Heat-Related Problems in Student Athletes – PediaCast 566
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Show Notes
Description
- Dr Jonathan Napolitano, Annie Imber, and Eric Leighton visit the studio as we consider student-athletes training and playing in hot, humid weather. Having an emergency action plan in place can prevent problems as temperatures soar. Tune in to learn more!
Topics
- Heat-Related Problems for Student Athletes
- Emergency Action Plan
Guests
Links
- Sports Medicine at Nationwide Children’s Hospital
- Korey Stringer Institute
- How to Help Your Kids Beat the Heat
- Fueling and Hydrating Before, During and After Exercise
- What is an Athletic Trainer? – They are Part of the Sports Medicine Team
Episode Transcript
Dr Mike Patrick: This episode of PediaCast is brought to you by the Sports Medicine Program at Nationwide Children's Hospital.
Hello everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 5 66. We're calling this one Heat Related Problems. In student athletes, I want to welcome all of you to the program.
So, fall sports are ready for action with training and conditioning and practicing and playing well underway, but the summer heat is still with us in many areas of the country, which could spell trouble for student athletes, as we think about hydration. And heat exhaustion and heat stroke, all of those things.
And I'm sure that these thoughts have crossed your mind as well, especially if you have a student athlete at home and a heat wave has taken shape in your neck of the woods. We want our young athletes to perform their best, of course, but we also want to keep them safe in the summer heat. So, we're going to talk about ways to prevent overheating during sports participation.
And we'll discuss the concept of an emergency action plan or EAP. So that student athletes and coaches and athletic trainers and parents have an idea of exactly what to do when the temperature and humidity are high. And how to help if trouble begins in our usual PediaCast fashion, we have a handful of experts here to help us out.
Dr. Jonathan Napolitano is a sports medicine physician at Nationwide Children's Hospital. Annie Imber is also with sports medicine. She's a certified athletic trainer at Nationwide Children's, and we have a co-host leading the conversation this week. It's Eric Layton. He is a certified athletic trainer.
At nationwide children's. Don't forget the information presented in our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you're concerned about your child's health, be sure to call your healthcare provider.
Also, your use of this audio program is subject to the PediaCast terms of use agreement, which you can find at PediaCast .org. Let's take a quick break. We'll get our experts settled into the studio. And then we will be back to talk about heat related problems in student athletes. It's coming up right after this.
Dr. Jonathan Napolitano is a sports medicine physician at Nationwide Children's Hospital and an assistant professor of physical medicine and rehabilitation at The Ohio State University College of Medicine. He also serves as director of our hospital's adaptive sports medicine program. Annie serves as the team physician for Reynoldsburg High School here in Central Ohio.
Annie Imber is a certified athletic trainer, also with sports medicine at Nationwide Children's, and she serves the student athletes in the West Jefferson School District. They both have a passion for keeping student athletes safe in hot weather and creating an emergency action plan for when athletes become overheated.
More on that shortly. First, let's offer a warm PediaCast welcome to Dr. Jonathan Napolitano and Annie Imber. Thank you both so much for stopping by today. Thanks for having me, Dr. Mike. It's a pleasure to be back.
Annie Imber: Absolutely. Thanks for having us.
Dr Mike Patrick: Yes, we are very excited to, to chat with you today. Eric Leighton is also in the house.
He too is a certified athletic trainer. And the functional rehab leader for sports medicine at Nationwide Children's. He's going to lead the conversation today. So, let's also welcome him to the program, Eric, thanks for all your work, putting this episode together. Thank you, Dr. Mike. And thank you so much for, for allowing us to come to the studio and talk on these subjects.
Absolutely. We are so glad to have you. And, uh, with that, I'll hand the reins over to you and we will talk about heat emergencies for student athletes.
Eric Leighton: Thanks, Dr. Mike. Yeah, so, heat illness, heat illness, heat injuries, and EAPs, as Dr. Mike said, emergency action plans, as we call them out in the field, out on the, on the sports fields, or, or just where anybody's participating.
As we get ready to head into fall sports, you know, we have to remember, in many parts of the world, it stays pretty hot for quite a while, and, of course, with fall sports around here, starting in August. We could still wind up in the heat, you know, well into the first month or more of competition, sometimes well into September.
