HEAT + HUMIDITY + HEAT INDEX + OZONE SYNERGISM + EXERCISE TO EXHAUSTION AND HEAT STROKE

Today, May 26, 2012 the National Weather Service issued an Orange Air Alert combined with Heat Index of mid 90’s for most of Kentucky and other surrounding states. Therefore, I felt compelled to re-post this important message now that the hot season has begun.

We “old timers” were acclimated to hot weather 50 years ago. When kids, we played outside all day, because we had nothing else but sports activities to occupy our time.

We had no computers, video games or central air conditioning. Air pollution was non-existent.

Today, in contrast, football, Baseball and all Sports Recreation and Exercise (SRE) are much different sports, because conditions have changed and many of those adults in charge and Coaches ignore or overlook weather alerts.

Now there are drastically different non-acclimated athletes, drastically different weather conditions that include global warming and air pollution / increased ground level Ozone.

Ozone and other emerging weather conditions are Pre-Disposing Risk Factors for Heal Illness and Heat Stroke. Ozone combined with an elevated heat index might also cause irreversible lung damage.

In addition, youth athletes participations are increasing dramatically while SRE communiies turn a blind eye to youth sports safety.

Youth SRE athletes are not acclimated to hot weather nowadays. They only go outside to practice and play when seasons begin. The news is that they potentially practice and play outside in dangerous heat, humidity and heat index also combined with air pollution. Often the detrimental air pollutant is Ozone.

OZONE TOXICITY is a well known toxic condition affecting both human and plant life. “New statistics from the World Health Organization show that in the United States, air pollution annually kills nearly twice as many people as do traffic accidents and that deaths from air pollution equal deaths from breast cancer and prostate cancer combined,” said Tiffany Schauer, executive director of Our Children’s Earth Foundation. The 2008 Beijing Olympic Smog has been systematically researched and confirmed athlete hazards.

Ozone (O3) is a tri-atomic molecule. It has three oxygen atoms. Ozone on ground level is an air pollutant with harmful effects on human lungs and the entire respiratory system. On the other hand, the ozone layer in the upper atmosphere is beneficial, acting as a filter and preventing potentially damaging ultraviolet light from reaching the Earth’s surface.

Ground level Ozone peaks in the afternoon after sunlight cooks air-born nitrogen oxides, volatile organic compounds and sulphur dioxide, after air pollution has been emitted during the day.

Ozone is a more powerful oxidizing agent than O2. The Ozone oxidation of human tissue cells in the lungs and entire respiratory system, when bad air is inhaled by athletes, proceeds rapidly with increasing dangerously hot weather. Ozone and heat act synergistically causing a greater effect on body tissues when combined together in the inhalation gas mixture that aerates the lungs. The two appear to have a linear relationship.

Ozone can irritate the respiratory system causing coughing and tightness in the chest. SRE athletes retch and have difficulty breathing. Breaths might be more rapid and shallow, hallmark signs. Symptoms may last hours after exposure.

Pre-existing Asthma is aggravated by Ozone. Asthmatics are more greatly affected by the irritant and high levels result in a greater number of asthma attacks and hospitalizations. Ozone also makes asthmatics more sensitive to allergens that cause asthma attacks and can aggravate chronic lung diseases like bronchitis and infections.

The inflammation and damage to the epithelial cells lining the entire respiratory system and lungs can be silent and rapid for certain groups of football athletes. Often there is no warning.

Ozone damage can occur without any noticeable signs. Football athletes initially might not manifest symptoms, but as Ozone continues to cause lung damage, the athlete might become symptomatic and suddenly collapse.

Pulmonary damage can be irreversible in some football athletes. ARDS (Acute Respiratory Distress Syndrome) is the most serious result. ARDS results in a fibroproliferative reaction that lines and blocks off . permanently, the permeable wall of the alveolar sacs. Oxygen cannot be exchanged with circulating pulmonary blood. Sudden catastrophic collapse ensues after oxygen deprivation. Death is almost certain after ARDS begins. Even steroids are ineffective.

Scientists are researching ozone’s long-term effects. SRE athletes repeatedly exposed to high levels of ozone may sustain lung damage, absent an acute attack. Studies suggest that ozone may also harm resistance to respiratory infections and later in life cause lung cancer.

Every coach, must daily check the Air Quality Index and Heat Index on their field of play or practice. Coaches have a duty to protect children who are participating in SRE activities. They are transferred the chain of protective custody for our children.

An AQI of 0-50 usually has no abnormal health effects. When there is an AQI of 51-100, SRE athletes with respiratory disease and asthma should not practice or play outside. During an AQI 101-150 in addition to asthmatics, an athlete in the sensitive group, should not practice football outside.

