Protecting Young Athletes

What should coaches, players and parents know about heat stroke?

heat illness athletes

Five Figures to Consider

9,000 student athletes are treated for sports-related exertional heat illness annually
11.4 times higher incidence of heat illness in football versus other sports
100% of heat stroke deaths are preventable
12 states require cooling tubs at high school football practices
6 states require high school athletic departments to stock heat stress monitors

Cross country runner Jaci Teahon, a high school junior from Nebraska, took a month to recover. Johnny Tolbert, a 12-year-old from Georgia, wasn’t so lucky; he suffered permanent brain damage. James Wooden of Barnwell, SC, a 6’ 5”,16-year-old football player, never made it home. All three were athletes. Young. Healthy. And competing or practicing in scorching heat. As Sirius, the dog star, ushers in the dog days of summer when it rises with the morning sun, it also heralds the start of pre-season sports practice for many student athletes. Temperatures can approach or surpass triple digits. The result? Hot and humid days that can lead to sports-related exertional heat illness — the third leading cause of sudden death among student athletes. Over 9,000 students are treated for heat illness annually. As extreme heat becomes more common and the push to exceed in sports more prevalent, can measures be taken to prevent fatalities?


While the incidence of sports-related exertional heat illness is about 11.4 times higher among football players than other athletes, it does occur in all sports (even swimming) and in all areas of the country (especially in August). The good news? It’s 100% survivable when it’s recognized and cooling begins within 10 minutes of collapse, according to the University of Connecticut’s Korey Stringer Institute. (The organization is named for the Minnesota Vikings player who died from heat stroke during training camp in 2001.) Unfortunately, medical professionals aren’t usually hanging around high school playing fields (just 33% of the time in fact), so athletes, coaches and parents need to know how to identify and respond to heat-related illness when they see it.


Mainly caused by dehydration, heat illness comes on rapidly. Some of the first warning signs are cramps, rashes, nausea, headache, thirst and dark urine. In most cases resting in a cool place, loosening clothing, drinking fluids and dousing the body with moist or iced towels is enough to help athletes return to normal. But if left untreated, symptoms become more severe (vomiting, goosebumps, dizziness or fainting, a racing heart), and heat exhaustion can set in. That can quickly morph into exertional heat stroke (EHS). Athletes may appear confused, agitated, have slurred speech or convulsions and finally lose consciousness. In half of cases athletes stop sweating as the body reserves fluids, and skin becomes red and dry. EHS is diagnosed when the core body temperature is more than 104 degrees Fahrenheit (rectal temperature is the only accurate measure.) Fast treatment is critical. If an athlete’s body temperature can be brought below 102 degrees Fahrenheit within 30 minutes, he or she should completely recover. If not, as the body struggles to cool itself it will increase blood flow to the skin putting a strain on the heart and causing oxygen-deprived internal organs, cells and nerves to swell. The brain, which is mainly comprised of nerve cells, is particularly vulnerable. The result can be cognitive, kidney or liver damage, even death.


The most effective treatment for EHS is whole-body, cold water immersion. Rather than waste critical time waiting for an ambulance, an athlete should immediately be eased into a tub of ice-cold water from the neck down, and then 911 should be called. Only when their body temperature drops to below 102 should an athlete be taken to the hospital — “cool first, transport second”.  However, just 12 states require athletic departments, specifically football programs, to have onsite cooling tubs. Ideally, cooling tubs should be brought to the field half-filled with water and a complete top cover of ice (four additional coolers of ice and water should be at the ready to supplement). If that is not feasible, then a portable cooler filled with ice, water and twelve towels is a start. Coaches can limit the chances of athletes getting heat stroke by investing in a heat stress monitor, which is required of high schools in just six states. The best monitors measure the Wet Bulb Globe Temperature (WBGT)  — a more sophisticated heat stress measure than the heat index — which gives coaches real-time field conditions to determine whether it is safe to hold practice. The measurement takes into account temperature, humidity, wind speed, sun angle and cloud cover. A reading over 92.1 is considered dangerous for outdoor sports practice.


A new ranking of states (developed by the  Korey Stringer Institute) by their heat safety measures for youth – which considers factors like presence of a cooling tub, a heat stress monitor, hydration and acclimatization plans – shows that 36 states received less than half the available points. One reason could be that while the National Collegiate Athletic Association bans two-a-day summer practices and the National Football League bans them before the fourth day of training, many high school athletes still face the risks associated with two-a-day practices in the hottest weather. Guidelines vary according to each state’s athletic association. The National Association of Athletic Trainers (NAAT) and Inter-Association Task Force for Preseason Secondary School Athletics (IPSSA) recommend school districts implement a pre-season heat acclimatization policy whereby coaches ease athletes into summer workouts over a 14-day period by limiting overall outdoor practice time on hot days and the use of full protective gear, while providing three hours of air-conditioned breaks when two practices are held in the same day. Currently, there is no enforcement of recommendations. Additionally, both the NAAT and IPSSA have a big loophole in their recommendations by leaving heat safety procedures for practices that fall outside of summer preseason up to county school districts.


It is important to remember that even well-conditioned, healthy-looking athletes like Jaci, Johnny and James can succumb to EHS. (Yet, there are some risk factors including having a high body mass, little sleep, recent sickness, being ultra-competitive or a having a prior heat injury.) With the frequency of very hot days – over 90 degrees – expected to significantly increase in the next decade, risk prevention is vital.


No sports trophy is worth a life. Organizations that represent high school athletes should consider requiring cooling tubs, heat stress monitors and adopting the NCAA’s complete ban on two-a-day practices in hot summer months. Simple precautions can save lives.

Sources, Interassociaton Task Force for Preseason Secondary School Athletics, Korey Stringer Institute, Mayo Clinic, National Athletic Trainers Association, National Collegiate Athletic Association, National Institute of Health