Managing Heat and High School Football

How common are heat injuries among high school football players?

Heat and high school football can make for a dangerous mix, but it’s unavoidable for anyone that participates in athletics of any sort. It’s especially problematic for football programs, and most heat-related injuries among high school athletes present in football players. This makes sense, given the extra gear that comes with football, as well as the constant exertion. But even with these additional risk factors, it’s unacceptable for any high school athlete to suffer severe or fatal injury due to heat stress. Heat injuries are almost always preventable and can be reversible if coaches and trainers take appropriate action beforehand and during an incident.

The Centers for Disease Control and Prevention (CDC) track heat injuries that result in lost time. In other words, if a heat injury forces the athlete to miss activities for one or more days, it is tracked by the CDC. And according to the CDC, high school athletes experience more than 9,000 heat-related injuries every year. Among them, football players are 10 times more likely to experience a heat-related injury, compared to other high school athletes. Again, football players are at a much higher risk of heat stress, accounting for about five percent of all heat-related visits to the emergency room between 2005 and 2009.

Prevention methods are getting better, but there is still room for improvement.

What can be done to stop heat-related injuries among high school football players?

An ounce of prevention is worth a pound of cure, as the saying goes. It’s certainly true when it comes to heat-related injuries, as they can be prevented with basic tools and prevention methods. If heat exhaustion or heat stroke does present, though, immediate action may protect the individual from fatal complications. “Immediate” is the keyword. Here is what coaches and trainers can do to protect their players:

1. Education and information – First, be aware of what heat illness looks like, how it presents and how it can be prevented. Make sure that the players take this seriously, because high school players aren’t likely to willingly admit they aren’t feeling well. Stress the importance of recognizing symptoms and allow anyone experiencing heat-related symptoms to seek respite as soon as possible.

Make sure trainers are also aware of the dangers of excessive heat, and task them with monitoring players. It’s not always clear from a distance who is in danger, so the more eyes, the better.

Heat Aware's Heat Cards - HATS40 | Avoid heat-related illnesses for workers2. Heat cards – Heat cards are simple reference, temperature monitoring and memory-jogging tools that encourage proper heat illness prevention. A heat card comes with a liquid crystal thermometer that constantly takes ambient air temperature. Check it often to keep abreast of what the weather is doing. Heat cards can also be customized with any reference materials needed, such as proper hydration methods, the symptoms of various heat illnesses, treatment methods and emergency contact information. It’s an inexpensive, easily worn and durable way to keep heat-related illness at the forefront of everyone’s thoughts.

3. Plenty of water – It is exceedingly dangerous to run football drills without water available to the players. This is obvious enough, but coaches often underestimate how much water players actually need to stay properly hydrated. Even if the temperature is below 90 degrees, humidity and heavy football pads will make it feel much hotter. To stay hydrated, players will need to intake at least 36 ounces of fluid every hour, and some will need even more. That’s a lot of water, so make sure there is always enough on hand. Assign someone to the sole task of keeping water supplies up, and don’t let players skip hydration breaks.

4. Provide a shaded rest area – Heat illness strikes when the body can no longer cool itself adequately. As the temperature and humidity climb, it’s harder for the body to transmit heat to the surrounding environment. Hydration will only provide minimal heat sinking, as important as it is, so additional measures are needed to keep players cool and safe.

Even something as simple as a shaded rest area, like a tent, can help normalize a player’s temperature. Consider placing the hydration station inside this area so players are forced into the shade for a bit. Also consider outfitting the spot with fans or misters, as this will cool players off quickly.

5. Act as soon as possible – If a player begins experiencing symptoms of heat illness, even if those symptoms are only apparent to the player, act immediately. If caught right away, heat illness can be stopped before it poses a serious risk. Before long, though, heat exhaustion will develop into heat stroke, and this is a medical emergency.

If the player is conscious and able, get them to a cool, shaded area and hydrate them. Move them inside where there is air conditioning and monitor their vitals to verify that their temperature is dropping. If heat exhaustion or heat stroke is apparent, rapid cooling is needed. If an ice bath is available, get them in one as soon as possible, taking care to keep the player’s head above the water if they are unconscious. If an ice bath is not available, get them to a cool area and cover them with cold, wet towels. In either case, contact emergency services as they may need to be taken to the hospital.