And so, because of that, that there's just certain heat related issues that we have to be aware of and prepare for, whether it's our young athletes or really anyone being physically active out in the weather, out in the elements. So, as we, as we look at some of those, so Annie, I'm going to go to you for the first one here.
What are some of the more minor, should we say, heat issues that we can run into with sports, for instance.
Annie Imber: Yeah, I would say you always will start off seeing just kids looking a little bit more tired, a little bit more sweaty and maybe cramping. So, heat cramps are kind of the first stage of heat injury, heat illness.
You'll usually see cramping; they'll complain of being thirsty or needing an extra water break or just a little fatigued. That's, that would be on the minor side. You could even see a little bit of heat syncope. That could be debated on whether that's minor or moderate. It's not necessarily severe. That would be more feeling a little dizzy, feeling a little lightheaded, maybe getting tunnel vision, fainting, fainting would be a little bit more moderate into the, you know, you want to make sure its heat related and not anything else, but yeah, I would say cramps, feeling dizzy, lightheaded.
Those are kind of our first signs of, okay, we have a heat illness, or we have some heat issues going on.
Eric Leighton: Yeah, exactly. There are definitely, there's a whole host of things that can happen. Not to mention, like you said, the dehydration, the cramps, but also one of the other ones, just having the right clothing.
But even to the point of, uh, rash, heat rash, those are things that could obviously mess with your enjoyment of your day or your athletics out there. So going from that, so Dr. Napolitano, I'm going to come to you on this one. You know, we get past those, we get to the ones that we would all consider a bit more serious.
So, what are those, what are those next stages of heat illness that we're concerned about and what signs should people be looking for, be aware of?
Dr Jonathan Napolitano: Yeah, thanks Eric. You know, traditionally This is thought of as a three different stages of heat illness from that cramping. to heat exhaustion and heat stroke.
However, I don't really consider that first as part of that linear trend because that can often just be independent, just the cramping and other things. So, so heat exhaustion is really that dehydration, that fatigue, that weakness, some of those symptoms that Annie was discussing with us. And those are kind of those early indicators or signs.
You may start to get some nausea, vomiting, even diarrhea. And, and you might start to feel dizzy or faint. And those are some pretty good indications that something's going on. Our body's not reacting well to the heat. From an observation standpoint of recognizing someone with, with those symptoms, it's also some important differentiators is oftentimes those patients will be warm.
So, they'll have a temperature. Somewhere between a hundred point four and one hundred and four, so they're, they're temperature or they're having a fever, but their skin is generally pale and moist, sweaty. But the most important part in differentiating this from the other is that this person's mentally intact.
They're making sense. They're having a conversation with you. We flip the switch and get to a much more serious scenario when we reach something we call heat stroke. And this can be, this can be a deadly condition and needs to be recognized early on. Those differentiating factors is instead of that pale, moist skin, we're often seeing warm skin or dry skin.
And that largely has to do with the body's inability to, to keep up. The temperature there is going to be greater than 104 is how we diagnose this and then most notable is this person is confused that that level of awareness is going to be kind of coming in and out. They may be thoroughly confused had patients who have spoken another language out of nowhere.
There's this confusion. I'm not sure where I am what I'm doing. And so that is really a good indication to say. This is very severe. This is not a joking matter as we all smile and laugh about my reference, but that's, that's a serious condition of heat stroke.
Eric Leighton: Yeah, definitely. I've been right. There are all kinds of things that even before you get to that level, like you both mentioned, uh, syncope or fainting, obviously the last thing you want to do is pass out while you're trying to stand upright or move.
That could cause an injury. I'm going to throw a little bit of an audible here. Of course, we are extremely lucky to be here with Dr. Mike, but Dr. Mike, being an emergency physician, emergency medicine physician, can definitely speak to these as well. So maybe for, for both Dr. Mike and Dr. Napolitano. So, as we talk about some of those heavier heat illness, heat injuries, so we know how powerful the human body is.
I mean, it can do amazing things from, you know, climbing mountains and doing all these crazy things. Typically has a pretty amazing ability to generally self-regulate and keep itself, keep itself in that stasis in the middle. So, what is it that's happening to us when our bodies either go into those cramps or heat exhaustion or at worse at heat stroke?
