Fall is return to school and return to high school sports. Enthusiasm. Every team is undefeated. Fall high school sports are now in session in the hot, humid Kansas City weather. This poses risk for heat related illnesses and the deadly heat stroke.

Heat stroke and sports, what do you know? T or F?

1. Death from heat stroke is preventable.

2. Heat stroke is always fatal.

3. Soccer has the highest rates of heat stroke.

Heat stroke during practice or competition is a leading cause of death and disability among U.S. high school athletes according to the CDC.

Football has the highest risk with most deaths occurring in August during preseason.

Heat stroke occurs when the body’s capacity to dissipate heat is compromised and core temperature becomes dangerously high. Heat stroke presents as rectal (core) temperature of 104 ̊F with collapse and central nervous system dysfunction which may include altered consciousness, confusion, dizziness, slurred speech, nausea and irrational behavior.

There are many risk factors for heat stroke. Physical activity in hot humid conditions can set the table for heat related illness and heat stroke. However, it can occur in cooler weather. Poor hydration can impair the body’s ability to maintain normal temperature. Poor conditioning, high intensity of physical activity and certain medications are also factors. Diuretics and some medications that are commonly prescribed for attention deficit hyperactivity disorder can increase risk for heat stroke.

Overweight and obesity are significant risk factors for heat stroke.

Over 64 percent of football players who die from heat stroke are overweight or obese. Think lineman. Think Minnesota offensive lineman Korey Stringer who died from heat stroke at the Viking’s preseason camp in 2001.

An athlete’s specific risk factors should be reviewed during the preparticipation evaluation ("sports physical"). An assessment of history, medications including supplement use, and physical examination should be performed. Risk factors should be identified and discussed. This can help the athlete better understand how he or she can prevent heat illness.

High schools implement plans to mitigate risk of heat illness among their athletes. The Missouri High School Activities Association has rules for when practices can begin and limits related to intensity, frequency and duration of practice sessions. Football has the highest rates of heat illness and deaths from heat stroke. MSHSAA rules address the need for heat-acclimatization over 10-14 days so athletes can gradually train their bodies to tolerate rigorous activity in hot, humid conditions.

All athletes, coaches, and parents should be aware of the risk factors for heat illness. Prevention strategies should include frequent water breaks to ensure good hydration and adherence to guidelines.

Athletes are advised to observe the color of their urine. Straw or lemonade color indicates good hydration. Dark, apple juice color indicates dehydration. Clear urine indicates over hydration.

There should be plans at practices and games to identify athletes with heat illness and heat stroke. Quick response can save a life.

Centerpoint Sports Medicine has partnered with several local high schools to promote the care of their athletes. Centerpoint Sports Medicine certified athletic trainers are highly trained in identifying athletes at risk and monitoring for heat stroke. On the sidelines at football practices they carry devices to monitor temperature and advise coaches on risk. They have pools with water and ice ready for immersion therapy in the event an athlete develops heat stroke. For an athlete with heat stroke rapid cooling is critical to survival.

The Korey Stringer Institute (ksi.uconn.edu) is dedicated to preventing deaths from heat stroke. Preseason training should be about preparing for a great season and having fun with your teammates. Not heat stroke.

Answers: 1. T; 2. F; 3. F.

Dr. Lori Boyajian-O’Neill can be contacted at lori.boyajian-oneill@hcahealthcare.com.