6. Keep an eye on players with additional risk factors – Some people are at a greater risk of heat illness, and these people should be monitored closely. Young people like high schoolers are generally healthy, but players who are overweight and those taking certain medications, including antidepressants and some antihistamines, are at an increased risk of heat illness. Keep an eye on them.

Heat illness is a constant threat to high school football players, but it doesn’t have to be a serious threat. With the right prevention and response methods in place, potentially fatal situations can be avoided.

What Are The OSHA Requirements for Heat Safety

The Occupational Safety and Health Administration, or OSHA, is the governing body overseeing the implementation of workplace safety measures. It organizes these measures through various regulations, all of which employers need to be concerned with. As of yet, OSHA does not have particular regulations in place for heat safety, but that doesn’t mean employers can slide on protective measures. OSHA’s General Duty Clause requires employers to be aware of and remove recognizable hazards that are likely to cause serious harm or death to their workers. OSHA considers excessive heat, both environmental and labor-induced, to be among those recognizable hazards. As such, it is the employer’s responsibility to account for the heat and take the appropriate steps to neutralize its effects on employees.

OSHA Requirements For Heat SafetyWhat OSHA Recommends

OSHA may not have a regulation dedicated to heat safety, but it has published materials detailing how to best approach it. These materials should be of interest to any employer that wishes to maintain OSHA compliance regarding heat safety. OSHA recommends greater levels of awareness and intervention as the heat index climbs. The heat index takes into consideration both air temperature and relative humidity. As humidity rises, the body’s ability to wick off heat using sweat worsens, so it’s more difficult for workers to mitigate heat caused by labor. As air temperature and humidity rise, it is up to the employer to offset the increased danger with additional resources.

Some of the most important points of heat safety, from OSHA’s perspective, include:

  1. Provide workers with a shaded rest area – Once the heat index climbs above 90 degrees, heat illness becomes a real possibility. Lower heat indexes can also be a concern if the worker is outfitted with impermeable protective gear, including gear designed to protect against chemical or biological agents. As soon as the heat index passes the 90-degree threshold, or when workers are expected to don heavy, insulated gear, OSHA strongly recommends employers provide their employees with shaded rest areas. This area should be shaded at all times, so it should be comprehensive enough to keep the sun from intruding at any point of the day. It’s also best to set the rest area up where it will be unexposed to warm breezes, which can accelerate the onset of heat-related illnesses. A shaded tent is an example of an appropriate rest area. Its mobile design and contained environment is ideal for establishing a cool area, regardless of the location. Tents equipped with air conditioners or heavy-duty fans can offer the ideal base for workers in need of cooling.
  2. Provide workers with plenty of potable water – OSHA recommends water that is between 50 and 60 degrees, and between four and six cups of it every hour. Water consumption should begin before the worker notices thirst, as it may be too late to prevent dehydration once the worker becomes thirsty. There should always be drinking water available, so employers must have procedures in place to ensure supplies are replenished with regularity. Workers, and particularly workers who are new to working in the heat, should be encouraged regularly, and firmly, to drink plenty of water. Most incidences of occupational heat-related illnesses occur among inexperienced workers, as they may not be accustomed to working in the heat.
  3. Monitor workers continuously for signs of heat illness – When the heat index climbs above 90 degrees, supervisors should ensure that all heat safety measures are being observed. Shaded rest areas should be utilized, plenty of water should be consumed and other cooling methods taken advantage of. As the heat index climbs even higher, it is imperative that worksites have experts on heat-related illnesses available. These experts should be able to recognize the signs of heat illness right away and know how to administer first aid to workers experiencing symptoms. The expert should also recommend changes to work schedules in response to dangerous conditions. In short, there should be someone at the worksite who will ensure workers are safe and following protocols related to heat. At higher heat indexes, medical facilities should be available within minutes. If they aren’t, then it is the employer’s responsibility to have resources on hand to treat any heat illness that emerges. If the heat index climbs above 115 degrees, or if workers are fitted with heavy, insulated gear for long stretches of time, then additional, significant measures to prevent heat illness must be deployed. This includes physiologically monitoring workers, regularly checking their heart rate, temperature and other vitals that may indicate overheating. Workers should be acclimatized to an extreme environment like this prior to taking on a full workload.
  4. Provide cooling measures, for both preventative and curative situations – When the heat index passes 103 degrees, it’s important that employers consider personal cooling methods. This will protect workers who must remain in the sun for extended periods of time, and workers who cannot access rest areas as often. Personal cooling may be as simple as clothing that has been dampened with water, or something a bit more advanced, like misting stations. Reflective clothing and vests with cooling packs are also effective. If heat illness does appear, then immediate steps must be taken to prevent permanent injury (or death) to the worker. This includes rapid application of wet cloths, transport to a cooled room, administering fluids and immersion in an ice water bath. As this scenario may cause unconsciousness, it is critical that measures are in place to handle an unconscious person.
  5. Pair workers together while they are exposed to heat – The signs of heat illness can creep in slowly and may not be noticed before they become serious. Using a “buddy system” can help worksite managers detect heat illness faster, which may make the difference in keeping workers safe.

