Exposure to abnormal or prolonged amounts of heat and humidity without relief or adequate fluid intake can cause various types of heat-related illness. Just ask any of the759 athletes who participated in the Longhorn Half Iron Triathlon last Sunday in Central Texas. Luckily for the athletes, race organizer Endorfun Sports, collaborator Jack and Adams Bicycles and Seton Southwest Hospital also knew what the heat could do to performance and prepared for it.

Although earlier in the week a forecast high of 80 degrees brought by a cool front looked promising for the event, the front stalled and temperatures, along with high humidity levels climbed during the day on Sunday. With the start time for Sunday's race at 7:30 a.m. and the average time for completion at a little over six hours, the majority of the athletes would still be competing when the heat index was 91 degrees.

"Here (in Central Texas) you expect the heat so you have to plan for it," says Drew Wolff of Jack and Adam's.Anticipating the hotter temperatures, race organizers trucked in more than 16,000 pounds of ice for the three events spread over two days. Sunday alone called for 10,000 pounds of ice. "We wanted to have more than enough," added Drew's colleague Marsha Ungchusri. Over the 13.1-mile run course, the normal number of aid stations was expanded to nine. Aid stations handed out cups of Gatorade, water, ice, and Pepsi. In addition to the liquid refreshment, pretzels, Twizzlers, electrolyte replacement capsules and sunscreen were provided. Water for external use was also made available throughout the run course including water-soaked sponges, water hoses, misting tents, a water-mist blower and volunteers armed with water cannons.

On the same day, the Chicago Marathon was halted mid-way through the race after the heat index climbed to similar levels. Hundreds needed medical attention, mainly due to dehydration and at least 40 were hospitalized. "The number one sponsor...if you have a marathon or triathlon is mother nature. She can really affect how things turn out," said Carey Pinkowski, Chicago Marathon Race Director in an interview with WGN Radio.

In Central Texas, competitors managed the hot and humid conditions differently. "I drank electrolyte drinks throughout and when ice was available I made sure I took it," says Mary Faria, PhD, FACHE, VP/Administrator, Seton Southwest, a Longhorn Triathlon participant and past Chicago Marathon competitor. "I grabbed those cool water sponges along the way during the run and made good use of the misting tents along the way. I also altered my goal pace because of the heat. It just wasn't worth the risk to go all out in those conditions. Unless it is a qualifier for another event, it's not worth pushing too hard under those conditions."

Seton Southwest Hospital volunteers along with other medical personnel provided support for the Longhorn Triathlons, both Saturday and Sunday. Saturday's sprint and International races were shorter in overall distance than the half Ironman distance on Sunday and were able to finish before the extreme heat affected the athlete's performance. While one person was treated for heat exhaustion, the majority of people requiring medical assistance on Saturday were from swarming bees. Sunday, the medical volunteers had their hands full with athletes experiencing cramps, heat exhaustion and one or two cases of heat stroke. "It was a long hot day with lots to be done, but in the end we are both glad we could help. Everyone was so very appreciative," says Karen Christensen RN.

Two Seton medical volunteers; Tiffany Aiken RN (left) and Karen Christensen RN.

Of the 759 Longhorn Triathlon athletes who started the race on Sunday, 728 finished. "Only 31 didn't finish and 31 is a small amount for a race of this nature," says Drew.

Heat-related Illnesses

If you are an athlete in Central Texas, it's a good idea to learn more about heat-related illnesses. There are three major types:

• heat cramps
• heat exhaustion
• heat stroke

What are heat cramps?

Heat cramps are the mildest form of heat injury and consist of painful muscle cramps and spasms that occur during or after intense exercise and sweating in high heat.

What is heat exhaustion?

Heat exhaustion is more severe than heat cramps and results from a loss of water and salt in the body. It occurs in conditions of extreme heat and excessive sweating without adequate fluid and salt replacement. Heat exhaustion occurs when the body is unable to cool itself properly and, if left untreated, can progress to heat stroke.

What is heat stroke?

Heat stroke, the most severe form of heat illness, occurs when the body's heat-regulating system is overwhelmed by excessive heat. It is a life-threatening emergency and requires immediate medical attention.

Symptoms and first-aid measures for heat injuries:

The following chart contains the most common symptoms of heat-related injuries. However, each person may experience symptoms differently. In addition specific treatment will be determined by your physician and may include some, or more, of the following:

Condition	Symptoms	First-aid and treatment
Heat cramps	painful cramps, especially in the legs flushed, moist skin mild fever, usually less than 102 F	Move to a cool place and rest. Remove excess clothing and place cool cloths on skin; fan skin. Give cool sports drinks containing salt and sugar such as Gatorade. Stretch cramped muscles slowly and gently.
Heat exhaustion	muscle cramps pale, moist skin usually has a fever over 102 F nausea vomiting diarrhea headache fatigue weakness anxiety, and faint feeling	Move to a cool place and rest. Remove excess clothing and place cool cloths on skin; fan skin. Give cool sports drinks containing salt and sugar such as Gatorade. If no improvement or unable to take fluids, call your physician or go to an emergency department immediately. IV (intravenous) fluids may be needed.
Heat stroke	warm, dry skin high fever, usually over 104 F rapid heart rate loss of appetite nausea vomiting headache fatigue confusion agitation lethargy stupor seizures, coma, and death are possible	Move to a cool place and rest. Call 911 or your local emergency medical service. Heat stroke is a life-threatening medical emergency and needs to be treated by a physician. Remove excess clothing and drench skin with cool water; fan skin. Place ice bags on the armpits and groin areas. Offer cool fluids if alert and able to drink.

Heat Effects on the Runner's Body

In the May 2007 issue of Austin Runner, Dr. Joseph Kozusko, an expert in the area of heat stress adaptation and hydration passed along these tips to keep the athlete's engine running optimally during an event where the heat index is high.

Mouth - When we need to hydrate, we develop flavor fatigue very quickly. Regardless of how tasty something is at first, we tend to get bored with the flavor even water so be sure to have a variety of options and flavors available.

Kidneys - The addition of electrolytes in some beverages (Gatorade, Ultima, Powerade, etc.) helps us retain fluid in our kidneys for urine production a key process in keeping the body working as efficiently as possible.

Stomach - We want fluids to empty from the stomach into our intestines at a fairly fast rate so they can be absorbed into other internal organs and the bloodstream to continue the cooling effort.

Skin - Overall maintenance of blood volume is the greatest factor in allowing our body to release the heat in our muscles via sweat, acting to keep our entire surface cool and safe.

Brain - With even small levels of dehydration, the ability of the brain to effectively operate is reduced. By entering a workout or race fully hydrated, were better able to focus on the task at hand.

Heart/Lungs - When fluids reach our bloodstream, the total blood volume increases to adequate levels so we can maintain the cardiovascular needs of our heart and lungs during exercise.

Muscles - By keeping the muscles well-lubricated, fluid replacement is critical to the proper contraction of working muscle groups, as well as prevention of injury.