National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

This NATA position statement, written by a panel led by Douglas Casa, gives athletic trainers and other health care providers recommendations on preventing, recognizing and treating exertional heat illnesses and on returning athletes to activity. It replaced NATA's 2002 statement and grades each recommendation using the SORT scale.

It covers exercise-associated muscle cramps, heat syncope, heat exhaustion, exertional heat injury and exertional heat stroke. Prevention centers on preparticipation screening, gradual heat acclimatization over 7 to 14 days, hydration, rest breaks and activity modification based on environmental conditions, and a rehearsed emergency action plan with cooling equipment on site.

For suspected heat stroke, it gives its strongest grade to rectal temperature as the only valid field measure of core temperature after exercise in the heat and to cold-water immersion up to the neck as the most effective cooling method, with cooling done on site before transport. It advises against same-day return after heat exhaustion and calls for physician clearance after heat stroke.