], relative humidity 5 40%).Patients or Other Participants: Fifteen males and 10 females.Intervention(s): Rectal, gastrointestinal, forehead, oral, aural, temporal, and axillary temperatures were measured with commonly used temperature devices. Temperature was measured before and 20 minutes after entering the environmental chamber, every 30 minutes during a 90-minute treadmill walk in the heat, and every 20 minutes during a 60-minute rest in mild conditions. Device validity and reliability were assessed with various statistical measures to compare the measurements using each device with rectal temperature. A device was considered invalid if the mean bias (average difference between rectal and device temperatures) was more than 60.276C (60.506F).Main Outcome Measure(s): Measured temperature from each device (mean and across time).Results: Conclusions: Even during laboratory exercise in a controlled environment, devices used to measure forehead, temporal, oral, aural, and axillary body sites did not provide valid estimates of rectal temperature. Only intestinal temperature measurement met the criterion. Therefore, we recommend that rectal or intestinal temperature be used to assess hyperthermia in individuals exercising indoors in the heat.Key Words: core body temperature, hyperthermia, tympanic membrane Key Points N As indicated by mean bias values, invalid estimates of rectal temperature (the ''gold standard'') were provided by forehead sticker, oral temperature, temporal temperature, aural temperature, and axillary temperature.N Intestinal temperature was the only measurement considered valid. N Successive intestinal, forehead sticker, temporal, and aural measurements demonstrated acceptable reliability.

Context: Authors of most field studies have not observed decrements in physiologic function and performance with increases in dehydration, although authors of well-controlled laboratory studies have consistently reported this relationship. Investigators in these field studies did not control exercise intensity, a known modulator of body core temperature.Objective: To directly examine the effect of moderate water deficit on the physiologic responses to various exercise intensities in a warm outdoor setting.Design: Semirandomized, crossover design. Setting: Field setting. Patients or Other Participants: Seventeen distance runners (9 men, 8 women; age 5 27 6 7 years, height 5 171 6 9 cm, mass 5 64.2 6 9.0 kg, body fat 5 14.6% 6 5.5%).Intervention(s): Participants completed four 12-km runs (consisting of three 4-km loops) in the heat (average wet bulb globe temperature 5 26.56C): (1) a hydrated, race trial (HYR), (2) a dehydrated, race trial (DYR), (3) a hydrated, submaximal trial (HYS), and (4) a dehydrated, submaximal trial (DYS).Main Outcome Measure(s): For DYR and DYS trials, dehydration was measured by body mass loss. In the submaximal trials, participants ran at a moderate pace that was matched by having them speed up or slow down based on pace feedback provided by researchers. Intestinal temperature was recorded using ingestible thermistors, and participants wore heart rate monitors to measure heart rate.Results: Body mass loss in relation to a 3-day baseline was greater for the DYR (24.30% 6 1.25%) and DYS trials (24.59% 6 1.32%) than for the HYR (22.05% 6 1.09%) and HYS (22.0% 6 1.24%) trials postrun (P , .001). Participants ran faster for the HYR (53.15 6 6.05 minutes) than for the DYR (55.7 6 7.45 minutes; P , .01), but speed was similar for HYS (59.57 6 5.31 minutes) and DYS (59.44 6 5.44 minutes; P . .05). Intestinal temperature immediately postrun was greater for DYR than for HYR (P , .05), the only significant difference. Intestinal temperature was greater for DYS than for HYS postloop 2, postrun, and at 10 and 20 minutes postrun (all: P , .001). Intestinal temperature and heart rate were 0.226C and 6 beats/min higher, respectively, for every additional 1% body mass loss during the DYS trial compared with the HYS trial.Conclusions: A small decrement in hydration status impaired physiologic function and performance while trail running in the heat.Key Words: environmental physiology, dehydration, rehydration, core temperature, heart rate Key Points N The physiologic and performance decrements associated with dehydration that exist in laboratory settings also exist in field settings. N Methodologic challenges in the field setting make isolating these effects difficult.