The tragic death of Manly rugby league player Keith Titmuss in 2020 from exertional heat stroke is a reminder of the life-threatening nature of this disease.
Titmuss died following a pre-season training session that the judge who oversaw a recent investigation said was “more likely than not inappropriate.”
New South Wales deputy coroner Derek Lee said some recommendations in a review of Titmuss’ death in the hope of reducing the danger of it happening again.
So what is exertional heat stroke and what should athletes and coaches find out about it?
What is exertional heat stroke?
Exertional heat stroke is essentially the most severe type of: spectrum of diseases classified as exertional heat diseases.
When practicing sports and exercise, the challenge is to keep up the best body temperature at around 36-38°C.
This is because exercise produces an enormous amount of internal heat that have to be released from the body to avoid overheating. Hot and humid conditions emphasize humans’ ability to release this internal heat and also potentially increase heat load.
If someone’s body is unable to manage the rise in body temperature during physical activity, it may eventually show itself central nervous system dysfunction. Symptoms include lack of muscle control in the arms and legs, combativeness, convulsions, or lack of consciousness.
AND very elevated core temperature (often, but not all the time, above 40°C) i multi-organ damage and failure are also characteristic of exertional heat stroke.
In one study 27% of individuals with severe exercise-related heat illness died. But even those that survive often face long-term negative health consequences, equivalent to: increased risk of cardiovascular diseases later in life.
How common is exertional heat stroke?
Less severe types of exertional heat illness (known as heat exhaustion and heat injury). more common during sports and exercise than exertional heat stroke. However, the life-threatening nature of the disease signifies that precautions have to be considered, especially for summer sports.
The disease affects “weekend warriors” all the best way as much as elite athletes and military personnel. Recent publication published in a journal Journal of Science and Medicine in Sport reported that 38 people died in Australia between 2001 and 2018 attributable to exertional heat stroke attributable to sports and exercise.
However, cases of exercise-related heat illness are regarded as common underestimated.
In an attempt to scale back the danger of future cases of exertional heat stroke in rugby league, Coroner Lee made recommendations following an inquest into Titmuss’ death.
1) Mandatory 14-day acclimatization training to heat
The human body can adapt quickly (over one to 2 weeks) to repeated gradual exposure to a hot and humid environment, ultimately reducing the danger of heat illness.
Tests shows that preseason heat acclimation protocols reduce the danger of heat illness in team athletes.
2) Consider screening and grading athletes for risk of exertional heat stroke
United States National Association of Athletic Trainers recommends that players who compete in hot and humid conditions be tested for heat illness.
This process seems intuitive, but we lack a standardized and validated questionnaire.
Other vital risk aspects include hydration status, history of heat illness and/or recent viral illness or infection, body composition (high body fat percentage), and age (elderly).
3) Identify cooling strategies which might be appropriate and effective
In hot and humid conditions, cooling interventions should be considered for each prevention (for play) and treatment (for the victim).
The evidence suggests that when it involves cooling interventions immersion in cold water, swallowing cold water or ice, cooling clothing (equivalent to ice vests or ice towels), portable fans (with or without additional skin moistening) or additional breaks in the sport may help.
The kind of sport will influence the choice about possible cooling interventions.
Other aspects include the extent of resources (the quantity of funding and support staff), the kind of sport (the variety of athletes requiring intervention will vary between team and individual sports), and the demands of the sport (continuous practice vs. sports with regular breaks).
Is there anything athletes and coaches can consider?
Many elite sporting organizations in Australia and abroad are working with researchers to develop modernized heat policies that aim to scale back the danger of heat illness in elite competition.
An example is the renewed heat policy on the Australian Open tennis.
At the community level, coaches and athletes can seek the advice of with one another Sports Medicine Australiaonline tool. This allows for risk assessment depending on the kind of sport and current geographical location.
Sports and educational organizations should also consider higher education of administrators, staff, and athletes to scale back the danger of exercise-related heat stroke in athletes.
