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Am Fam Physician. 2003;68(3):561

Guidelines on Exertional Heat Illnesses

An inter-association task force organized and sponsored by the National Athletic Trainers' Association has released a consensus statement on exertional heat illnesses. “Inter-Association Task Force on Exertional Heat Illnesses Consensus Statement” is available online at

The risks associated with exercise in the heat are well documented, but policies and procedures often do not reflect current state-of-the-art knowledge. Many cases of exertional heat illnesses are preventable and can be successfully treated if onsite personnel (e.g., physicians, emergency medical technicians, athletic trainers) identify the condition and implement appropriate care in a timely manner.

General considerations for risk reduction include the following:

  • Encourage proper education regarding heat illnesses (e.g., for athletes, coaches, parents, medical staff). Education about risk factors should focus on hydration needs, acclimatization, work/rest ratio, signs and symptoms of exertional heat illnesses, treatment, dietary supplements, nutritional issues, and fitness status.

  • Provide medical services onsite (e.g., certified athletic trainer, emergency medical technician, physician).

  • Ensure preparticipation physical examination has been completed that includes specific questions regarding fluid intake, weight changes during activity, medication and supplement use, and history of cramping/heat illnesses.

  • Ensure that onsite medical staff has authority to alter work/rest ratios, practice schedules, amount of equipment, and withdrawal of persons from participation based on environment and/or the athlete's condition.

The athlete's physician should devise a careful return-to-play strategy should the athlete experience exertional heat stroke, heat exhaustion, or exertional hyponatremia. Physician clearance is strongly recommended in all cases of exertional hyponatremia.

In cases of heat exhaustion, the physician should rule out any underlying condition that predisposes the athlete for continued problems.

In minor cases of dehydration, continued participation is acceptable if the athlete is symptom-free.

CDC Awareness Campaign on Healthy Swimming

Aimed at creating awareness about the spread of illnesses caused by recreational water activities and at reducing the number of cases of these illnesses, the Centers for Disease Control and Prevention (CDC) has created a program entitled “Healthy Swimming 2003.” The program is available online at

The use of modern disinfection systems in recreational water sites, such as swimming pools, water parks, and hot tubs has improved the quality of recreational water. Despite this, more people are becoming ill from swimming in contaminated water. Typically, water is contaminated by human urine and fecal matter.

“Healthy Swimming 2003” provides information for swimmers, pool operators, public health professionals, and physicians regarding recreational water illnesses, where they are found, how they are spread, who is most likely to become sick, why chlorine is not always effective, and how these illnesses can be prevented. Included in this information are the following six tips physicians can give people who will be swimming:

  • Do not swim when you have diarrhea. This is especially important for children in diapers.

  • Do not swallow pool water. Try your best to avoid having pool water get in your mouth.

  • Practice good hygiene. Take a shower before swimming. Wash your hands after you use the toilet or change a diaper. Germs on your body can end up in the water.

  • Take your children on bathroom breaks or check diapers often. Waiting to hear “I have to go” may mean that it is too late.

  • Change diapers in a bathroom and not at the side of the pool. Germs can spread to surfaces and objects in and around the pool.

  • Wash your child thoroughly with soap and water before swimming.

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