Beat the heat and playing it cool: How can YOU keep your athletes safe during a heat wave?
As the hot weather begins, practicing and playing sports for kids and young adults can become dangerous. Heat illness during practice or competition is the leading cause of death and disability among US high school athletes. Sudden onset of symptoms combined with a lack of preparedness can change an ordinary practice into a life or death situation. In 2018, 19 year-old Jordan McNair died from heat stroke that occurred during practice. Prior to the incident, McNair was a seemingly healthy offensive lineman for the University of Maryland's football team. The temperature at the time of practice when the incident occurred was 80 degrees with 71 percent humidity. You may be wondering how can this happen? Recent studies are showing the intensity of the workout can be just as important as the heat index. Teammates who watched McNair that day could see that he was struggling in practice, yet he was told to push harder, faster, keep going. As he collapsed and seized on the field, EMS was called, but it was too late. He died 15 days later. You may ask... what can you do to make your sport practices and games safer for your athletes in hot weather?
Acclimatize to heat gradually. Practices for the first 14 days should be shorter and less intense. Athletes should be encouraged to initiate their own conditioning program several months prior to the beginning of the season. During the predicted hottest days of a heat wave, practice and games should be scheduled during the cooler parts of the day.
Account for heat and humidity. Both the temperature and relative humidity should be taken into account in determining the length of practice sessions. Various international and national medical and sports associations recommend that if the sum of the temperature and relative humidity are greater than or equal to 160, special precautions must be taken. If the sum is greater than 180, cancelling practice is recommended. These recommendations can vary with the type of sports activity, age of participants, and location of sporting event.
Provide for frequent breaks. During hot weather you may want to adjust the intensity and duration of practice, providing frequent rest periods (at least 15 minutes per hour of practice). Athletes should rest in shaded areas; hats and helmets should be removed, and jerseys should be loosened or removed.
Rehydrate. Cold water or sports drinks should be available in unlimited quantities to players. Scheduled water breaks should be strictly enforced.
Identify athletes at greater risk. Athletes with the greatest risk of heat illness include younger participants, athletes who have an acute or chronic illness, and those who have history of heat illness.
Know your staff. Is everyone on board with safety? Does your team have an emergency action plan (EAP) in place? Do you have a safety officer who monitors changing practice conditions?
Listen to your players parents. Parents know their kids best. If an athlete has had a prior heat illness incident, they may not want to report it. Make sure there is open communication with parents and that all preseason medical forms are completed, reviewed, and accessible.
Learn the warning signs. It is imperative that all coaches, parents, and players are aware of signs of dehydration and heat illness. An athlete exhibiting any symptoms such as nausea, confusion, dizziness, or sudden onset of headache, should be immediately removed from practice, cooled down, and placed in a shaded environment.
Here is a great image from the CDC showing all heat-related illnesses
Recommendations from the American Academy of Pediatrics include:
"Community and team/school physicians as well as athletic directors, community parks and recreation programs, and youth sport governing bodies should emphasize comprehensive awareness, education, and implementation of effective exertional heat-illness risk-reduction strategies to coaches and their staff, athletic trainers, teachers, administrators, and others who oversee or assist with exercising children and adolescents and youth sports, especially for those involved with youth and preseason high school American football.
Trained personnel and facilities capable of effectively treating all forms of heat illness, especially exertional heat stroke by rapidly lowering core body temperature, should be readily available on site during all youth athletic activities and community programs that involve vigorous physical activity and are held in the heat.
Children and adolescents should be regularly educated on the merits of proper preparation, ample hydration, honest reporting, and effectively managing other factors under their control, such as recovery and rest, which will directly affect exercise-heat tolerance and safety.
Each child and adolescent should be given the opportunity to gradually and safely adapt to preseason practice and conditioning, sport participation, or other physical activity in the heat by appropriate and progressive acclimatization. This process includes graduated exposure (typically over a 10- to 14-day period) to the environment, intensity, duration, and volume of physical activity and to the insulating and metabolic effects of wearing various uniform and protective-equipment configurations. Specific guidelines for American youth football are available and can be used as a basis for developing other youth sports-acclimatization and practice-modification/monitoring strategies.