Dr Jonathan Napolitano: Sure, I can, I can start there and, and, and you're correct, Eric, that that really is quite amazing. And I think it's even more notable just how amazing it is when we think about how fragile this balance is of when we go into this heat exhaustion or heat stroke. And as I indicated, one of our body's main mechanisms for cooling ourselves off is, is sweating and bringing that blood flow to the surface.
It's a, it's a way that kind of works like the human air conditioner where we're bringing that hot blood outside to, to kind of cool off. And, and when we overwhelm that, that becomes, that tips that scale. Anything that you'd add, Dr. Mike, there for that mechanism?
Dr Mike Patrick: Yeah, you know, I think a lot of it has to do with blood getting to the muscles and to the brain.
So, as you had mentioned, you know, the blood's sort of getting diverted to the skin, and so lactic acid builds up in our muscles, because it doesn't have a chance to get into the bloodstream to get eliminated. And then, you know, the confusion and, and suddenly speaking a different language is because we're not really getting good blood supply up to our brain because again, that blood's being diverted.
And so that's why it's so important to stay hydrated, because when we drink, that actually becomes blood volume as that water goes into our, into our blood vessels from our intestine. And so, you know, that's the main thing is really replacing fluids. And then if you're sweating a lot and you know, you're getting to that point, you probably need electrolytes replaced as well.
So, sodium, potassium, those kinds of things. So that's when, you know, if you're sweating a lot over the course of an hour or you're starting to have symptoms rather than just water, and most of the time, plain water is going to be fine. But if it's really prolonged and you think, you know, you're really losing electrolytes, then a sports beverage with electrolytes, and it's going to be a good idea.
Yeah. And then when you go to the emergency department, because maybe you did have syncope or you passed out, you know, then we'll likely put an IV in and get you the fluids and the electrolytes that way. One
Dr Jonathan Napolitano: other thing I'd add, Eric, there, as far as, you know, as part of my introduction, you introduced my role as a director of adaptive sports medicine program.
And that's really of note here to think of the human body's ability to regulate temperature Is kind of taken for granted in most of us. However, those with spinal cord injuries, traumatic brain injuries, other things, some of that typical expected adjustment and accommodation of changes in temperature is altered as well.
And so those athletes need to be even more aware of changes to their body temperature because they may not get these early clues that that the rest of us get.
Eric Leighton: Yeah, definitely. You're right. That's, that's something that, uh, you know, as we're going to see here in just a couple more weeks or in a week or so, the Paralympics coming up.
So of course, these athletes are really just, you know, excelling what they do and doing the hard work, but they, they're dealing with another level, dealing with another complication, so to speak. So, all of this, you know, comes about, of course, a lot of it is completely due to the weather. If you don't have a different physical difference.
The weather can play a huge factor in how we approach that day at practice or a game or anything we're prepping outside and what we need to be on alert for. So, Annie, I'm going to go to you. So, the heat index, the heat index is something that we track daily when anyone's really exerting themselves outside in those warmer months and sometimes in the other seasons as well.
So, can you tell us what is that index and how does that affect your planning or approach to uh, to planning for practice or games?
Annie Imber: Yeah. Thanks, Eric, for. Us at the high schools, our gold standard version of heat index would be wet bulb globe thermometry. So, we have, they're wet bulb globe thermometers, and these are specifically designed to give us an overall heat stress indicator.
So, it takes into account direct sun rays, humidity, wind speed, and ambient temperature to give us an overall stress. That, you know, some days if it's cloudy or windy, but the temperature is high, it's still going to feel a little bit better than when it's sticky, humid, and just no clouds in the sky. So that is our gold standard that we like to use.
And so, that is accompanied with a chart that kind of shows us, okay, once we get into these higher levels, we need to maybe, Take back some equipment usage during practice, or we need to have more water breaks, or we need to shorten our practices a little bit, and so we'll have, you know, a yellow zone for caution, orange zone for, okay, we need to take this a bit more seriously, and then, you know, you have your red and your black zones that are, okay, this is, these are terrible conditions, we don't need to be putting our athletes through this today.
So that is what we, what our gold standard use would be at the school. Now, we know not all schools have the ability to have those fancy wet bulb globe thermometers, and so heat index is kind of just temperature and humidity and those relative to each other, again on a chart, so that as one or the other increases, we have a bigger stress of heat outside.
So, this can be useful for maybe our coaches who are there during the summer if an athletic trainer is not there or they don't have a wet bulb globe thermometer. You can use a basic heat index chart to kind of figure out, okay, today we're in a little bit more of a heat stress situation, so let's be cautious, more water breaks.
