By Abigail Funk
More and more athletic programs are using written policies to govern practices and workouts in the hot, humid months. From getting everyone on board to deciding what rules to set, there are several critical steps to a successful policy-making process.
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Almost three hours into the first practice of the 2007 football season, and just minutes before the coach planned to send everyone to the showers, 16-year-old Kenny Wilson collapsed on the field. The junior linebacker at Beckman High School in Irvine, Calif., was immediately put in an ambulance, but he went into cardiac arrest and died en route to the hospital. Speculation ensued that the 90-degree temperature and high humidity that day played a role in Wilson’s death, and a few months later, the county coroner’s autopsy report confirmed that heat stroke was the cause.
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Wilson was one of several football players who made grim headlines in recent years after a heat-related death. In February, the National Center for Catastrophic Sport Injury Research at the University of North Carolina released its Annual Survey of Football Injury Research, reporting on data collected through 2007. The report says that since 1995, 33 football players have died from heat stroke, including 25 high school students and five college athletes.
While those numbers suggest the odds of your program experiencing a heat-related death are quite low, they also show that heat illness is a serious threat that warrants serious action. Across the country, athletic programs have helped minimize the risk by implementing comprehensive heat policies, and by updating them regularly to reflect best practices and all available information and resources.
These policies are more than just a set of guidelines spelling out when it’s too hot to practice in full equipment, when two-a-days have to be canceled, and who to call if an athlete is in distress—though they can include all those components and more. A well-designed heat policy is a statement of preparedness and awareness, and a way to show that your program’s primary goal is protecting student-athletes’ health and safety.
Getting Started
The first step in crafting a heat policy or revising one that already exists is making sure all the right people understand that a policy is necessary. If sport coaches, your athletic trainer, parents, school board members, and student-athletes are not aware of the dangers of heat illness and the effects of working out in extreme heat, you’ll have trouble garnering the support necessary to make the policy effective.
“If I were in a high school setting, I would go to the parent organizations first,” says Sandra Fowkes Godek, Medical Coordinator at West Chester University and Director of the school’s HEAT (Heat Illness Evaluation Avoidance and Treatment) Institute. “If you educate parents about the potential problems—such as coaches being too aggressive with workouts early in the preseason—they have a way of making things happen. Parents can be great advocates for athletic trainers in building momentum behind a heat policy.”
What exactly should you educate people about? Jon Almquist, Athletic Training Program Administrator for Fairfax County (Va.) Public Schools, says a basic review of the published research on heat illness can provide a convincing case to any stakeholder in scholastic athletics. “There are many studies out there to give you scientific support,” he says. “It’s well established that precautions must be taken in extreme heat, or else the end result could be tragedy.”
Aaron M. Karlin, Pediatric Sports Medicine Specialist with Ochsner Health System in Covington, La., used the awareness-first strategy as the medical advisor for a committee that created a district-wide heat policy in St. Tammany Parish (La.) earlier this year. “Some people in the group, which consisted of principals, assistant principals, a school board secretary, athletic directors, and parents, had misconceptions about what heat illness is,” he says. “Everybody knew on some level that practicing in the heat is dangerous and there needed to be certain precautions in place, but they were not educated about the real effects of extreme heat.
“So for our first couple of meetings, I brought in 20 or 30 different research articles, reports from the American College of Sports Medicine and the NATA, and examples of policies from other states,” Karlin continues. “I bombarded the committee with information to show them the reality of heat illness. If I had just said, ‘This is what I think we should do,’ I would have gotten nowhere.”
Group Project
Once you’ve demonstrated the need for a heat illness policy, it’s essential to keep supporters from various groups—such as other administrators, your athletic trainer, coaches, and parents—involved in its creation and maintenance. They will help get the policy adopted, and once it’s in place, ensure that it is followed to a T.
As the medical advisor for St. Tammany’s committee, Karlin wrote most of the policy himself. “But our administrative members took care of the up-front wording, so they were involved in that way,” he says. “Everyone on the committee read the draft and made corrections and recommendations before we submitted our final proposal to the superintendent.”
The St. Tammany committee met in person five times, and sent e-mails back and forth over the three months the group worked on the project. “It really came together pretty quickly,” Karlin says. “We didn’t try to reinvent the wheel—we pulled from policies already in place in other states and just kind of adapted them to our own environment.
“For instance, some of the policies we looked at used a specific heat index reading to determine when to cancel practice,” Karlin continues. “But our approach is not to stop practices—it’s to alter them so they’re safe. So we have a flag system based on the heat index: Green means we’re good to go, yellow and red mean alterations will be implemented, and we don’t cancel practice until we hit black. Coaches and athletes find a scale much more fair than a straight cutoff.”
Perhaps the toughest group to win over is the coaches. While there are now fewer “old school” types who believe any accommodation for weather is a sign of weakness, coaches face conflicting interests that they can’t ignore.
