NFL Chief Medical Officer Dr. Allen Sills recently spoke with Dr. Doug Casa, a leading expert in exertional heat stroke and the CEO of the Korey Stringer Institute (KSI) at the University of Connecticut.
Dr. Casa has spent over 30 years researching heat illness, hydration, and heat acclimatization, and has worked with athletes across levels, military warfighters, and laborers to prevent and treat heat-related emergencies. Dr. Casa joined Dr. Sills to reflect on the 25th anniversary of Minnesota Vikings player Korey Stringer passing in 2001 due to complications from heat illness.
From the conversation:
- "The core tenet is getting people under 104 degrees within 30 minutes…so we make sure all policies and procedures, all emergency action plans are geared towards that one goal." - Dr. Doug Casa
- "The people who are moving on to exertional heat stroke have significant findings, right? They have neurologic changes, so if you've got mental status changes, you've got a confused or combative athlete. That moves that into that category of more severe illness. That's the person [we've] got to monitor." - Dr. Allen Sills
- "If you are around an athletic event, whether it's a practice or a game, and it's in a hot environment, you should be thinking about heat illness, heat stroke, and have on hand the necessary basic tools to perform the resuscitation, which is that cold tub that you mentioned, a rectal thermometer, and more than anything, just a climate of recognition and an awareness that this can occur." - Dr. Allen Sills
- "You just always have to have a plan… how are you going to cool this person down aggressively and quickly?" - Dr. Doug Casa
Additional takeaways and resources from KSI:
- Heat stroke is survivable, if you act fast: Exertional heat stroke is one of the leading causes of preventable death in sport, and proper training, education and preparation can make a real difference. With immediate cold water immersion, outcomes are dramatically better, but the window for action is short, so knowing what to look for matters. Whenever possible advocate for an athletic trainer at all practices and games as they are trained in the prevention, recognition, and treatment of exertion heat stroke.
- Know the warning signs and symptoms: Confusion, disorientation, or an athlete who just seems "off" during practice in the heat are all red flags. In cases of exertional heat stroke, it's likely the patient will be sweating excessively because it is the intense physical activity that caused their temperature to rise. Don't wait to see if they can shake it off, get them cooled down and call 911 because this is a medical emergency.
- Heat illness can be preventable: Make sure to stay hydrated before, during, and after exercise, take frequent rest breaks, and wear loose-fitting or moisture-wicking clothing, in addition to getting sufficient rest and a well-balanced diet. Slowly increase exposure and intensity of exercise in the first 7-10 days of practice to allow the body to get used to the heat. Avoid conditioning as a form of punishment and have training appropriate for position.
The Korey Stringer Institute is working to keep athletes safe across the country. KSI's Team Up for Sports Safety (TUFSS) initiative, supported by groups such as the NFL Foundation, has advocated in states across the nation to promote policies that reduce deaths and serious injuries in high school sports.
To learn more, visit KSI’s website for free, practical, and ready-to-use resources that can be helpful at any level of sport.