But yeah, so those, those two are the things that we love to use the most. And it just takes communication between the athletic trainer, the coaches, the admin, whoever is being involved in this process so that you can communicate earlier on in the day, maybe. Hey, you know, it's going to be pretty hot and humid out later.
Let's have a plan in case we do have to take off our shoulder pad during practice, or in case we do have to practice without helmets, or we need, you know, we can only practice for an hour. So, I think that helps a lot too. As my job is the athletic trainer coming to a coach in the middle of practice saying, hey, all of a sudden you need to take all your equipment off and they weren't prepared for that.
So, preparation is key talking about it early on. Those are the main things that we use to kind of determine how stress, stressful the heat will be for that day.
Eric Leighton: Yeah, definitely. I remember, you know, my days, you know, back out in the field in high school when I worked there for myself and also as an EMT before that, as you mentioned, taking off the equipment, the more of the football equipment as an example we'll use, I mean, that's, it's all plastic.
It's all plastic and padding. It's about that. And of course, the more of that armor the kids wear, the more sweat they're keeping in and it just stays on the skin. And so. We, uh, we've become kind of amateur weather scientists out in the field because we're looking for all kinds of things. That wet bulb thermometer that Annie mentioned, we used to have a version called the sling psychrometer.
It was two, uh, two thermometers side by side and one had like a little sock on it. We would get it wet and literally sling it and spin it through the air for a certain number of minutes. Depending on how much humidity, how much water vapor is already in the air. Well, the other one doesn't cool down as much.
So, we get that difference. But you notice that. So, if you go outside in the summer and, you know, the sweat is just rolling off of you. That's because there is literally so much water pressure already in the air. It's holding back the water that's on your skin. So now it's not evaporating off like Dr.
Napolitano and Dr. Mike mentioned. You're not getting that air conditioner effect where it evaporates causing that cooling. So yeah, those are the huge things that we have to keep looking for.
Dr Mike Patrick: All right. Hey, if I could interrupt just a moment, I had no idea that whether not predicting, but whether analyzing was so fancy in sports medicine, I had, I had no idea that this, that these things existed.
Eric Leighton: Oh, yeah, we have all kinds of tools waiting and we're looking for, yeah, the relative humidity, the temperature, this, I mean, we, a lot of us will even have lightning monitors that will keep out with us that will literally, you know, pull up that electrical potential in the, in the air. We can tell if there's one within 30 miles before we even see it.
Dr Jonathan Napolitano: Yeah, that's pretty amazing. You use that same technology. I'm one of the captains of the medical tents at the marathon. We use that same scale of the yellow, the green, yellow, red, and black, as far as the safety of the race, again, based on the, the white bulb globe temperature. But they even go so far as for a mass event like that, where they have the national weather surface.
Do a specific report to a small geographic area so that we know exactly what's coming and it's, as you said, Dr. Mike, a lot of technology and a lot of science into that because we've got to keep people safe.
Eric Leighton: Yeah, information is key and as Annie said, communication. The more we're on top of this and paying attention, the more we can avoid those unfortunate incidents.
As we know, so we've been talking about the heat. We know what we're doing. We know how we think about it prep for it. What we do on our end, but so dr. Napolitano, what what's the best way for the kids? To prepare themselves for exercise in this type of weather, you know, right now it's summer here where we're at and it is hot.
So, what's the best way for them to prep to be ready for the season and hopefully avoid these injuries?
Dr Jonathan Napolitano: Yeah, great question. And he touched on some of this, but I think That preparation is so important, right? It's important to go into a workout, a practice, a race day, a game day with a plan, but then also multiple plans and being able to adjust that plan with what the forecast is, what the weather is that day.
I think one of the biggest pointers that I need to use when talking to athletes and coaches and parents as well is that, you know, Annie mentioned extra water breaks or something. Um, That's almost too late, right. If you are going out and you're looking at the forecast and you know you have two practices today and it's supposed to be 90 degrees, you should be hydrating the day before, the morning of, before you get out there.
You never want to be playing catch up. I think it's also important to think of that nutrition is a huge important part of this too, almost as important as hydration. Whereas, if you're running out to an early practice and you haven't fed your body, your body is going to struggle to accommodate and adjust and do those normal healing or accommodation mechanisms to allow those muscles to recover.
