Top Tips for Heat-Related Illnesses in Athletes

Posted on 
September 14, 2023

Heat-related illnesses are cause for concern in athletes of all ages, especially young athletes. Approximately 9,000 high school student-athletes each year suffer from heat-related illnesses, ranging in severity from heat cramps and heat exhaustion to heat stroke, a life-threatening condition.

Forté Fast Orthopedic Care medical director, emergency medicine physician and fellowship-trained sports medicine physician Dr. Matthew Negaard breaks down the best ways to prevent, identify and manage heat-related illnesses to keep athletes safe in the summer heat.

Prevention Tip: Keep Practice Under Three Hours

Studies show that most heat-related incidents happen in August when temperatures are high and athletes are more likely to be deconditioned. Additionally, most issues occur when practice lasts three hours or longer.

“Three hours significantly increases the risk of heat stroke,” says Negaard. “Most guidelines recommend limiting practice to two to three hours unless there is a break in between.”

Identification Tip: Take a Temperature

The first signs and symptoms of heat-related illnesses can include stumbling or becoming clumsy. An athlete can also suffer from headaches, nausea, dizziness and confusion. The appearance of any of these symptoms is your cue to check an athlete’s temperature. In this case, taking a rectal temperature is the most accurate way to determine core temperature and confirm whether a person is suffering from a life-threatening medical emergency.

“Never use skin, mouth or armpit temperature to diagnose heat stroke or heat exhaustion,” says Negaard. “To ensure you take their temperature properly, you want to have the right equipment available for a rectal temperature.”

Typically, heat stroke is diagnosed when an athlete displays one or more symptoms along with a rectal temperature equal to or greater than 104 degrees Fahrenheit or 40 degrees Celsius.

Management Tip: Cool the Athlete Immediately

If an athlete suffers from heat stroke, the most important thing to do is to cool them down immediately.

“Time is brain at this point,” says Negaard. “If they’re in an altered state and have a temperature, their brain is affected. The best thing is to cool them as rapidly as possible.”

The goal is to get an athlete’s temperature back to 102 degrees Fahrenheit or 39 degrees Celsius. If you cannot continue to monitor rectal temperature, focus on cooling the athlete until their mental status improves. Once an athlete’s temperature has dropped, they should be transported to an emergency department.

While the benefits of cooling first and transporting second are well-documented in literature, Negaard recommends reaching out to local EMS.

“EMS might want to load and go, so I suggest reaching out to your local medical director ahead of time to ensure you’re on the same page,” says Negaard. “If their current policy is to transport, I would have a discussion about changing that because it can ultimately save lives.”

Cooling Tip: Immerse in Icy Water

Total body immersion is the preferred method for cooling an athlete with heat stroke. Using a tub, trough or tarp, submerge the athlete from the neck down as quickly as possible in cold water with ice. Negaard says there’s no need to worry about removing layers of clothing or equipment first.

“The most important thing is to get them cool,” he says. “Put them in icy water, and while they’re in there, you can start removing their helmet, shoulder pads and so on.”

If you’re in a situation where total body immersion isn’t possible, focus on cooling the cheeks, palms of the hands and soles of the feet.

A Quick Response Can Save Lives

In general, heat illness is one of the leading causes of non-cardiac death in athletes. It’s important to know what to do in an emergency, and as Negaard emphasizes, that you’re prepared to act quickly.

“Studies show that cooling an athlete within 30 minutes of collapse will save lives nearly every time, so the initial response, in which you play a major role, is significant,” he says.

The IHSAA has a full list of resources focused on the health and well-being of student-athletes. To learn more and download their guides for preventing and managing heat illness, visit

These recommendations have been excerpted from Coaches Corner, a free monthly webinar series for coaches, athletic directors and athletic trainers. The series, developed and presented by Forté, in partnership with IHSAA, aims to arm coaching and support teams with helpful information to consider when working with their athletes. Subscribe online so you don’t miss an episode.

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