ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity

Abstract

Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

Impacts of climate change on organized sport: A scoping review

“…With the latest Summer Olympics and Paralympics and FIFA World Cup being hosted in locations that regularly experience extreme heat conditions (Tokyo and Qatar, respectively; Gerrett et al, 2019;Sofotasiou et al, 2015), the potential risks of thermal stress among athletes and spectators were common concerns raised by researchers (Honjo et al, 2018;Kakamu et al, 2017;Olya, 2019;Tipton et al, 2019;. In the context of organized sport, thermal risks can be defined as the probability of suffering from heat exhaustion or heat illness during play or spectating at sport competitions; these risks depend on both environmental factors (e.g., hot weather) and personal factors (e.g., age, poor physical fitness, health conditions) (Roberts et al, 2021). For athletes and officials on the field, the primary concern is exertional heat illness.…”

Current Clinical Concepts: Heat Tolerance Testing

“…As discussed above, it is important to recognize that results of HTT are dependent on a myriad of situational and individual characteristics that indicate the timeline should not be standardized across cases. First, appropriate diagnosis and fast, aggressive treatment of EHS benefit the recovery of an individual, whereas delayed or treatment with unfavorable cooling rates 34 The clinical algorithm to guide RTA decisions following an EHS, originally constructed by Kazman et al, 21 was adapted to incorporate the aforementioned considerations (see Figure 1 below).…”

“…3,22 To more accurately measure an individual's ability to thermoregulate following an EHS, further research is warranted to better understand the impact the above variables may influence assessment of heat tolerance. 34 Therefore, the future of HTT may include activities more specific to the individual's needs, whether in an athletic event, at work, or within a military setting. As health care professionals, clinical judgment and individualized considerations are key in the use, adaption, and interpretation of HTT.…”

Thermal Strain During Open-Water Swimming Competition in Warm Water Environments

“…The variation in the dataset (38.4 ± 0.8°C) highlighted that some athletes well exceeded a peak T re of 39.0°C. While it is acknowledged that these core temperatures may not be problematic for some elite athletes ( Racinais et al, 2019 ), it is still generally considered to be high risk for exertional heat illness ( Roberts et al, 2021 ). Additionally, there are other published case reports of elite swimmers exceeding a T gi of 39.0°C, and even recording close to 40.0°C during competitive swims ranging from 5 to 10 km in T w up to 32°C ( Bradford et al, 2019 ).…”