The problem with this category is that members of the sensitive group might only become known following catastrophic collapse. During dangerous heat, no one should practiceor play SRE outdoors with AQI greater than 100.

Youth athletes should move indoors to practice and play in any of the following categories: AQI of 151 – 200 is Unhealthy”. AQI of 201 – 300 is “Very Unhealthy. AQI greater than 300 is” Hazardous”.

Green 0-50 good
Yellow 51-100 moderate
Orange 101-150 unhealthy for sensitive groups
Red 151-200 Unhealthy
Purple 201-300 very unhealthy
Brown 301-500 Hazardous

Another serious condition has been discovered but not reported. When activity diesel school buses arrive near the end of football practice, if parked idling near practice fields, while football athletes are running gassers or wind sprints finishing practice, they can create “hot spots” of Ozone in already hazardous heat and Ozone environment and push athletes’ Ozone Toxicity over the edge. Beware.

Exercise to exhaustion in dangerous heat and ozone is a recipe for youth SRE athlete death. Body organs bake and oxidize. Children die. Often Ozone Toxicity is accompanied by Exertional Heat Stroke.

Youth Athlete Fatality is the catastrophic outcome, when the core body temperature elevates to 107* after exposure to an increased Heat Index and Ozone synergism.

The only hope for survival once the core body temperature is 107* is to place the Youth Athlete in a kiddy pool with ice water as soon as the athlete is unclothed down to shorts.

