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Dr. Eric Coris, director of the Sports Medicnie Department at the University of South Florida.

Team Physicians Use Cutting-Edge Technology, Common Sense to Battle Heat-Related Illness

Three years after he accepted a grant from the National Football League to develop a game plan for combating heat-related illness in athletes, Eric Coris is finding that his best offense is a strong defense.

Coris is director of the sports medicine program at the University of South Florida (USF) in Tampa, and an assistant professor of family medicine. Since he began his research in 2005, Coris has used technology, which originally was developed for NASA in the 1980s to measure the core body temperature of astronauts, to record the core temperature of football players who must endure the grueling heat and humidity of Florida summers.

The monitoring system is CorTemp™. It is marketed by HQ Inc., a globally-marketed company headquartered in Palmetto. It consists of a silicone-covered pill, which is swallowed by the athlete several hours before working out. The pill has a battery-powered sensor that transmits the user's body temperature to a team physician or trainer who holds a device that records the data. When the core body heat reaches a potentially dangerous level, the player is pulled off the field and appropriate protocols are taken to cool him.

Under Coris' tutelage, USF has been the beneficiary of multi-year grants from the NFL and the National Institute for Occupational Safety and Health, in addition to support from the university's own Sports Medicine and Athletic-Related Trauma Institute. Each year he has procured more equipment and now is able to arm his athletic trainers with monitors and dispense pills to any player who needs or wants to participate. These days, "we end up (monitoring) about a third or a half of the team on any given day," Coris said.

But now that he has had time to analyze the data, Coris said he is placing new emphasis on preventing heat-related illness before it occurs.

"The first few years were more helpful from a descriptive standpoint. What we are really getting into now mainly revolves around prevention,'' Coris said. "Specifically, we have developed a questionnaire that we give the athletes after practice that we call the 'heat illness symptom index,'" he said. "We are trying to develop something low-tech and inexpensive that youth football teams could use.''

"We constructed a 13-symptom questionnaire that we have refined. We continue to narrow it down to what is a simple checklist to identify athletes who are at risk,'' Coris said.

He is hopeful that youth coaches will one day use the tool to screen youngsters who are susceptible to heat-related illness.

But even when team physicians employ a standard pre-season assessment protocol, which essentially is a medical history as it relates to heat-risk problems, and then follow-up with a post-practice appraisal, it still can be difficult to recognize problems.

Coris said that even though using CorTemp™ has made it easier to identify athletes who are having heat-related issues, it also has raised his concern about those who escape routine observation. At a recent practice in August, Coris said, "We had a guy with a (core body) temperature of 104 degrees, but who had no symptoms whatsoever. That makes you nervous because it can happen right under your nose,'' Coris said.

Not all athletic departments can afford a system like CorTemp™, which costs about $2,500 for each monitoring device and $35 per pill per day. That's one reason why sports medicine specialists at the University of Central Florida (UCF) in Orlando place their emphasis on prevention of heat-related illness.

Daniel Monette, MD, is one of four team physicians for the UCF Golden Knights football team. He said he and his colleagues "don't see a lot of (heat-related illness) because we prevent it before it becomes an issue.''

"We do weigh-ins and weigh-outs. We see how much water weight they have lost and we try to replenish that. We also look at their urine; if there is a dark color to it then we tell them to drink more,'' Monette said. "We also have 25-minute water breaks, shade, fans and GatorLYTES,'' which are powdered electrolyte supplements, he said.

Monette also said UCF football players no longer do two-a-day practices, limiting their outdoor workouts to the morning when it is cooler.

In the six years he has volunteered his services at UCF, Monette, who also has a private medical practice in Sanford, said he can remember only one time when he had to take a player to the medical center to obtain a rectal core body temperature. "It just doesn't happen very often,'' he said.

He credits that infrequency to the team's diligence in "taking a clinical history before they ever step on the field,'' and with the judicious use of IVs, to rehydrate at-risk players. "There are certain players you know who are going to need an IV," Monette said. "That's the great thing about our training staff; they keep an eye on the athletes, so it really hasn't been an issue for us."

Over at USF, Coris complements his high-tech prevention methods with low-tech, but infinitely sensible, advice.

Beyond the pre-participation exam to make sure that an athlete is not predisposed to problems, and the after-practice survey, he recommends coaches be more active about watching for players who are struggling. Coris said that included educating kids about pre-hydrating. "They need to take in a good 500cc of fluids a couple of hours before they take the field, and they need to hydrate while they are participating, with at least 8 to 10 ounces of fluid every 10 to 15 minutes,'' he said.

Coris said that every day he pulls nearly 10 guys off the field and cools them down.

Monitoring players' heat and fatigue levels likely will become the norm as the technology increases and the price to participate decreases, Coris said.

"Ultimately, it may get into the performance realm,'' Coris said. "As we get more sophisticated in monitoring … it would be nice to one day have a quarter-sized sensor in every player's shoulder pad that would transmit (pertinent physical data) to the sideline," Coris said. "It not only would help me watch for people in trouble, it might even help coaches know who is getting fatigued. So, if we were going to run a certain play, (the coach might decide) 'Maybe be need to get a fresh set of legs in there.'"

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