Heat-related illnesses are potentially deadly, and it is up to employers to neutralize hazards before they materialize. Adhering to OSHA recommendations will go a long way in doing this as they provide an excellent starting point.

Hydration and Avoiding Heat-related Illnesses

Hydration is the best defense against heat-related illnesses

Heat-related illnesses, most often in the form of heat exhaustion and heat stroke, are serious threats to worker safety. Every year, excessive heat kills dozens of U.S. workers, and incapacitates many more. Although it doesn’t have to be this way because with proper education, monitoring and worker safety procedures, heat illness can be avoided. It’s critical that serious heat illness be avoided on job sites because even if a worker is revived, they can face long-term complications that can affect their quality of life.

Ideally, worksites should be equipped with plenty of educational and reference materials so workers are constantly reminded of necessary precautions regarding heat. It is essential that site managers have this knowledge down pat so they can make sure their crew takes proper precautions when outside temperatures and heat indexes climb to dangerous levels.

A frontline approach to avoiding heat exhaustion or heat stroke is frequent hydration. Hydration will not guarantee workers are safe from heat-related illness, but it will provide a strong measure of protection. This is what proper hydration looks like:

  1. Less than 90 degrees Fahrenheit – No work restrictions or fluid intake measures are required. Intake fluids as needed and rest as needed.
  2. Between 90 and 94 degrees Fahrenheit – Workers should rest 10 minutes out of every hour and take in between 12 and 24 ounces of fluid.
  3. Between 95 and 99 degrees Fahrenheit – Workers should rest between 10 and 20 minutes out of every hour, depending on how strenuous their job is. Fluid intake should measure between 24 and 36 ounces every hour.
  4. Between 100 and 104 degrees Fahrenheit – Rest at least 20 minutes every hour, and more if needed. Take in 36 to 48 ounces of water every hour.
  5. Between 105 and 109 degrees Fahrenheit – Workers should get at least 40 minutes of rest hourly and take in between 36 and 48 ounces of water per hour.

When temperatures rise above 109 degrees Fahrenheit work should only proceed under the watchful eye of Health and Safety professionals.

As outlined above, extensive hydration is needed to maintain safety, and it should be reinforced with clear reference heat cards, heat index posters and the like.

The importance of avoiding heat-related illness

Athletes and workers in demanding, labor-intensive fields, such as construction and landscaping, are most often affected by heat exhaustion and heat stroke. Among athletes and laborers, there is often a sense of powering through the job, even when symptoms of heat exhaustion begin to emerge. This can prove to be fatal and should be strongly discouraged. Instead, the symptoms of heat exhaustion and heat stroke should be constantly checked for, along with making sure there is time for rest in the shade and adequate hydration. Symptoms of heat-related illness include:

  1. Heat exhaustion – Symptoms include excessive thirst, nausea, dizziness, weakness, excessive sweating, decreased urine output, headache, irritability and high body temperature. Heat exhaustion can be triggered by physical exertion in hot and humid weather and is the result of loss of electrolytes through sweating. Sweating pulls both fluids and electrolytes from the body, and they must be replenished to ensure continued cellular function.Most consider heat exhaustion to be a transition step to heat stroke, so aggressive treatment measures should be undertaken if it manifests. Fortunately, with prompt treatment, recovery is promising and rapid. Get the worker to a cool place, have them shed any extra clothing and cool them off with fanning or wet towels. Make sure to give them fluids, but only if they are awake and not confused. Intravenous fluids are an option if the worker is unresponsive.
  2. Heat stroke – Heat stroke produces most of the same symptoms as heat exhaustion, though disorientation and lack of sweating are also present. Heat stroke emerges when the body’s core temperature rises in excess of 105 degrees Fahrenheit, and at this temperature, cellular damage and, by extension, organ failure, is expected in 30 minutes. When the body is stressed with this much heat, proteins inside the cells denature (or lose their physical properties). As a result, the cells lose their structure and leak their contents into surrounding tissue. This can occur throughout the body, so mass organ failure is expected if treatment is not prompt and extensive.Reducing body temperature is the primary goal when heat stroke is present. In fact, it should be attempted before transporting the worker to a medical facility. Move the worker to a cool place and engage in aggressive mechanical cooling. Ideally, the worker would be placed in an ice bath, taking care to monitor the worker at all times, especially if they are unconscious. If an ice bath isn’t available, apply wet, cold towels to the body and head. Intravenous fluid delivery will likely be essential to rehydrate the worker.