You're going to fatigue faster if you don't have nutrition there. And then the other thing is, is yeah, just really going through this gradual buildup process. One of the things that the Ohio High School Athletic Association has done is they've instituted what's called an acclimatation period. So, Instead of just August 1st comes and we got our, our football team who has been sitting around through the summer and we put on their pads and go for a two day practice without anything, there is a week long process that ahead of that process is that you're gradually getting adjusted to the heat, gradually getting adjusted to activity before we're putting on all that plastic insulation and limiting our ability because You can't all of a sudden start a season.
There's, there's a purpose of a preseason and to build up to things is really important. And that's really where I think a lot of this cramping comes into. I'm in the school of thought that, that cramping isn't so much just heat related, but it really is neuromuscular fatigue. I'm seeing that in our, you know, athletes who are the high skill players who are going both directions and are playing an entire game.
And so, as you're fatiguing, you're running out of that endurance and then you start cramping. So. By training and preparing, you're less likely to experience all of these different stages of illness.
Eric Leighton: Yeah, you're right. Like I said, all that pre-season conditioning and fueling yourself, how you fuel before, how you recover.
I tell the kids all the time, I said, listen, your workout is not just a workout. It's what you did before it, it's how you recover from it, it's how you rest. And I always have a lot of ridiculous sayings I use for the kids to help them remember things. But you guys all talked, uh, touched on hydration and making sure that we have enough in there.
And the blood volume, as you mentioned, Dr. Mike. So, I always tell the kids, I said, we need blood, not mud. So, if you're all dehydrated and you're pushing sludge around, things aren't going to work really well. So, keep yourself, keep it, keep it hydrated. But yeah, keep it fed, you've got to rest, you've got to take care of your body.
So now hopefully, you know, if we've done all the right things, we've done the stuff on our side, the kids are hopefully, and the parents are taking care and doing what they can, try to avoid these things. In the case, I'm going to go to you, Annie. So, in the event we do have a case of heat illness or heat injury, that's when we go to those EAPs, the emergency action plans.
So how do we create those and what's involved in a typical situation, for instance, at the high school?
Annie Imber: Yeah. So, emergency action plans should be created. Ideally with your athletic trainer at the high school, your administration at the school, maybe even a school nurse who is there during the day or during times of athletic activities and your coaches.
So, emergency action plans kind of cover everything from a broken bone to heat illnesses. Basically, the whole point of this plan is so that in the event of any emergency. We all know what to do. We have our steps lined out. We have our roles lined out, so we know who is going to take care of what. Because the last thing we need is a serious emergency situation, especially like exertional heat stroke.
And People running around trying to figure out who's doing what. We're just wasting time. We're wasting possible treatment time for this athlete. So, identifying roles is a huge, huge factor in emergency action planning, as well as practicing those roles and practicing what to do as well. I try to do once a season with each sport team practicing going through our emergency action plan.
And so, we'll get the coaches together. We'll maybe get a kid to act like they are having an issue. And we'll run through it just like we would in an emergency situation. And then we'll talk about it afterwards and say, okay, what could we have done better? What, you know, what went really well, what didn't go well.
So, this, this whole process of just emergency action planning is honestly the thing that I think saves the most lives. Because we know what we're doing, and we're confident in what we're doing, so that we're not hesitating. Especially when it comes to heat stroke. We need to get them into the tub, cold water immersion tub, as quickly as we can, and to get them treated as quickly as we can.
So that, that would be my version of emergency action planning. And how we kind of use that towards heat illnesses.
Eric Leighton: Yeah, exactly. Those are hugely important. You know, should, should something unfortunately go to this type of level, having, like you said, practicing it, we do the drills. One of the other elements I've been involved in for years when I was at the schools, but before that I was an EMT.
I actually worked in emergency medicine prehospital, but I still do a lot of that work around here too. So, one of the things that our schools also do is we coordinate these emergency action plans with our local EMS and fire stations. So that we've all talked about it pre-season. We know for instance, okay, Friday night football, if this I need the ambulance to come to this entrance.
We also know exactly who has the keys. We don't want to be looking for the keys to a certain gate. But then that might be different in the winter when we're inside for basketball and wrestling. So, some of those change. So sometimes you have different emergency action plans, very specific for different seasons, depending on which part of the facilities you're using.
So that is something that we, again, we practice, we drill, we think about, we, like I said, we practice. We. You know, what went wrong? What can we make better? We make it as, you know, as, as tight a process as possible.
Annie Imber: Yeah. And you also have to include. Kind of like you said, we have different locations during each season, but we also have different personnel.
So, for example, Friday night football games, most of us will have a team physician with us. Any other time of the year, that's most likely not going to happen. So, I'm sure, Dr. Napolitano, you can speak a little bit more on that on your side of Emergency action planning with your school and your athletic trainers, but that that can make a huge difference as well.
Dr Jonathan Napolitano: Yeah, the thing I wanted to add there is just that education. I agree. And it's a great idea to practice this. And so, others are aware. I think something that's taken for granted is what can be done and needs to be done. In the field and really that trusting the people in charge, right? Having, even though a team physician is not there, Annie and our other outreach athletic trainers are trained professionals in this.
And if you think about an overheating athlete, someone who's in this heat exhaustion or even heat stroke, that person needs to be cooled before anything else is done. And so. Oftentimes, we'll think about, oh, let's call EMS and wait for the ambulance. Waiting is a problem, and then number two, if, if that athlete is transported with a temperature of 105, 108, there, that's time that's wasted, and, and that's going to continue to stay high.
And so, really, by treating this patient in the field is the best medicine for them. I, I, you know, it's maybe a crude analogy, but it's, it's the idea of transporting somebody Who doesn't have a pulse without starting CPR first, right? You are going to initiate a treatment plan in the moment you're putting on an AED.
You're doing your CPR before you're transporting somebody because you have a role in saving their lives. Yes. Healthcare system and all that is here for maybe the next stages, but the initial treatment is getting that temperature down as soon as possible and that's done best at a school in a gym wherever you are.
Eric Leighton: Yeah, for those of you for anyone who's ever taken a CPR course, one of the things you learn in your CPR course is chain of life that early activation of EMS and AED getting that defibrillator on somebody who's having a cardiac issue starting that process early as Dr Napolitano mentioned. Definitely increase their, their chances, increase the likelihood of a, you know, a positive outcome for all of that.
So actually, Dr. Napolitano, coming back to you. So, we've gotten, unfortunately, to that situation of a heat injury or healing this. If someone's been affected by one of these injuries, so what can they expect as far as recovery goes from. You know, again, we have the cramps, the heat exhaustion, and then maybe all the way up to the heat stroke.
What's the safest way for them to work back to exercise and exertion should we get into that, that level of issue?
Dr Jonathan Napolitano: A great question, Eric. And this is often a point of this that is somewhat, um, overlooked. And I think that's rightfully so in the fact that, that we need recognition, prevention, and emergency treatment are really as the priority here.
And so that's, what’s researched and that's what's communicated. But, but you're right. We do. We know that the benefits of sport far outweigh just a fun activity, right? We want to get somebody back to sport and we need to do so safely. So, I often think of this as a similar return to play process or a.
protocol like we do with concussion, a similar severe injury and significant injury. So, my return to play recommendations for someone with, with heat exhaustion or rhabdomyolysis, which we haven't really talked about, but it's basically overuse of those muscles that can cause electrolyte abnormalities or other problems with the body, is that we need to gradually work back to this.
So, step one of a concussion. Protocol is, is the same as a step one here, which is, is getting these symptoms to resolve, right? We have to no longer be dehydrated. We have to no longer be confused. We have to no longer. Have those that nausea, the vomiting and to be able to take normal hydration, take normal nutrition and you're feeling kind of back to your normal self when we're back to our normal self, then we can't just jump right back in the deep end, right?
We can't just play a game the next day. There needs to be a gradual stepwise progression to really build into that and build up into that. And so, a protocol that we've formulated within our sports medicine group is, is how does that look for these padded sports, specifically football is how it's designed, but, but it's really can be applied to others.
And so that gradual return to activity. Needs to keep the environment and the equipment and everything else involved. So, our early stages of that are indoor workouts, where it's air conditioned, where it's cool, and you're gradually building up your intensity to kind of get back to that activity scene.
If any of those symptoms come back, are you having trouble to stay hydrated? Are you having trouble? to stay nourished. You're still feeling nauseous. That's a good indication that we're not yet ready for this. The body hasn't rebounded all the way. After we can tolerate some indoor practices, we progress outside, but without those pads.