“Coaches are torn,” says Jeff Hopp, Head Athletic Trainer at Marietta (Ga.) High School. “There is pressure on them to win and have a successful program, but hopefully they have their athletes’ best interests at heart, too. In order to have your policy followed, you will need them to understand why it’s there in the first place.”
Karlin found out quickly that coaches were a concern for the St. Tammany group. “I was surprised how worried some committee members were about potential backlash from coaches,” he says. “They thought that making these rules might cause problems. This is SEC country—high school football is big, and any restrictions put on our kids are viewed with suspicion. We really highlighted to the coaches and committee members that we were not trying to prevent practice, but protect practice.”
The last key group that must take stock in a heat illness policy is the athletes themselves. “We are dealing with very highly motivated individuals,” Lunt says. “It’s not just the coaches doing the pushing. These athletes push themselves past the point where an average person would stop. They’re vying for a spot on the team or a starting position. The players need to know the signs of heat illness and be told to watch out for each other.”
Nuts & Bolts
So it’s time to sit down and write a policy or update one that hasn’t been revisited in a few years—what should today’s policies look like? While each one will differ due to geographic location and corresponding heat and humidity levels, there are several key areas to address. The first is implementing an acclimatization period at the start of preseason.
“If you look at the epidemiology, football players who die during preseason have all died within the first three days,” Fowkes Godek says. “It never happens during the second week because by day eight, players have expanded their blood and plasma volume by 10 to 12 percent. I have data showing core body temperatures the first, second, and third days versus the eighth to 10th days, and athletes are all significantly cooler that second week.
“The NCAA rules do a great job forcing football athletes to go through a true acclimatization process,” she continues. “The first five days it’s one practice a day and players gradually get into full pads. The first couple of days they’re in shorts and helmets, then half pads or shells, and it’s not until the sixth day they’re in full equipment. Also, there are never consecutive days of two-a-days during preseason. I suggest looking closely at the NCAA’s policy before drafting your own. If you can somehow include early conditioning without full equipment, you can head off many potential problems.”
Deciding what weather will trigger alterations to practices is another important aspect to clearly address. “You can’t simply say that when the temperature is 95 degrees or the humidity is above 80 percent, there will not be practice,” Lunt says. “Coaches and players will have a fit—we’d never practice down here if that were the rule. A policy should be more general. For instance, say you will monitor weather conditions on a daily basis and make appropriate adjustments, not just cancel everything completely. That may mean changing the time practice starts, the type of gear players wear, the intensity of work, or the number and frequency of breaks.”
Most policies use either a wet bulb reading (which incorporates temperature and humidity) or wet bulb globe reading (which incorporates temperature, humidity, and solar radiation) to determine the risk level of weather conditions. “But a lot of it is common sense,” Stinson says. “Football coaches, for instance, need to know that when they’re not running a drill in practice, the kids should be encouraged to remove their helmets and must have access to water. Putting something that simple into writing can make a difference. You don’t necessarily have to say there must be formal breaks every X number of minutes.”
One thing both Almquist and Karlin were very cognizant of when drafting their school systems’ policies was to not give any real decision-making power to coaches. “Our policy gives coaches no direct control over enforcement,” Karlin says. “It is specifically written that heat index readings are performed by the school’s athletic trainer or an administrator, and coaches are excluded from this responsibility.”
Your policy should have clear educational material in it—not just a heat index chart and a cutoff point for canceling practice. And it’s your job to make sure the rest of the athletic training staff, coaches, and student-athletes understand all parts of the policy.
“Our athletic training staff sees every coach at every preseason meeting,” Almquist says. “They have the signs and symptoms of heat illness brought to their attention at that time, and we go over the policy so they’re aware we may be telling them they can’t use helmets or full pads on certain days, or maybe can’t even be outside. We inform the kids and their parents at our preseason meetings, and we also have the policy posted on our Web site.”
The final piece of an effective heat policy involves “what if” scenarios. Outlining the specific steps to be taken when an athlete exhibits signs of heat illness is extremely important.
“An emergency action plan must be part of the policy,” Lunt says. “When is it time to notify EMS? Who is going to make the call? Where are you going to take the athlete in the meantime? Who’s going to direct the ambulance and who will notify the parents? When we created our policy, we made sure those roles were clearly delineated.”
Lunt also thinks proactively, flagging athletes who are at higher risk for heat illness and keeping a close eye on them early in the preseason. “That’s why a good preseason physical is extremely important,” he says. “At Florida State, our physical is extensive, including a full cardiac workup with EKGs so that we’re able to identify at-risk athletes. High body fat, for instance, is an indicator. It’s important that you know the people who tend to have issues with heat.”
A version of this article has appeared in Training & Conditioning, a sister publication to Athletic Management.
For more information on the latest heat illness studies and research available, check out T&C’s monthly feature online now at: www.training-conditioning.com.
Abigail Funk is an assistant editor at Athletic Management.