Sufficient, sanitary, and appropriate fluid should be readily accessible and consumed at regular intervals before, during, and after all sports participation and other physical activities to offset sweat loss and maintain adequate hydration while avoiding overdrinking. Generally, 100 to 250 mL (approximately 3–8 oz) every 20 minutes for 9- to 12-year-olds and up to 1.0 to 1.5 L (approximately 34–50 oz) per hour for adolescent boys and girls is enough to sufficiently minimize sweating-induced body-water deficits during exercise and other physical activity as long as their preactivity hydration status is good. Preactivity to postactivity body-weight changes can provide more specific insight to a person's hydration status and rehydration needs. Although water is often sufficient to maintain adequate hydration, long-duration (eg, ≥1-hour) or repeated same-day sessions of strenuous exercise, sport participation, or other physical activity might warrant including electrolyte-supplemented beverages that emphasize sodium to more effectively optimize rehydration. This is especially justified in warm- to hot-weather conditions, when sweat loss is extensive.
Exercise, sport participation, and other physical activity should be modified for safety in relation to the degree of environmental heat stress: air temperature, humidity, and solar radiation, as indicated by the heat index or wet-bulb globe temperature (WBGT), for those with access to such a device. Effective modifications include lowering the intensity and/or shortening the activity duration and increasing the frequency and duration of breaks, which would preferably be in the shade. Individual medical conditions and other risk factors identified by a preparticipation physical examination or as indicated by a more recent change in health status that could lower tolerance for exercise in the heat and increase risk for exertional heat illness should also prompt these and additional modifications.
Any child or adolescent should avoid or limit exercise, sport participation, or other physical activity in the heat if he or she is currently ill or is recovering from an illness, especially those involving gastrointestinal distress (eg, vomiting, diarrhea) and/or fever.
Supervisory staff such as coaches, athletic trainers, physical education teachers, and playground aides should receive appropriate training and closely monitor all children and adolescents at all times during sports and other physical activity in the heat for signs and symptoms of developing heat illness. Any significant deterioration in performance with notable signs of struggling, negative changes in personality or mental status, or other concerning clinical markers of well-being, including pallor, bright-red flushing, dizziness, headache, excessive fatigue, vomiting, or complaints of feeling cold or extremely hot, should be sufficient reason to immediately stop participation and seek appropriate medical attention for those affected. First aid for evolving heat illness should not be delayed. Anyone experiencing exertional heat illness should not return to practice or competition, recreational play, or other physical activity for the remainder of the current session, game/match, or play/activity period.
An emergency action plan with clearly defined written protocols should be developed and in place ahead of time. Emergency medical services (EMS) communication should be activated immediately for any child or adolescent who collapses or exhibits moderate or severe central nervous system dysfunction or encephalopathy during or after practice, competition, or other physical activity in the heat, especially if the child or adolescent is wearing a uniform and/or protective equipment that is potentially contributing to additional heat storage. Although treatment should not be delayed pending core body-temperature verification, when feasible, rectal temperature should be promptly checked by trained personnel and, if indicated (rectal temperature > 40°C [104°F]), on-site whole-body rapid cooling using proven techniques should be initiated without delay. This process includes promptly moving the victim to the shade, immediately removing protective equipment and clothing, and cooling by cold or ice-water immersion (preferred, most effective method) or by applying ice packs to the neck, axillae, and groin and rotating ice-water–soaked towels to all other areas of the body until rectal temperature reaches just under 39°C (approximately 102°F) or the victim shows clinical improvement. If rectal temperature cannot be assessed in a child or adolescent with clinical signs or symptoms suggestive of moderate or severe heat stress, appropriate treatment should not be delayed. Prompt rapid cooling for 10 to 15 minutes and, if the child or adolescent is alert enough to ingest fluid, hydration should be initiated by attending staff while awaiting the arrival of medical assistance.
To improve athlete safety and performance, youth sports governing bodies, tournament directors, and other event administrators should provide adequate rest and recovery periods of 2 hours or more between same-day contests in warm to hot weather to allow sufficient recovery and rehydration.
In conditions of extreme heat or humidity when children or adolescents can no longer maintain thermal balance, safety should be the priority, and outdoor contests and practice sessions should be canceled or rescheduled to cooler times, even if it means playing or practicing very early in the day or later in the evening."
-Council On Sports Medicine and Fitness and Council on School Health. (2011). Climatic Heat Stress and Exercising Children and Adolescents. https://pediatrics.aappublications.org/content/128/3/e741
By having your coaching staff, parents, and athletes on the same page about heat illness, you will beat the heat and keep your athletes in the game!
More resources on heat illness can be found here: