Exercise-Associated Muscle Cramps

  • Stop activity
  • Hydrate with sodium-containing fluids
  • Mild stretching
  • Massage muscle spasm
  • Lay flat to assist  with redistribution of blood flow to cramping muscles

Heat Syncope

  • Move to shade
  • Monitor vital signs
  • Elevate legs above level of head
  • Rehydrate

Exercise (Heat) Exhaustion

  • Measure body-core temperature (rectal)
  • Remove excess clothing
  • Cool the athlete with fans, ice towels, or ice bags if temperature is in excess of 102°F
  • Place the athlete in a cool and/or shaded environment
  • Start fluid replacement
  • Transfer care to a physician if IV fluids are needed or if recovery is not rapid

Exertional Heatstroke

  • Measure body-core temperature (rectal) to differentiate between heat exhaustion and heatstroke (≥104°F = likely heatstroke)
  • Assess cognitive function
  • Lower body-core temperature as quickly as possible
  • Monitor temperature every 5-10 minutes during cooling. Stop cooling when temperature is 100°F-101°F to prevent overcooling
  • If a physician is available on-site, transport to a medical facility may not be necessary so immersion can continue
  • If a physician is not available on-site, aggressive first-aid cooling should be initiated on-site and continued during transport to a medical facility (Portable cooling)
  • Activate emergency medical system
  • Monitor vital signs and other signs and symptoms of heat stroke
  • During transport and when immersion is not feasible, other methods can be used to reduce body temperature: remove clothing; sponge down with cool water and apply cold towels; apply ice bags to as much of the body as possible (especially the major vessels in the armpit, goin, and neck); provide shade; fan the body
  • Manage airway (if needed)
  • Monitor for organ-system complications

Exertional Hyponatremia

  • Attempt to differentiate between exertional heat exhaustion and hyponatremia
  • Attempt to differentiate between heatstroke and hyponatremia
  • If hyponatremia is suspected, immediately transfer to an emergency medical center via emergency medical services
  • Do not administer fluids until a physician is consulted

(Source:  Adaptation of NATA)

*Products and product websites shown do not imply endorsement from NATA


The following video from the University of Tennessee at Chattanooga depicts ice water immersion and the ice water taco method:


Next: Emergency Action Plan