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Why you should think twice before exercising in extreme heat
Most heat-related deaths happen when people are old or sick. But even people in exceptional health can die from something called exertional heat stroke, which happens when the body cannot cool itself down and organs fail. Exceptionally active people like athletes, soldiers and outdoor laborers are at risk when the temperatures exceed 90. Are you and your family at risk? - photo by Jennifer Graham
John McMordie was 23 years old. Kelly Watt was 18. Both were athletes in exceptionally good health, and both died after suffering a heat stroke while running during the summer.

Their tragic stories, and others like them, are a warning to people venturing outside in extreme temperatures, particularly if they're exercising. While most heat-related deaths happen when people are old and sick, even exceptionally healthy people can suffer a debilitating or fatal heat stroke. When strokes occur while people are exercising, they're called exertional heat strokes. That's what killed McMordie and Watt, and also a 15-year-old Boy Scout who died while hiking in Texas last month.

Since 1995, 61 football players have died from exertional heat strokes, and dozens more are hospitalized for heat distress each year, according to the National Center for Catastrophic Sports Injury Research.

McMordie, a Stanford University student, died after suffering a heat stroke while running a half-marathon in Pennsylvania last year. Watt, whose 2005 death was examined by Runner's World magazine, collapsed while training alone, just weeks before he was to join the cross-country team of the College of William & Mary. Reid Comita, the Boy Scout in Texas, collapsed while hiking with his troop on a day when temperatures were in the high 90s.

You don't have to be exercising to suffer a heat stroke. According to the National Center for Health Statistics, about 620 Americans die every year from heat-associated causes, many while sitting in homes without air conditioning.

But people who are in motion outside are especially at risk, which is why every person in an active family should know the signs of heat stroke, and how to treat it.

How the body overheats

The human body is usually effective at cooling itself, expelling heat through sweat and its evaporation. But the body's efficiency at this task declines as temperatures rise and worsens if you're dehydrated.

The first sign that the body is in trouble may be heat cramps, marked by cramps and spasms in the abdomen and legs, and the onset of heavy sweating. To treat heat cramps, move to a cooler location, massage the cramping muscles and drink small amounts of water.

If the heat continues, heat exhaustion may ensue. In addition to heavy sweating, cramping and nausea, the person may experience dizziness, clammy skin and fainting, according to the Centers for Disease Control and Prevention. To treat a person with heat exhaustion, move the person to a cooler environment, apply cool, damp cloths to the skin, and have the person drink water.

Heat stroke is the most serious heat-related ailment, and a person suffering heat stroke may be unable to do anything to help himself. Unlike other forms of heat distress, heat stroke is notable because the person is no longer sweating. He may be confused, dizzy or delirious, have a throbbing headache and nausea, a rapid pulse, shallow breathing, and a body temperature above 103 degrees.

As his condition deteriorates, the person will lose consciousness, and his organs will begin to fail.

"Once you start having a heat stroke, once you pass that line, you're not able to recognize what's normal in your body and think clearly," Hunter Knighton, an offensive lineman at Tulane University, told Herbie Teopie of The Times-Picayune in New Orleans.

Knighton spent 12 days in a coma after suffering a heat stroke in 2014. He has recovered, but says, "It was a really long road back. After I got out of the hospital, I couldn't really walk very far distances."

Ways to treat heat stroke

"Exertional heat stroke is literally your body cooking itself. If you keep persisting in a warm environment, it could lead to death," Dr. Neha Raukar, a primary care sports physician at Rhode Island Hospital, said in Men's Health magazine, an appropriate venue since 68 percent of Americans who suffer heat strokes are men.

But people who suffer a heat stroke can often survive if they receive appropriate treatment on the scene. In fact, one report published in the Journal of Emergency Medical Services in May, said, "When prompt, proper and aggressive treatment begins within 10 minutes of collapse, EHS (exertional heat stroke) is 100 percent survivable."

The authors said bystanders and first responders should follow the advice of the National Athletic Trainers Association: "Cool first, transport second."

The gold standard of treatment for first responders is to immerse the person in cold water when possible, the report in the Journal of Emergency Medicine said. When immersion is not possible, the next best treatment is covering the patient with cold, wet towels.

When emergency medical providers aren't around, bystanders should call 911, then attempt to cool the person with any means possible, such as sponging or hosing him with water, and applying ice packs on the neck, armpits and groin, according to the Mayo Clinic. This treatment applies whether the patient has collapsed on a trail or on a bedroom floor.

How to prevent it

Although it seems that a person who suffers a heat stroke while running up a mountain is more likely to die than a person who suffers a heat stroke while sitting in a chair, the opposite is true.

Well-conditioned athletes are better able to survive a core body temperature of 104 degrees or higher, the authors of the article in the Journal of Emergency Medicine wrote.

But they're better off if they can prevent it from happening at all.

For starters, people should know that they're at higher risk for heat stroke if they suffer from any gastrointestinal problems, if they take certain medications or supplements, if they're not used to heat, or if they're overweight. People with these risk factors might want to work out in an air-conditioned gym until an extreme heat wave passes.

If the lure of the trail is too much, know the early warning signs of heat distress headache, dizziness, nausea, lightheadedness, or extreme fatigue and don't try to push through if one or more of these occurs in you or a family member. Get to shade or air conditioning, drink water and pour some on your body.

Exercise or hike with at least one partner, and always carry identification and a cellphone.

And make sure your body is well-hydrated before you go outside, not after you're there. Men's Fitness recommends ice slushies in addition to water, and also suggests carrying an extra shirt that you can put on when the first one becomes soaked with sweat. A sweaty shirt hinders the evaporation of sweat.

Loose clothing also helps, according to The Heat Factor, a campaign to educate the public about exertional heat stroke.

Equally important: When moving around outside in the heat, whether you're running, hiking or mowing the lawn, take plenty of breaks, preferably in the shade.