Exertional Heat Stroke

Originally published: June 27, 2014

Today, athletic trainers from all over the country are convening for the National Athletic Trainers’ Association’s 65th Clinical Symposia in Indianapolis. One of the “hot” topics at this convention is the matter of heat-related illnesses.

In addition to general discussions of heat-related illnesses, these leading healthcare professionals have released an executive summary of NATA’s position on exertional heat illnesses.


In the summertime exertional heat stroke is the number one cause of death in sport. Between 2010 and thus far in 2014, a total of 20-22 deaths have resulted from heat stroke, and we have yet to enter the hottest part of summer. When athletes, coaches, and athletic trainers are properly trained, death from heat stroke is completely preventable. Key elements to know include prevention, recognition, and treatment.


In this newly released executive summary from NATA, they include the updated guidelines for preventing heat stroke, specifically on the topic of heat acclimatization. You can find their official statement here. We’ve outlined some of their recommended (and updated) preventive measures below.

1. Pre-Season Heat Acclimatization Program – For 7-10 days, athletes should be allowed time to acclimate to the increased temperatures an exertion. In their updated recommendations, NATA suggests the following schedule:

  • Days 1-2: Single three hour practice OR single two hour practice and single one hour field session. Only helmets may be worn.
  • Days 3-4: Single three hour practice OR single two hour practice and single hour field session. Only helmets and shoulder pads may be worn.
  • Day 5: Single three hour practice OR single two hour practice and single one hour field session. Full equipment may be worn.
  • Days 1-5 Equipment guidelines for preseason participation only impact days 1-5 of the acclimatization period.

2. “Plan rest breaks and modify the work-to-rest ratio to match environmental conditions and the intensity of the activity.”


1. Know the signs – The two primary indications of exertional heat stroke are “profound central nervous system dysfunction” and a core body temperature over 105° F.

2. Temperature – To obtain the most accurate core body temperature, it is best to use a rectal thermometer.

(We published a brief post last summer on how to recognize dehydration.)


1. Lower core body temperature to below 102.5°.

2. Cold Water Immersion – New guidelines from NATA “suggest a step-by-step protocol for cold water immersion for the clinician to implement with an exertional heat stroke patient.” The cooling rate can be expected to reach 1°F every three minutes throughout immersion.

3. “Cool first, transport second” – New guidelines dictate that a suspected heat stroke victim should be treated with the cold water immersion for the length of time necessary to reduce their core temperature BEFORE they are transported to a hospital.


Heat Illness Executive Summary from National Athletic Trainers’ Association

NATA Summary of Hot Topics in Heat Illness

Heat Illness Resource Center