Exertional Heat Illness during Training and Competition[1]
Summary
This American College of Sports Medicine position stand describes exertional heat illness during high-intensity or long-duration exercise, covering exercise-associated muscle cramping, heat exhaustion and exertional heatstroke. It states that exertional heatstroke can affect seemingly healthy athletes even when the environment is relatively cool, while those not acclimatised, using certain medications, dehydrated or recently ill are more prone to collapse in the heat. Exertional heatstroke is defined as a rectal temperature greater than 40 degrees C accompanied by symptoms or signs of organ system failure, most frequently central nervous system dysfunction. The statement says early recognition and rapid cooling can reduce both morbidity and mortality, that the clinical changes can be subtle and easy to miss, and that in some on-site evaluations rectal temperature is the only discernible difference between severe heat exhaustion and exertional heatstroke. Heat exhaustion generally resolves with symptomatic care and oral fluids; muscle cramping usually responds to rest and replacement of fluid and salt.
So what
For event medicine this argues for on-site rectal thermometry and an active cooling capability, because the statement says temperature may be the only thing distinguishing severe heat exhaustion from exertional heatstroke at the point of collapse. It also undercuts the assumption that cool weather makes heat protocols unnecessary. This is a consensus position stand, so it sets expected practice rather than reporting measured outcomes.
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