Heat Stroke References

1. Vertuno Jim, The Associated Press, Longhorns Tackling the Heat: Pill Helping Texas Survive Rising Temperatures, published by the Victoria Advocate, August 15, 2007.
2. Hyperthermia, Wikipedia Encylopedia, October 2006, Retrieved from “http://en.wikipedia.org/wiki/Hyperthermia”
3. Heat Illness, Heat Exhaustion, Heat Stroke. The Nemours Foundation/Kids Health at www.revolutionhealth.com January 3, 2007.
4. Joseph Rampulla, MS,APRN,BC (June 2004). Hyperthermia & Heat Stroke: Heat-Related Conditions (pdf). The Health Care of Homeless Persons pp.199-204. Boston Health Care for the Homeless Program. Retrieved on 2007-02-22 at: http://www.bhchp.org/BHCHP%20manual/pdf_files/part2_PDF/Hyperthermia.pdf .
5. “Are you ready for extreme heat?” Courtesy: Federal Emergency Management Agency, Department of Homeland Security. Available from FEMA at: www.fema.gov/areyouready/heat.shtm. Updated August 20, 2007. This information may have changed or been updated since it was accessed. For the most current information, contact FEMA at http://www.fema.gov/.
6. Scott Anderson “Preventing Muscle Cramping in Football”. Coach and Athletic Director. May 2001. At www.FindArticles.com, 15 September 2007. http://findarticles.com/p/articles/mi_m0FIH/is_10_70/ai_n18611880 E.
7. Randy Eichner “Muscle cramps: the right ways for the dog days”. Coach and Athletic Director. August 2002. FindArticles.com. 15 Sep. 2007. http://findarticles.com/p/articles/mi_m0FIH/is_1_72/ai_n18613963.
8. Maddali Sirish, Rodeo Scott, Barnes Ronnie, Warren Russell, Murrell George: Post-exercise Increase in Nitric Oxide in Football Players with Muscle Cramps. The American Journal of Sports Medicine 26: 820-824, 1998.
9. Ruiz E J, Mitchell I D, Eberman L E, Cleary M A. Severe dehydration with cramping resulting in exertional rhabdomyolysis in a high school quarterback. In Cleary M A, Eberman LE, Odai ML eds. Proceedings of the Fifth Annual College of Education Research Conference: Section on Allied Health Professions. April 2006; 1: 31-35. Miami: Florida International Univeristy. http://coeweb.fiu.edu/research_conference/.
10. Cleveland Minot. Musle Cramp. University of Illinois Medical Center at Chicago: Health Library, at www.uimc.discoveryhospital.com, March 13, 2000; reviewed January 4, 2007. “Salt tablets are not useful and should be avoided.”
11. Texas Children’s Hospital. Preventing Heat Illness. Texas Children’s Hospital: Caring for Your Child’s Health at www.texaschildrenshospital.org, 2005. “Salt pills are unnecessary and possibly dangerous.”
12. Centers for Disease Control and Prevention. Frequently Asked Questions about Extreme Heat. Emergency Preparedness and Response Website at www.bt.cdc.gov/disasters/extremeheat/faq.asp. August 15, 2006. “Do not take salt tablets unless directed by your doctor.”
13. Gillis Rick (reviewer). Heat-Related Illness Can Quickly Become Serious. Healthlink: Medical College of Wisconsin at:
Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19,
2009
www.healthlink.mcw.edu/article/1031002770.html, June 28, 2007. “Salt pills should not be used without first asking your health care provider.”
14. Taylor-Oring Leslie. Is it Heat Exhaustion or Heat Stroke? Tae Park Tae Kwon Do at: www.eod.gvsu.edu/tkd/newpage22.htm. March 14, 1999. “Give them cool liquids—NO SALT PILLS.”
15. Eichner Randy. Curbing Muscle Cramps: More than Oranges and Bananas. Hot Topics in Sports Nutrition. Gatorade Sports Science Institute, at: www.gssiweb.com/ShowArticle.aspx?articled=619. July 25, 2003.
16. Coyle Edward. Fluid and Carbohydrate Replacement During Exercise: How Much and Why? Gatorade Sports Science Institute, Sports Science Exhange #50, Volume7 (1994), Number 3, at: www.gssiweb.com/Article_Detail.aspx/articleid=23&level=2&topic=2.
17. Eichner Randy. Heat Stroke in Sports: Causes, Prevention, and Treatment. Gatorade Sports Science Institute, Sports Science Exchange #86, Volume 15 (2002), Number 3, at: www.gssiweb.com/Article_Detail.aspx?articleid=597&level=2&topic=7.
18. Eichner Randy. Heat Stroke in Sports: How to Protect Yourself and Help Your Teammates. Gatorade Sports Science Institute, Sports Science Exchange #86, Volume 15 (2002), Number 3 Supplement, at: www.gssiweb.com/Article_Detail.aspx?articleid=597&level=2&topic=7.
19. Murray Robert, Eichner Randy. Preventing Heat Illness: Keeping Athletes from Falling into Danger Zones. Gatorade Sports Science Institute, Sports Science Library at: http://gssiweb.com/Article_Detail.aspx?articleid=570&level=2&topic=7.
20. Casa Douglas, Murray Robert. Sports Science News: Preventing Exertional Heat Illness: A Consensus Statement. Gatorade Sports Science Institute, Sports Science Library, 2007, at: http://gssiweb.com/Article_Detail.aspx?articleid=625&level=2&topic=7.
21. Conrad Mark. Mark’s View: Heat Stroke and Football Practice (A comment on the heat stroke death of Minnesota Viking Korey Stringer). Mark’s Sportslaw News, 2001, at: www.sportslawnews.com.
22. CNN News. Vikings football player dies of heat stroke, at: www.CNN.com./U.S., August 1, 2001. This is a CNN news story about Korey Stringer.
23. Associated Press, Mankato, Minnesota. Vikings tackle Stringer dies from heatstroke, August 2001.
24. The Associated Press, Gainesville, Florida: Florida player Autin dies six days after heat stroke. Volume 101, No. 187, Thursday, July 26, 2001. This article discusses the heat stroke death of 18 year old freshman Eraste Autin who collapsed during a work out in 88 degrees, 72% humidity, heat index of 100.
25. Smith Michael. Football Practice Heat Stroke Deaths Preventable (An article about the heat stroke death of 18 year old Chris Stewart). MedPage Today, Daily Headlines, Oklahoma City, August 18, 2005.