So lighter activity and then gradually building in the intensity of it to get back to those sprints, to get back to that max lifting and other things. And then we add in the pads so that you have your, your insulation on and your helmets on where you've really kind of impaired your body's ability to cool itself and to see if again, do any of those symptoms come back once we can tolerate that, then we build back into normal practices and then after that would be normal games.
So. It is pretty regimented as far as how we would go about this return progression through this, but it, but it's done so in a reason to really avoid that thing, the things returning. And the last thing that I would add about that is I'm going to focus each of my visits on why. Not so much how do I get you back and recover from this injury.
But if you sprained your ankle, why did you sprain your ankle? I'm going to look at the deficits in the muscle. If you had a heat exhaustion, heat illness, heat stroke, why did that happen? And what do we need to do to improve that underlying foundation? What's your conditioning like? What is your body's ability to cool like?
What's your hydration plan? What's your nutrition plan? We got to understand the why. Before we get back to it all.
Eric Leighton: Yeah, that stepwise progression that you mentioned, Dr. Napolitano. I mean, any injury, whether it's a sprained muscle, injured joint, or like you said, heat illness. Yeah, trying to come back too soon.
Another, another thing. So, in rehabilitation up here in the gym, when I do get kids, you know, back to their sport, one thing they always have to remember is like, well, just because you're done doesn't mean you're back to 100%. You still got your conditioning to do. And I always remind them, I said, listen, fine, you're going to start running again.
Yeah. Do not go out and run at the hardest part of the day. Don't go out and try to get in shape and that much heat stress. That's just a double whammy. So, I always advise them, I say, you know, start in a cooler in the morning or in the evening, build up to it. Yeah, don't, don't hit yourself with a double whammy of, of being tired and, and being hit with heat.
So, we have, you know, despite our best efforts, there are things that do happen, obviously, of course. That's why we have plans, that's why we practice them, that's why we, we train the way we do, you know, between our education and school and. Continue education, but in practicing and drilling and just, you know, being ready, being ready for it all.
But out of that, of course, have come some, some great things and some, uh, some things have changed some just recently. So, a couple of topics I want to kind of bring up here, kind of go around the horn. Uh, maybe you have Dr. Napolitano, Annie, Dr. Mike to please join in on these, but, uh, a couple of things that have come up recently around here for us in central Ohio house bill 47 house bill 47 that I just went through.
The local, uh, local government is, uh, is a big thing that is now helping with, uh, AEDs. Now being, they're now mandatory in all schools in Ohio, as well as all municipally owned sports and rec areas. So, that's a huge thing. If you guys could just touch on that for a second and why that's so important.
Dr Jonathan Napolitano: Yeah, this has been something that's been in the works for a while and really excited to hear this finally go through.
In the, we, we mentioned it just kind of in passing as far as that. On the field assessment in that early intervention, an AED has repeatedly been proven to increase survival after cardiac events and also recognition of a true cardiac event. We haven't touched on it, but, but when we're thinking about heat illness, one of the things that we may notice in severe heat stroke is seizure like activity.
So, if we see seizure activity, it could be heat illness, it could be low blood sugar, but it can often be a cardiac event. And so, by putting an AED On that, that athlete early, we get to see it. Now that the fact that this is a law within our state, it's really exciting. And I think I also want to point out the importance of the necessary funding associated with the law, right?
It's one thing to demand that everybody have this. Equipment, but there are more and more opportunities to gain funding to access this equipment and that it's not only just in the schools and it's in one building, but we know where it is. And as part of that, I'm sorry, action plan is that you know where that is and who's going to get it and where are we going to bring it.
So for us on the sideline of the fall football games, we bring our off from the Wall in the school office where the building is empty and no one's there and we have it with us on the sideline not only For our athletes on the field But for the parents in the stands and the coaches on the sideline and the doctor covering the team I want everybody to be comfortable using that ad so I'm really excited for this bill
Dr Mike Patrick: Yeah, I think it's such an important thing and as you said the funding is really Important as well because it is one thing to say, hey, this ideal situation to have an AED, but to actually have it there and knowing that there's a way for it to be paid.