Heat stroke should be avoided at all costs. Even if the worker is rapidly resuscitated, serious, long-term complications can emerge. Mortality rates following heat stroke rise dramatically for recovered patients, suggesting that even after recovery, permanent cellular damage is still present and capable of interfering with the body’s normal functions. Research into heat stroke patients has found that functional impairment and loss of independent function are potential outcomes following recovery.

Fortunately, heat exhaustion and heat stroke can be avoided outright if employers take them seriously. Stay educated on heat-related illness awareness and provide plenty of information and hydration options for workers on the job site.

Heatstroke 101: What You Need To Know

Knowing the signs of heatstroke are important for anyone who works in a high temperature environment. This includes those that work outdoors, where hot, humid days produce heat-related illnesses in rapid fashion. At particular risk are people who labor outside and those who participate in organized sports, as the vast majority of heatstroke cases are brought on by extended physical exertion. Even those who are otherwise fit and healthy can be affected by heatstroke, so prevention and treatment methods should be standard in any high risk environment.

What are the signs of heatstroke?

Heatstroke is one of several heat-related illnesses, but is widely considered to be the most severe. Unlike other forms of heat-related illnesses, like heat cramps, heat rash or heat exhaustion, heatstroke is an immediate medical emergency that can result in death or permanent injury if not treated promptly. Recognizing what heatstroke looks like is the first step in preserving life, and the signs look like this:

  1. Elevated temperature – Heatstroke is usually diagnosed symptomatically, but the defining characteristic of the condition is a temperature in excess of 105 degrees Fahrenheit. At this temperature, the body’s organs are at risk of sustaining damage. Indicator tools like heat cards can alert workers to dangerous outdoor temperatures, but the only way to confirm the presence of heatstroke is to get an accurate temperature reading from the affected person. Rectal thermometer readings are generally regarded as the most accurate.An important note – fever and heatstroke are not the same thing. Fevers are caused by physiological mechanisms in response to infection or illness. Heatstroke is a product of the body’s thermoregulatory mechanisms being overwhelmed. When the body’s thermoregulation is defeated, it is normally due to a combination of exertion, excessive environmental heat and impaired heat loss.
  2. Dizziness, mental confusion or weakness – These symptoms are often present before true heatstroke sets in, so they should serve as troubling red flags. Heat exhaustion is the standard term for heat illness that results in mental impairment or weakness, and always precedes heatstroke.
  3. Excessive sweating or a complete lack of sweating – Excessive sweating may be present in people who are exerting themselves during the onset of heatstroke. A complete lack of sweating is an alarming symptom, as it suggests that the body is severely dehydrated and unable to remove heat through sweating. At this stage, rapid temperature increase is imminent and potentially fatal.
  4. Loss of consciousness – As heatstroke progresses, loss of consciousness is possible and signals a high risk of neurological or cardiological complications. Loss of consciousness is usually an indicator of a poorer prognosis, even if the patient is able to fully recover from the episode. Lack of consciousness can also make some forms of treatment more difficult, so prevention should be emphasized so that people do not lose consciousness due to heatstroke.

If any of these signs are present, it is paramount that the person is immediately removed from the high temperature environment and administered treatment. As heatstroke is an emergency medical situation, emergency personnel should be alerted at once.

How to Prevent and Treat Heatstroke

According to The Journal of Emergency Medicine, heatstroke kills more than 600 people in the U.S. every year. The vast majority of these deaths occur in people who are at a higher risk of heatstroke, such as the very young or old, people with other medical conditions and people on medication that affects their thermoregulatory mechanisms. However, death is still a possible outcome in anyone who does not receive treatment. And death is not the only severe consequence of heatstroke. Researchers with the University of Chicago Medical Center studied dozens of patients affected by the 1995 Chicago heat wave, and found that even when patients fully recovered from heatstroke, they were often profoundly affected by the episode, even years later. Specifically, the researchers found that about half of the studied patients died within the following year, and many others had severe functional impairments related to the heatstroke.

