Duties of Administrators Regarding Heat Illness

By Jon Almquist

TURN UP THE HEAT

Playing sports when the thermometer approaches triple digits, or even the 80s or 90s, can place a student-athlete at risk of suffering heat-related illnesses such as heat exhaustion or heat stroke. The higher the humidity, the lesser impact evaporation (sweat) has on cooling and, thus, the higher heat stress to an athlete. School districts that leave the decision to play when the heat stress index approaches the risky range in the hands of the individual coaches are at risk for criticism, and in a worst-case scenario, a lawsuit. The development of a Participation in Heat Protocol, based on scientifically sound information, will provide a consistent and defensible approach to minimize risk to student-athletes when competing and practicing in the heat.

Developing the Protocol

The development team should consist of representative coaches from the sports impacted by the protocol as well as a medical professional, such as the certified athletic trainer, and athletic administrators. To help the group stay focused and on track, the mission of the team should be discussed and agreed upon early in the process. When creating the policy, the development team should review the most recent scientific studies available as well as the protocols used by surrounding school districts or other prominent forward-thinking programs.

Accountability

A policy or protocol is only as good as the rules that support it.  Having a policy in place that is not followed by the coaches can be considered negligence on the part of the coach, or negligence on the part of the school for not enforcing the rules. Coaches, athletes and parents are more likely to buy into a policy when policies are consistent within a certain geographical area.

Education

Education is the most beneficial intervention a school can implement. Everyone involved in the athletic program, including the athletes, parents, coaches and officials, should be educated in the prevention strategies and signs and symptoms of heat illness. Catastrophic consequences from heat illness are often avoidable. Recognizing the signs and symptoms of heat illness AND immediately implementing the appropriate intervention are two critical components to maintaining a safe environment and are critical components of a policy. Education of coaches and athletes to proper fluid replacement practices is essential to maintain a "heat healthy team," and is also a vital component of preventing heat illness.

Prevention Strategies

Limiting the amount of exercise during high heat stress times will help in the prevention of a heat-related illness. Restriction of sports equipment that prevents heat loss such as helmets and shoulder pads can prevent heat illness and still allow some activity to take place. An example of a progressive restriction of activity and equipment is available in Appendix 1.

Determine a method to assess the heat stress in your system.  Most scientific documents use the wet bulb globe temperature (WBGT) as an indicator of heat stress. This method requires use of a fairly expensive apparatus that calculates the heat stress based on the ambient (dry) temperature, wet bulb temperature and radiant heat. Another method commonly used is the wet bulb temperature (WBT), which takes into consideration the cooling effect evaporation has at a given ambient temperature and the humidity level. A third method is using a heat stress chart, which uses the ambient temperature and humidity to determine a heat stress value. Each of the methods will provide a different number associated with the heat stress value, so your protocol should choose a method and craft the restrictions based on that heat stress value. 

Emergency Action Plan

Development of an Emergency Action Plan specific to the topic of heat illness is important to ensure that a rapid and appropriate response is provided to any athlete, coach or official with signs and symptoms of heat illness. Immediate cooling is the key to proper care. If an athlete has any sign or symptom of heat illness, immediate removal of any equipment and immediate cooling should reverse the symptoms quickly. If symptoms don't resolve quickly, EMS should be activated and aggressive cooling efforts should be continued. Mechanisms to provide immediate cooling for overheated athletes, such as ice towels, cooling tub, electric fans and coolers of cold water, should all be identified in the emergency action plan. Protocols to follow regarding EMS activation, providing access for the ambulance to reach the athletic fields, and emergency contact information for athletes' parents are all components to include in an Emergency Action Plan.

Other Considerations

A heat protocol should also address the return to participation after someone suffers a heat-related incident. Supplements and medications can also make an athlete more susceptible to a heat illness. Education regarding supplements and general nutrition to athletes as well as the awareness by staff of the medications students may be taking are also important aspects to consider.  Schools in suburban and urban areas may also be faced with air quality indexes (smog and ozone) that may impact an athlete's ability to accommodate heat stress during exercise. 

Conclusion

If you are developing a heat policy, or revising an existing one, it is essential that the most recent scientific evidence is used as a reference. It is also important to include appropriate personnel to craft a policy that can be approved by the school district administration. Inform, implement and enforce the policy with consistency under all circumstances. 

Additional Resources:

National Federation of State High School Associations - Sports Medicine Web site http://www.nfhs.org/web/2006/08/sports_medicine.aspx
Gatorade Sports Science Institute - www.gssiweb.com
Gatorade - www.gatorade.com/hydration/
ZUNIS - www.zunis.org
National Athletic Trainers Association - www.nata.org/statements/
Virginia High School League - http://www.vhsl.org/medicine.htm

Jon Almquist is a certified athletic trainer and is the athletic training program administrator for the Fairfax County Public Schools in Falls Church, Virginia.