Legal Issues Involved with Dehydration & Heat Illness
There are many issues of legal liability within the field of sports medicine. Over the past several years dehydration has drawn more public attention with the high profile death of Minnesota Viking Korey Stringer as well as a number of deaths in high school and college athletics.
“Heat illness is inherent to physical activity and its incidence increases with rising ambient temperature and relative humidity” (Binkley, et al., 329, 2002). Although heat illness is more likely to occur in hot, humid weather; it can occur in other weather conditions (Binkley, et al., 2002). Evaporation is typically the primary form of heat dissipation during exercise. This evaporation of sweat assists the body in regulating its core temperature. The body’s core temperature can rise dramatically if it is unable to evaporate sweat from the skin’s surface (Casa, et al., 2000).
Dehydration is considered one of the most common risk factors of heat illness but is preventable when proper hydration protocols are met (Casa, et al., 2000). Some other risk factors of heat illness include hot and humid climate, lack of acclimatization, sleep deprivation, and medications. Body weight can drop by 6-10% in dehydration with a subsequent rise of .15-.2 degrees Celsius for every 1% of bodyweight lost to dehydration (Coris, Ramirez, and Van Durme, 2004). This can occur in just an hour of exercise or less if the athlete is already dehydrated (Casa, et al., 2000).
Case law has established that schools have a duty to provide athletes with quick and appropriate medical care even if the activity was voluntary. King v. University of Indianapolis (2002) provides an interesting perspective into the complexity of the issues involved with respect to legal liability and compensation. Michael King was a 19-year-old sophomore football player at the University of Indianapolis. On the first day of football practice of the 2000 season Michael suffered a heat stroke and died from complications later that day. Michael had signed an assumption of risk form prior to his participation. A wrongful death lawsuit was filed and the court ultimately ruled in favor of the plaintiff. The court ruled that although Michael King had signed an assumption of risk form, the form did not specifically mention assuming the risk of negligence and therefore Michael King did not knowingly accept the risk of negligence (Sawyer, Connaughton, and Spengler, 2003).
There are several recommendations to reduce the risk of heat illness including exercising during the coolest parts of the day, getting acclimated to the heat before exercise, consulting a heat-index prior to and during practice, and modifying warm-ups so participants do not greatly increase body temperature in hot climates. Perhaps the most important recommendation though is the hydration of the body before, during, and following exercise. It has recently been reported that one can consume too much fluid and suffer from over-hydration. This condition is actually worse than dehydration and can lead to a fatal condition called hyponatremia, which occurs when salt levels in the blood drop to very low levels. Nausea, vomiting, weakness, and confusion are all symptoms and can lead to swelling of the brain (Costello and Fryhofer, 2003).
The issue of dehydration and heat illness is something that must be a concern to all those involved in athletics. Coaches and personnel should be prepared and act in a reasonable manner to provide care to avoid claims of negligence. Dehydration and heat illness are typically preventable illnesses. They can be prevented through education, proper precautions, communication, and adequate supervision. While many cases of heat illness may be minor and rarely result in death, the fact is that heat strokes and deaths do occur and this must be made a priority for all coaches and staff. The number one priority of any school must be the safety and well-being of the athletes.
References
Binkley, H.M., Beckett, J., Casa, D.J., Kleiner, D.M., & Plummer, P.E. (2002). National Athletic Trainers’ Association position statement: exertional heat illnesses. Journal of Athletic Training, 37, 329-343. Retrieved January 7, 2005, from http://www.nata.org/publicinformation/archive/files/exertionalheatillness.pdf.
Casa, D.J., Armstrong, L.E., Hillman, S.K., Montain, S.J., Reiff, R.V., Rich, B.S.E., et al. (2000). National Athletic Trainers’ Association position statement: fluid replacement for athletes. Journal of Athletic Training, 35, 212-224. Retrieved January 7, 2005, from http://www.nata.org/publicinformation/archive/files/fluidreplacement.pdf
Coris, E.E., Ramirez, A.M., & Van Durme, D.J. (2004). Heat illness in athletes: the dangerous combination of heat, humidity and exercise. Sports Medicine, 34, 9+. Retrieved November 18, 2004, from Academic Search Elite database.
Costello, C., & Fryhofer, S. (2003, July 8). Drinking too many fluids can be dangerous. The America’s Intelligence Wire. Retrieved November 18, 2004, from InfoTrac OneFile database.
Sawyer, T.H., Connaughton, D., & Spengler, J.O. (2003). Preventing injuries, deaths, and liability associated with heat illness. Journal of Physical Education, Recreation, & Dance, 74, 9+. Retrieved November 18, 2004, from InfoTrac OneFile database.