26. Sparks Tara. Death has parents concerned. Victoria Advocate, page 1, August 15, 2003 at: www.nl.newsbank.com/nl-search/we/Archives?p_product=VA&P_t.
Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19,
2009
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This article describes a parents’ safety meeting following the death of 14 year-old Matthew Thomas.
27. Victoria Advocate staff writer. Autopsy not yet released. Victoria Advocate, page 1, August 15, 2003, at: www.nl.newsbank.com/nl-search/we/Archives?p_product=VA&P_t.
28. deLench Brook. To Nineteen Youth Athletes Dying Young. MomsTeam, A Parents Trusted Youth Sports Source, at www.momsteam.com. August 25, 2007.
29. Reddy Vinay. Heat Cramps, Heat Exhaustion, and Heat Stroke. Dr. Reddy’s Pediatric Office on the Web at http://www.drreddy.com, 1/12/07.
30. Williamson David. UNC Warns of Possible Heat Strokes for High School Atheletes, at www.unc.edu//depts/nccsi, 2004.
31. Roberts William. Death in the Heat: Can Football Heat Stroke be Prevented? Current Sports Medicine Reports. (3), 2004.
32. Roberts William. Common Threads in a Random Tapestry: Another Viewpoint on Exertional Heatstroke, The Physician and Sports Medicine. 33(10) 2-5, October 2005.
33. Roberts William. Exertional Heat Stroke during a Cool Weather Marathon: A Case Study. Medicine & Science in Sports & Exercise, Official Journal of the American College of Sports Medicine, pages 1197-1203, January 2006 at http://www.acsm-msse.org.
34. Fighting Heat Stress, at http://fighting_heat_stress,asp.htm.
35. Donohue Paul. Exertional Heat Stroke: A Preventable Cause of Death, To Your Good Health. Victoria Advocate, page E-5, Saturday, July 14, 2007.
36. Jung Alan, Bishop Phillip, Al-Nawwas Ali, Dale Barry. Influence of Hydration and Electolyte Supplementation on Incidence and Time to Onset of Exercise-Associated Muscle Cramps. Journal of Athletic Training 40(2): 71-75, April-June 2005.
37. The Zunis Foundation. How Hot is Hot? How Safe if Safe? At www.zunis.org, April 8, 2007.
38. It’s Hot, It’s Humid, It’s Sunny: Information on Heat and Sun-Related Illnesses. Street Medics, www.action-medical.net
39. Hirsch Larissa. Heat Exhaustion and Heat Stroke: A Poster. This is a handy instructional “Heat Sheet” found at www.kidshealth.com
40. Bergeron Michael F, Cannon Joseph G, Hall Elaina L, Kutlar Abdullah. Erythrocyte Sickling During Exercise and Thermal Stress. Clinical Journal of Sport Medicine. 14(6): 354-356, November 2004.
41. Gallais Daniel Le, Bile Alphonse, Mercier Jacques, Paschel Marc, Tonellot Jean Louis, Dauverchain Jean. Exercise-induced death in sickle cell trait: role of aging, training, and deconditioning. Medicine and Science in Sports and Exercise. 28(5): 541-544, May 1996.
42. Kark J A, Posey D M, Schumacher H R, Ruehle C J. Sickle-cell trait as a risk factor for sudden death in physical training. New England Journal of Medicine. (317): 781-787, September 1987.
43. Binkley Helen M, Beckett Joseph, Casa Douglas J, Kleiner Douglas M, Plummer Paul E. National Athletic Trainers’ Association Position Statement: Exertional
Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19,
2009
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Heat Illnesses. Journal of Athletic Training. 37(3): 329-343, July-September 2002.
44. Guyton Arthur C, Hall John E. Circulatory Shock and Physiology of its Treatment, Chapter 24, Textbook of Medical Physiology, Eleventh Edition. W.B. Saunders Company, Philadelphia, June 2005.
45. Guyton Arthur C, Hall John E. The Body Fluid Compartments: Extracellular and Intracellular Fluids, Chapter 25, Textbook of Medical Physiology, Eleventh Edition. W.B. Saunders Company, Philadelphia, June 2005.
46. Guyton Arthur C, Hall John E. Body Temperature, Temperature Regulation, and Fever, Chapter 73, Textbook of Medical Physiology, Eleventh Edition. W.B. Saunders Company, Philadelphia, June 2005.
47. Guyton Arthur C, Hall John E. Regulation of Extracellular Fluid Osmolarity and Sodium Concentration, Chapter 28, Textbook of Medical Physiology, Eleventh Edition. W.B. Saunders Company, Philadelphia, June 2005.
48. Graves, Will. Case of Kentucky Coach puts Football on Trial. The Associated Press. The Victoria Advocate, page C-7, Friday, January 30, 2009.
49. Mahalo.com. Max Gilpin, at http://www.mahalo.com/max-gilpin
50. Louisville News, Homepage. Witness: Teen’s Death was Preventable. August 27, 2008. http://www.wlky.com/news/17315849/detail.html Copyright 2008 by WLKY.com.
51. Konz, Antoinette. 911 Call: PRP player drifted in, out of consiousness. Courier-Journal.com, Louisville, Kentucky at http://www.courier-journal.com/article/20081107/NEWS01/811070437/1008/rss01, November 7, 2008.
52. WLKY.com. PRP Football Player Collapses at Practice, In Critical Condition. http://www.wlky.com/sports/17267086/detail.html. August 22, 2008.
53. WLKY.com. PRP Football Player Dies 3 Days after Collapse in Practice. Louisville, Kentucky. At http://www.wlky.com/health/17280899/detail.html, August 27, 2009.
54. Binkley, Helen; Beckett, Joseph;Casa, Douglas; Kleiner, Douglas; Plummer, Paul. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. Journal of Athletic Training. 2002 Jul-Sep; 37(3): 329-343.
55. Parents’ and Coasches’ Guide to Dehydration and other Heat Illnesses in Children. National Safe Kids Campaign. Adapted from: Inter-Association task force on exertional heat illnesses consensus statement: National Athletic Trainers’ Association. June 2003. Available at: www.nata.org/industryresources/heatillnessconsensusstatement.pdf.
Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19,
2009
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