Exertional heatstroke, a preventable death


DEAR DR. DONOHUE: Next month I am running a basketball camp for teenagers. I have not done this kind of work before, and I am a bit leery on a number of issues. One that bothers me is heat injuries. Could you supply some guidelines that I could follow? – R.W.

Heat-caused injuries rank third as the cause of death in high-school athletes.

That might sound overblown, but it’s true. There are not that many sports-related high-school deaths, so that’s one reason heat deaths are ranked so high. One such death is one too many, as heat-related deaths are preventable.

It takes up to 10 days to fully acclimatize to heat. You should assume your campers are not acclimatized. Have them take it very easy in the first few days.

Practice sessions on days one to three should be held in the early-morning hours, should be limited to three hours and should not be all that strenuous.

Be sure that water is accessible at all times. In more extended practices, have sports drinks that contain sodium and potassium also available.

If you can obtain the wet-bulb temperature index, use it. It was devised by the United States Marines and takes into account temperature, humidity and wind speed.

At wet bulb indexes of 90 and greater, practices should be suspended.

If you cannot obtain this information, there are many charts readily attainable that correlate temperature with humidity and indicate when physical exertion is dangerous.

Exertional heatstroke is the most serious heat injury. Affected boys or girls might be sweating profusely or have dry skin.

They’re weak, dizzy and often complain of headache. Body temperature is 104 F (40 C) or higher. This is an emergency and, if you don’t have the facilities to handle it, make advance arrangements for quick transportation to a hospital.

The child should be taken to a cool place, and all constrictive clothing should be removed.

He or she should be covered with wet sheets or sprayed with cold water and be exposed to fans.

In the best of circumstances, the child should be put in a tub of cool water. Mental changes are one of the hallmarks of heatstroke. If the child isn’t able to drink fluids, intravenous fluids should be administered.

DEAR DR. DONOHUE: What’s the best way to treat sunburn? I get one every year. I know it will happen this year too, and I want to be prepared. – D.J.

The best way to treat sunburn is not to get one.

What makes you think you’ll get one this year? You’re doing something wrong. I have to repeat things that should be common knowledge, so bear with me.

Don’t go out into the sun during the hours of its greatest intensity – 10 a.m. to 3 p.m. I have a feeling this is a rule observed more in its breach.

Always wear sunscreen with an SPF – sun protection factor – of 15. If you are very sensitive to sunlight, use one with an SPF of 30.

Apply it 15 to 30 minutes before going outside, and reapply it at least every two hours. Each application requires about 1 ounce. If you go into the water or are sweating heavily, apply the sunscreen more frequently.

With a sunburn, in about three hours after exposure, the skin reddens and becomes painful and hot. Taking aspirin relieves pain and can lessen the damage done to the skin. Don’t give aspirin to young children – they can take Tylenol. Cool baths or cool compresses make a person more comfortable. Apply a skin moisturizer, but don’t use butter or petrolatum. If blisters form, don’t break them. If they’re extensive, see a doctor.

DEAR DR. DONOHUE: I have read that most sunscreens don’t protect you. What does that mean? – H.D.

Most sunscreens don’t protect you against ultraviolet A rays.

Those rays contribute to skin cancer and skin damage, like formation of wrinkles. Ultraviolet B rays are the ones that cause sunburn. Sunscreens do protect you against them.

Anthelios SX from La Roche-Posay does afford protection against ultraviolet A. You might find other products that also do so, but you have to look hard.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com