By Rick Weber
Southwest Florida’s emergency rooms are gearing up for another sweltering summer. Except that this summer could be even worse.
The Centers for Disease Control and Prevention (CDC) puts it like this: “Heat-related illness (HRI) will continue to be a significant public health concern as climate change results in longer, hotter and more frequent episodes of extreme heat.”
In Region 4—which includes Florida—the number of days that the HRI emergency department visit rate exceeded the 95th percentile nearly quadrupled in the most recent study, going from five in 2022 to 18 in 2023. Anyone can suffer from it, but children and adults with underlying health conditions, pregnant women, outdoor workers and males and adults aged 18–64 years are more susceptible.
Jason Craddock, Associate Professor of Exercise Science at Florida Gulf Coast University’s Marieb College of Health & Human Services and a certified athletic trainer who has helped build athletic training programs, is trained to evaluate and treat individuals with Exertional Heat Illness (EHI)—a subset of HRI that specifically refers to a spectrum of conditions that are triggered by intense, strenuous physical activity (like running, heavy labor or military drills).
“Most people don’t understand the initial signs of symptoms and how quickly they can progress through the different categories,” he says. “That’s because of the insidious nature of the symptoms. Some of the early warning signs and symptoms someone may experience—like thirst, headache and mild fatigue—are what a person may normally feel while being outside in Southwest Florida.
“If we look across the lifespan and the active nature of our population in Southwest Florida, our active older population may have overlapping medical conditions that exhibit some of the same signs and symptoms. And some medications may influence the body’s natural thermogenic response to regulate heat through reduction in sweating or masking the early signs of EHI.”
He said heat illness can progress from exercise-associated muscle cramps (acute, painful, involuntary muscle contractions arising during or after exercise) to heat syncope (collapsing in the heat, resulting in loss of consciousness) to heat exhaustion (inability to continue exercise due to cardiovascular insufficiency) to exertional heat stroke (severe hyperthermia leading to overwhelming of the thermoregulatory system).
Here are the primary treatment recommendations for each stage, as issued by the National Athletic Trainers Association (NATA) in the Journal of Athletic Training:
. Exercise-associated muscle cramps: Stop exercising, provide sodium-containing beverages.
. Head syncope: Lay patient supine and elevate legs to restore central blood volume.
. Heat exhaustion: Cease exercise, remove from hot environment, elevate legs, provide fluids.
. Heat stroke: Immediate whole-body, cold-water immersion to quickly reduce core body temperature.
As an individual begins to show signs and/or symptoms of EHI, the failure to detect or treat it adequately can result in damage to the kidneys, brain, heart and muscles, according to the Mayo Clinic. Heat stroke—which happens when the body temperature rises above 104° and the brain begins to shut down—can be deadly if not treated immediately.
Exertional heat stroke, the third leading cause of mortality in athletes during physical activity, is the most severe manifestation of exertional heat illnesses, according to the National Institutes of Health (NIH).
In “Exertional Heat Stroke: Pathophysiology and Risk Factors,” a 2022 paper published in BMJ Medicine, the NIH wrote, “Exertional heat stroke is characterized by central nervous system dysfunction in people with hyperthermia during physical activity and can be influenced by environmental factors such as heat waves, which extend the incidence of exertional heat stroke beyond athletics only.
“Epidemiological data indicate mortality rates of about 27%, and survivors display long-term negative health consequences ranging from neurological to cardiovascular dysfunction. The pathophysiology of exertional heat stroke involves thermoregulatory and cardiovascular overload, resulting in severe hyperthermia and subsequent multi-organ injury due to a systemic inflammatory response syndrome and coagulopathy.”
As a licensed (LAT) and Certified Athletic Trainer (ATC), one of Craddock’s domains of practice is prevention. The idea is to ensure that someone doesn’t suffer heat exhaustion, and if they do, ensure that it doesn’t progress to heat stroke.
“I have had many opportunities to evaluate and treat individuals with EHI,” he says. “The biggest impact is in the areas of prevention and early recognition. No matter the age of the athlete or individuals who work outside, acclimatizing is the best prevention.
“The National Athletic Trainers Association as well as the American College of Sports Medicine have issued position statements on how best to acclimatize and prepare athletes for participation in hot/humid climates. Those guidelines are posted in athletic facilities as well as given to athletes.”
Craddock currently teaches courses in FGCU’s Exercise Science program, which provides the opportunity for students to learn how the body responds to activity and exercise throughout the lifespan.
“We prepare our students to understand how the body responds physiologically to internal and external stressors,” Craddock says. “This understanding is then applied specifically to different environmental exercise physiology parameters. We then utilize the resources from our professional governing bodies to guide our preparation for practice when our students advance into the field.”
FGCU
Marieb College of Health & Human Services
10501 FGCU Boulevard South, Fort Myers, FL 33965
(239) 590-1000 | fgcu.edu