In short, heatstroke prevention is not just a life or death situation – it is also about preserving the patient’s quality of life over the long haul. For this reason, prevention is the best cure, and workplaces and sports teams can minimize the chances of heatstroke by doing the following:

  1. Know when hot is too hot – The single biggest mistake that people, managers and coaches make is not taking the heat and humidity seriously. There is often a stigma attached to taking it easy, even when it’s hot outside. This is a dangerous stigma to abide by, as the chances of rapid heatstroke increase as the temperature rises. It’s not enough to just look at the thermometer either, as high humidity can greatly increase the heat index, or the perceived outdoor temperature. On a humid day, heat indexes can run up to 10-15 degrees hotter than the listed temperature, and indexes above the 100s mean dangerous conditions for outdoor workers and athletes. When the temperature gets this hot, consider bringing activities indoors, if possible.
  2. Enforce mandatory rest periods – If work or play cannot be brought inside, then workers should be required to rest a certain amount of time every hour. For example, if temperatures are above 100 degrees outside, workers should be required to rest at least 20 minutes out of every hour, and ideally inside. As temperatures climb, rest periods should be lengthened and workers monitored to ensure they are getting enough downtime.
  3. Dress codes that emphasize heat regulation – Impaired heat loss mechanisms are a key cause of heatstroke, but this can be addressed to an extent by promoting a safe dress code. This should include light fitting clothes that allow for better ventilation, lightly colored clothing that does not absorb as much sunlight and wider brimmed hats that block sunlight from reaching the face and neck.
  4. Ready access to rehydrating fluids – Dehydration is a ubiquitous feature of heatstroke, which suggests that many people who suffer from it did not hydrate adequately prior to symptoms. The problem is that most people don’t hydrate until they become thirsty, but thirst is an inadequate measure for determining when someone has lost too much fluid. For this reason, water or electrolyte drinks should be available at all times, and workers encouraged to rehydrate regularly, even when not thirsty.
  5. Carry helpful temperature indicators like heat cards – Heat cards equipped with liquid crystal thermometers (also called thermochromic liquids) are easily portable and can provide continuous monitoring of ambient temperature. With a heat card, safety personnel and workers know exactly when exterior temperatures are entering unsafe territory.

If worksites and sports teams rigorously apply these prevention methods, the chances of anyone suffering from heatstroke will be extremely low. However, if someone is suspected of experiencing heatstroke, treatment must be applied without hesitation. The goal of treatment is to reduce the patient’s core temperature to 102 degrees Fahrenheit as quickly as possible. At this temperature, the patient is unlikely to experience further damage due to heatstroke and is also unlikely to experience “rebound” hyperthermia.

There are two methods of treatment that are generally considered to be the most effective. They include:

  1. Ice water bath immersion – Full body ice water immersion is considered to be the fastest method of temperature reduction possible. Ice water is able to bring core temperature down to 102 degrees within 20-40 minutes, which is typically fast enough to guarantee a positive prognosis. The problem with ice water bath immersion is that it is particularly uncomfortable and possibly dangerous if the patient is unconscious, as they may slip below the water and drown. Close monitoring of the patient is therefore necessary.
  2. Evaporative heat loss methods – This involves spraying the patient with water and placing a high powered fan next to the patient to wick away excess heat. Water is capable of absorbing a lot of heat in a short amount of time, so constant reapplication of water can also reduce core temperatures in a hurry. Although it is completely safe to use in unconscious patients and generally makes it easier to resuscitate the patient, if need be, it is not as effective as ice bath immersion. However, evaporative heat loss is usually easier to execute, as an ice bath is not always a feasible option.

There are other methods of reducing temperatures, including delivery of intravenous cold fluids, gastric or rectal lavage and application of cold, wet towels. None of these rival ice water bath immersion or evaporative heat loss in terms of effectiveness.

Heatstroke can be a killer, and even when it doesn’t result in death, it can leave the sufferer in poor shape for the rest of their life. To guarantee the near and long-term safety of workers or athletes, safety personnel must take heatstroke seriously and avoid it at all costs.