Preventing heat stroke

By Ronnie Barnes
Giants Head Trainer
President, Professional Football Athletic Trainers Society

August 1, 2001

Q. What can be done to prevent something like this happening to other athletes?
A: The fact is 99 percent of the time it's just heat exhaustion and replacement fluids will solve the problem. What's tragic is you can go right from heat exhaustion to heat stroke, primarily because these are very highly motivated men who work very hard and really don't often tell us if they are having trouble. They might throw up and not tell us, there is a lot of peer pressure to stay in and work hard, so unfortunately in some situations athletes work just beyond their point. But they have certainly been doing this a long, long time, and all of us are aware that heat illness is a very serious illness. Hence, we preach hydration constantly. Athletes should drink before practice, after practice and during practice. We make water available for them, and we make Gatorade and other electrolyte beverages available for them. It's so important because they lose so much more than water. An athlete can really sweat almost a gallon of fluid, and in that fluid is salt and minerals and other important electrolytes that the body needs, and that's why we preach that water is just not enough. That's why we have Gatorade and other sports drinks.

Q: Do people react the same way to dehydration?
A: Various people are vulnerable to heat exhaustion and even heat stroke, and that would be older people, large people, obese individuals, people who have had heat exhaustion before are more likely to have it again. Heat illness, we universally believe it is preventable through hydration, but given athletes can sweat as much as a gallon of fluid in a practice, sometimes you just can't drink enough. They're tired, exhausted, and they just don't drink. But we really do believe that in most instances it is preventable. Unfortunately, as I said before, you can get yourself into trouble really fast without really even knowing it. It sounds like Mr. Stringer had heat exhaustion the day before and was low on reserves and pushed himself more than he should have the next day. I really don't know the details of that, but we universally believe that heat stroke is a preventable illness.

Q: How have things changed in your 20 years here in your approach to water?
A: Throughout the sport, hydration has changed. Two decades ago, coaches didn't allow fluids on the field. Certainly no water, and if so, only half a cup. We have done tremendous research just on how much athletes sweat and the seriousness of heat illness. That being said, water and Gatorade is available at all times and we talk to our players and we try to educate them. I meet with them the night before we start training in this environment. If you have high heat and high humidity, that's when you can get a heat illness. We talk about drinking plenty and that water is available, take it back to the dormitory. We also weigh our players before practice. We ask them to weigh in, and then we weigh them after practice. We monitor their weight. So throughout the league, people are very interested in making sure of preventing heat injury and heat illness.

Q: What is your cutoff on the weigh-ins?
A: It varies in terms of the size of the athlete. Certainly if an athlete starts to lose 6-8 pounds, we would take a look at it.

Q: How does peer pressure come into play?
A: In football practice around the National Football League, all of the athletic trainers are very aware of heat illness, and so we're watching these players, looking at their weight, how much they're losing between practices and everything else. Of course, the larger players, the linemen, heavy players that weigh 300 pounds, so we're all aware of it, and they're aware of it, too. My point was that they are very highly motivated, and often times they just don't want to come out and they don't want to drink, and so there can be problems. Even in the military you see that in very hot environments where you're training for the Marine Corps, people get themselves into trouble. Very rarely. We've never had a death from heat illness in the National Football League. We've been doing preventative programs for a long time, and this just happens to be a very unfortunate situation.

Q: Does this prompt you to re-evaluate what you're doing?
A: Twice a year, the athletic trainers and doctors meet. We meet at the combine in Indianapolis, and we meet at the National Athletic Trainers Association meeting. There is not a meeting that we convene that we don't talk about heat illness. It's all a part of what we do. We've been doing research as close as yesterday. We were evaluating some of our players, putting bags on their arms and measuring the concentration of sweat they were having. We all understand the serious nature of it, but again prevention is the most helpful thing we can do, and we've been doing that for a long time.

Q: Would there ever be a time when the heat was so bad that you would tell the coach he shouldn't practice?
A: Certainly. High humidity, high heat, particularly if the humidity was very high and the heat index was high. Fortunately for us in this area, we don't have those kinds of conditions, but we could have them as early as tomorrow. Coaches are aware of it, as well. They are very well educated about this thing. As a matter of fact, there is a program right now that is going on between the American Football Coaches Association and the National Athletic Trainers Association about heat. It's called "Helping Educate Athletes in Training," and it's a national program, so our coach is aware of this all the time, looking at the heat index, talking to me, and I think Denny Green and every other coach in the league (is), yes. Our Florida teams, Jacksonville and Tampa and Miami, they take even more precautions than we do here. They have air conditioned tents that players can walk through. As I said early on, heat illness can happen and it can happen quick. We think that universally it's preventable, but certainly you can go from sweating to not sweating and heat stroke and that's probably what happened.

Q: If you see a guy headed there quickly, what would you do?
A: We try to hydrate them all the time. If they get cramps, we try to cool them down, and then we get expert medical attention from there if we can't manage it by giving them intravenous fluids. We have them drink electrolyte solutions, Gatorade. We still believe that water is not enough because they're sweating profusely, so we make sure they get plenty of water, plenty of Gatorade, and of course, we'll take them out a few plays.

Q: How many incidents of heat stroke have you seen during your career?
A: We haven't had any heat strokes here, and it's very rare that you would see it. You often see heat stroke in very large people, obese people, and you see it in the elderly and people who aren't drinking. We have had lots of heat illness, heat exhaustion, but no heat stroke.