And there's, there's upkeep as well in terms of replacing pads and making sure that the, the battery, you know, is, is working properly. And I tell you, it's, it's something that everybody should know how to, how to do an AED. They're really easy. There's a card inside that tells you exactly what to do, but there's nothing like actually doing it.
You know what I mean? Like putting the pads on someone, letting it read. And if you do a CPR class, usually they'll have an AED. And it's just good to have your hands on one of those, you know, you see it at the airport, the shopping malls, wherever you are, you see AEDs these days, but if you don't know how to use it or you're not comfortable using it in an emergency, it's not going to do a lot of good.
So it is, it is, it is important to familiarize all of ourselves with those devices.
Dr Jonathan Napolitano: One thing I'll add to that quickly, Dr. Mike, is I'm not sure who our audience will be today, but don't be scared of it, right? If you've not taken that class, if you've not heard about it, I mean, you're opening up a laptop and trying to find out where the power button is and clicking through things.
That device is way more complicated. In AED, there's a big power button, and from there, it's going to tell you exactly what to do. So yes, it's important for us to all be certified, but don't be afraid of it and just, and let yourself be guided in using it. Yeah,
Eric Leighton: yeah, really? Yeah. For those of you might, might be aging myself a little bit, but yeah, you turn it on.
It literally starts talking to you like the old school speaking spell. It will literally call out things and tell you what to do. So, one of the other things that comes out of, you know, of dealing with these injuries and of course, you know, treating them and learning from them. is research. Another great resource for people to look up, and it's been, it's a terrific resource for us, of course, in the medical field, is the Cory Stringer Institute.
So, Cory Stringer, he was a, uh, offensive lineman for the Minnesota Vikings. And unfortunately, back in August of 2001, he passed away from exertional heat stroke. But after that, his wife, Kelsey, joined up with an expert in heat stroke and heat illness, athletic trainer and PhD, Douglas Casa. And he's at the University of Connecticut.
And the institute went online, came to fruition in April of 2010. So, there's a lot of research. They, they use some of the, the world's experts, leading experts in exertion and, and heat stroke and heat illness, and just the physicality of what happens, not only for athletes, but also for laborers, for people that aren't working, doing physical jobs out in the heat and the elements.
And our war fighters, our women and men in the military, because again, they are put in these heat stress situations. And so, a terrific resource for looking these types of things up. And, of course, you can also always find more resources if you go to NationwideChildrens .org and just search HEAT, you'll find all kinds of articles and blogs and posts and more information on that.
So, I think this has been a terrific discussion and, but, uh, at this point, I'm gonna throw it back to you, Dr. Mike. Yeah,
Dr Mike Patrick: no, thank you so much. You did a fantastic job and, uh, Annie and Jonathan, you did fantastic as well. We are going to have a lot of links in the show notes for everyone. We will have a link to, of course, sports medicine at Nationwide Children's Hospital, but also, we'll put a link to the Corey Stringer Institute as well.
So, folks can find that easily. And I do have some of those resources you mentioned in the show notes. So, we do have articles from Nationwide Children's on how to help your kids beat the heat, fueling and hydrating before, during, and after exercise. And another one that I love is what is an athletic trainer?
They are part of the sports medicine team. You know, we do hear a lot, but the more that I interview and talk and engage with, with athletic trainers, there's always, I'm always surprised at just how much you guys do and, uh, all the different things that you're called upon to do. So, kudos to you keeping our kids safe right there on the, on the playing field.
So, so important. So once again, Dr. Jonathan Napolitano with Sports Medicine and Annie Imber, Certified Athletic Trainer, also with Sports Medicine at Nationwide Children's Hospital. And our, uh, our host this week, Eric Layton, also a Certified Athletic Trainer from Nationwide Children's. Thank you all so much for being here today.
Thanks, Dr. Mike.
Annie Imber: so much.
Dr Mike Patrick: Thank you,
Eric Leighton: Dr. Mike, really appreciate you let us come hang out in the studio with you. Dr. Mike, really appreciate you let us come hang
Dr Mike Patrick: out in the studio with you.
back with just enough time to say thanks once again, to all of you for taking time out of your day and making PediaCast a part of it really do appreciate that. Also thank you to our guests this week, Dr. Jonathan Napolitano, sports medicine physician at Nationwide Children's, Annie Imber, certified athletic trainer, and Eric Leighton, also a certified athletic trainer, both from Nationwide Children's Hospital.
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