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Exertional Heat Stroke

Korey Stringer, an offensive lineman for the Minnesota Vikings, died suddenly in August 2001 while in football camp.  The cause of death was determined to be exertional heat stroke (EHS).

EHS consists of neurologic abnormalities and failure of multiple organs when the core body temperature reaches 104 degrees.  As opposed to other causes of sports-related deaths, there are symptoms leading up to an EHS crisis that are fatal if ignored.

 EHS, along with heat exhaustion, heat syncope and heat cramps, are all exertional heat illnesses.  EHS is the most serious and all are associated with dehydration and vigorous activity in hot environments.

 Symptoms include lightheadedness, hyperventilation, confusion, headache, fatigue, loss of balance, vomiting and diarrhea.  More severe symptoms of seizures and coma are the result of an uncontrolled rise in temperature.

 The Korey Stringer Institute was established at the University of Connecticut.  Dr. Douglas Casa is a professor of kinesiology and among the world’s foremost experts on EHS. “Athletes must listen to their bodies for signs of illness,” states Casa.  Once symptoms begin, athletes should take a break, get to a shaded area and rehydrate.

 “When EHS is suspected, immediately remove the athlete’s equipment and begin cooling,” said Bob Howard, Head Athletic Trainer for UCONN. 

 The best way to initiate cooling is by immersion in a tub of cold water within 10 minutes of symptom onset.  The player should remain submerged to the neck until the temperature drops to 101 degrees and improvement begins.  This treatment alone has a perfect survival rate when properly followed.

 Although most common in football, parents and coaches must be alert to these symptoms in all activities, including marching band.

 Easy access to hydration and the availability of an ice tub or other rapid cooling mechanism can save lives.

Anthony G. Alessi, MD, is Stroke Center Medical Director at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org, or listen to his podcasts, comment on his blog or buy his book at www.backushospital.org.