5 Pillars of Exertional Heat Stroke Prevention*


  • Maintaining appropriate levels of hydration prior to, during, and post exercise will assist in attenuating large increases in core body temperature during intense exercise in the heat.
  • Factors that contribute to dehydration are exercise intensity, environmental conditions (humidity and temperature) and availability of fluids during exercise.
  • Performance impairments are noticeable once an individual loses 2% of their body mass from fluid loss. These impairments become more extreme with greater levels of dehydration. For every 1% of body mass lost from water through sweat, core body temperature increases by 0.5°F (0.22°C).
  • To decrease the risk of exertional heat stroke, athletes are encouraged to minimize fluid losses during exercise. Fluid needs are individualistic depending on an athlete’s sweat rate and a specific rehydration plan should be in place for every athlete.
  • More on hydration: http://ksi.uconn.edu/prevention/hydration/

Body Cooling

  • Body cooling can be an effective means of debilitating the rise in core temperature and is the most effective when done pre-exercise, during exercise, and post-exercise.
  • There are a number of cooling modalities that can be effective in assisting to keep the body cool during exercise in the heat and are applicable to most sports settings (equipment laden sports, sports with minimal or no rest time during activity, etc.).
  • When exercising in the heat, a specific plan for utilizing cooling during rest breaks is imperative. This is especially important the equipment-laden athlete/laborer/soldier who may be at great risk of exertional heat stroke.

Work-to-Rest Ratios

  • Having appropriate work-to-rest ratios (the amount of time spent involved in exercise versus the amount of time spent in recovery) should be modified, as environmental conditions become extreme and when athletes gain or lose fitness.
  • Environmental extremes should be measured using wet bulb globe temperature (WBGT). WBGT is a composite of ambient temperature, relative humidity, and the radiation from the sun used to give an accurate measure of the heat stress that the athlete will be experiencing during exercise in the heat.
  • Measure WBGT with an accuracy certified Heat Stress Tracker such as the Kestrel 4400 (link to purchase)
  • Adjustments of work-to-rest ratios include increasing the number of rest breaks, the duration of rest breaks, and having unlimited access to hydration.

Heat Acclimatization

  • Heat acclimatization is loosely defined as a series of physiological adaptations the body uses to tolerate exercise in the heat and occurs over a period of 7‐14 days.
  • Having athletes go through a heat acclimatization protocol at the start of exercise in the heat is one of the best ways to help prevent exertional heat stroke. Athletes, when preparing to acclimatize to the heat, should have a base level of fitness in a cooler environment before heat exposure.
  • It is imperative that athletes maintain an appropriate level of hydration to experience the full effects when adapting to heat acclimatization
  • More on heat acclimatization: http://ksi.uconn.edu/prevention/heat-acclimatization/


  • Athletes, coaches, parents, athletic trainers, and other medical professionals should all be educated on the proper preventative strategies to prevent exertional heat stroke. Proper education will minimize the risk and incidence of exertional heat stroke.
  • Having proper education and knowledge of the signs and symptoms are also imperative to ensure appropriate treatment in the event of an athlete suffering from exertional heat stroke.
  • If medical care is present and exertional heat stroke is suspected, cool first, and then transport second to ensure appropriate treatment.
  • If no medical care is available and exertional heat stroke is suspected, immediately contact EMS (9-1-1) and begin cooling the athlete. For cooling immerse the athlete in whole body cold‐water immersion, which is the gold standard for cooling, and exercising athlete.

Factors to Consider when Assessing a Person's Risk for Heat Stress Include:

  • Age
  • Body composition
  • Weight
  • Degree of physical fitness
  • Degree of heat acclimation
  • Introduction to new activity or task
  • Dehydration
  • Metabolism
  • Use of alcohol or drugs
  • Sleep loss
  • Recent illness
  • A variety of medical conditions such as hypertension
  • Type of clothing and equipment worn


Environmental Factors to Consider

  • Air Temperature
  • Radiant Heat
  • Air Movement
  • Conduction
  • Relative Humidity

Treatments for Exertional Heat Stroke*

  • Remove all equipment and excess clothing.
  • Cool the affected person as quickly as possible within 30 minutes via whole body ice water immersion (place them in a tub/stock tank with ice and water approximately 35–58°F); stir water and add ice throughout cooling process.
  • If immersion is not possible (no tub or no water supply), take athlete into a cold shower or move to shaded, cool area and use rotating cold, wet towels to cover as much of the body surface as possible. Maintain airway, breathing and circulation.
  • After cooling has been initiated, contact emergency medical system by calling 911.
  • Monitor vital signs such as rectal temperature, heart rate, respiratory rate, blood pressure, and monitor for any central nervous system dysfunction.
  • If rectal temperature is not available, DO NOT USE AN ALTERNATE METHOD (oral, tympanic, axillary, forehead sticker, etc.). These devices are not accurate and should never be used to assess an athlete exercising in the heat.
  • Cease cooling when rectal temperature reaches 101–102°F (38.3–38.9°C).

* Adapted from Korey Stringer Institute: http://ksi.uconn.edu

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