Heat Illness Prevention – Keep the Marching Band Playing

Around the country, August signals the return of football players to the field, excited to start a new season. And as they are practicing on their field, the sounds of the high school marching band can be heard echoing through the community.

August is also the hottest month of the year for most of the United States, and with that comes the need for heat illness awareness. While many policies exist to protect athletes from the effects of the heat, few people understand the training and physical exertion required to participate in marching band. Consequently, participants in marching band are often not afforded the same protections despite practicing their art under often harsher conditions. They are mastering the movements of the choreography, learning their marching steps and placement drills, while playing their instrument and perfecting the season’s marching band show.

Like participation in sports, the marching band develops skills such as leadership, discipline and self-esteem as well as teaching teamwork and time management. These benefits are the result of many hours of practice, dedication and skill, mirroring what is happening on the football field.

Participants in marching bands spend hours practicing and perfecting their art outdoors; however, unlike a football team, few states have limitations on how long a marching band can rehearse. A full day of practice with few breaks is the norm while temperatures soar into the 80s, 90s and over 100 degrees.

Marching bands will rehearse on several different surfaces and the type of surface dramatically influences the heat stresses the body must manage. For example, on a 90-degree day, grassy areas will mimic the ambient temperature while the temperature in a shaded grassy area can be as low as 78 degrees F. Conversely, surface temperatures on a concrete parking lot can reach 135 degrees F and an asphalt surface can reach 145 degrees F.

There are underlying medical conditions, such as obesity or medications, that can also increase one’s risk for succumbing to the effects of heat. Athletes in all states undergo a pre-participation physical exam to identify medical conditions that can limit participation in activity. States such as Texas and Oklahoma have started to require pre-participation physical evaluations (PPE) for marching band participants as well, realizing that the physical demands and environmental conditions of these students are similar to those experienced by athletes. This evaluation underscores the importance of identifying risk factors for heat stress in these participants.

The marching band uniform often consists of a jacket, a shirt or a blouse, pants or a bib, and a shako (hat). These are often made of a cotton/polyester blend or wool. Polyester in not breathable and instead traps the heat, increasing the temperature the participant feels. Wool is a heavy heat-trapping material that can also rapidly increase body heat. Given that up to 10 percent of your body heat can be lost through your head, the shakos that musicians wear limits heat loss and, both the outfit and the hat, increases the risk of heat illness.

These musicians skillfully balance their instruments while performing. An average bass drum weighs between 15 and 40 pounds, the tuba weighs 25-35 pounds, while the tenor drums weigh 35 pounds. It takes a lot of strength and skill, as well as stamina to carry these instruments for extended periods of time.

In 2021, a study done by the University of Georgia looked at news reports of heat illness among marching band participants. The study found between 1990 and 2020 nearly 400 participants became ill due to heat exposure and 44 percent required hospital treatment. As only a percentage of cases are reported by the media, this likely represents the tip of the iceberg with the true number being much higher.1

Other studies have shown results also worth mentioning:

1. The patterns of injuries are similar between athletes and marching band members. Specifically, there are similar rates of upper extremity injuries, higher rates of lower extremity and general health conditions among marching band participants, and higher rates of other musculoskeletal injuries among athletes.2,3

2. Musculoskeletal injures are common, often involving the lower extremities though upper body torsion and biomechanical stress can lead to upper body and back injuries.4

3. Other injuries include skin problems and gastrointestinal complaints.4

4. In one study, when using water bottle belts and encouraging hydration (8-16 ounces of water before practice, 4-8 ounces every 15 minutes during practice, and 16-32 ounces after practice), there were fewer symptoms of heat-induced illness, the marching band participants were better able to concentrate, the directors reported more productive rehearsals, and there were no calls to summon EMS.5

5. Marching band participants experience core temperatures similar to those among collegiate and professional football players. Heat stress is under-recognized in marching band, but it should be recognized that these participants exert themselves in a hot, humid environment for several hours a day on surfaces that radiate heat.6

The NATA provides the following practical tips to students, parents and marching band leadership:

1. The participants should have a general health exam prior to the start of the activity season.

2. As in sports, all marching bands should have an emergency action plan that is well rehearsed.

3. A progressive increase in activity, such as an acclimatization protocol, should be created, and should start four weeks before the start of the season with 20-minute walks, gradually increasing in time and distance.

4. Acclimatization should also gradually start mimicking the conditions of actual performance – moving outside to the heat and on the surface the students will be marching on.

5. Safety protocols should also include plans to be alerted when lightning is near. The lightning policy should prescribe where to move if lightning or thunder is seen or heard. For example, the guideline “When thunder roars, go indoors” should instruct participants where to go and a person should be identified to keep time. Participants should not be allowed to return outside until 30 minutes after the last clap of thunder or flash of lightning.

6. Wearing light-colored and lightweight clothing reserving dress rehearsals in full attire for cooler days.

7. Hydration is the mainstay of treatment to temper the effects of the heat on the body. Hydrating before and after practice as well as allowing water breaks during activity is a best practice and should be encouraged.

See more advice and details.

It is important that school administrators understand that participants in the marching band undergo vigorous physical activity under stressful conditions. Consequently, music directors should have the same level of training when it comes to recognizing the signs of heat stress on their students, and should be provided with the same health and safety resources as the more traditional athletes.

The NFHS Band Safety Course offers some guidance for schools.

References:

1. Merchant RK, Grundstein A, Yeargin S, Emerson D. Exertional heat illnesses in marching band artists: a case series. Int J Biometeorol 2021;65:2181-8.

2. Mehler AS, Brink DS, Eickmeier KM, Hesse DF, McGuire JW. Marching band injuries. A one-season survey of the University of Michigan Marching Band. J Am Podiatr Med Assoc 1996;86:407-13.

3. Acosta R, Rortvedt R, Ruhde K, Braun S, Stow RC. Self-Reported Injuries and Illnesses in DIII Marching Band Members (Poster at Student Research Day/ UWEC Office of Research and Sponsored Programs). MINDS@UW 2021; http://digital.library.wisc.edu/1793/82411.

4. Kilanowski JF. Marching athletes: injuries and illnesses at band camp. MCN Am J Matern Child Nurs 2008;33:338-45; quiz 46-7.

5. Vepraskas C. Beat the heat: managing heat and hydration in marching band. J Sch Nurs 2002;18:237-43.

6. Emerson DM, Torres-McGehee TM, Yeargin SW, et al. Collegiate Marching Band Artists Experience High Core Body Temperatures during Rehearsals and Performances. J Athl Train 2020;2020:0.

7. NATA Offers TImely Recommendations to Keep Marching Band Members Healthy and Well Prepared for Activity. at https://www.nata.org/NR08182017-1.