In 2012 Georgia became the sixth state to adopt pre-season heat-acclimatization guidelines to reduce the risk of exertional heat stroke among high school athletes.
In adopting key recommendations from a 2009 position statement from the National Athletic Trainers Association and Korey Stringer Institute, the Georgia High School Association joined Arkansas, Connecticut, New Jersey, Texas and North Carolina. Since then, however, only Arizona, Florida and Iowa have adopted all seven of the heat guidelines.
"Exertional heat illness deaths are preventable with proper acclimatization of the athlete, recognition of the condition and immediate and rapid cooling when heat stroke occurs," said NATA President Marjorie J. Albohm, MS, ATC in announcing Georgia's action. "We are pleased to see that states across the country are reviewing these important guidelines and we will continue to work with high school associations and other groups to encourage adoption of this vital information."
"These guidelines are critical to the safety of young athletes at any level of play," added consensus statement task force co-chair and University of Connecticut's Korey Stringer Institute Chief Operating Officer Douglas J. Casa, PhD, ATC. "Allowing the body to gradually adjust to temperature and level of physical activity will result in improved performance and reduced risk of injury."
"The Georgia High School Association is committed to protecting the health and safety of its student athletes," added Executive Director Ralph Swearngin, who oversaw the passage of the recommendations at the GHSA board meeting. "We know that the biggest risk for heat illness is during the first two weeks of practice and that it is essential to establish guidelines that allow for gradual acclimatization of the student athlete to the environment and physical activity."
"The NFL and NCAA already have instituted pre-season guidelines for acclimatization and the policy changes have been well accepted by coaches and athletes alike," said Ferrara. "Our previous research also shows the heat illness rates are highest in the southeast."
The Georgia State Association's guidelines will now:
- Require that the first five days of practice be single sessions with a maximum length of two hours during which athletes will only be permitted to wear shorts, helmet, mouthpiece, and shoes;
- Allow teams to conduct two-a-day practices in the second week (and only after August 1, 2012), but prohibit double sessions on back-to-back days;
- Permit athletes to wear full equipment during practice sessions in the second week;
- Mandate at least a three hour rest period between sessions on a double session day;
- Limit total practice time during double session days to five hours of practice time.
- Modify equipment and work/rest ratios as heat stress increases:
- When Wet Bulb Globe Temperature (WBGT) reading is under 82: Normal activities but at least three separate rest breaks (involving both unlimited hydration intake, e.g. water or sports drinks, and rest (football helmet removed) in a "cooling zone" out of direct sunlight each hour of minimum duration of 3 minutes each during workout;
- For WBGT reading between 82.0 and 86.9: Use discretion for intense or prolonged exercise; watch at-risk players carefully; Provide at least three separate rest breaks each hour of a minimum of 4 minutes duration each [Note: if WBGT reading over 86, ice towels and spray bottles filled with ice water should be available at the "cooling zone" and cold immersion tubs must be available for practices for the benefit of any player showing early signs of heat illness];
- For WBGT reading between 87.0 and 89.9: Maximum practice time is two hours. For football: players restricted to helmet, shoulder pads, and shorts during practice. All protective equipment must be removed for conditioning activities. For all sports: Provide at least four separate rest breaks each hour of a mininum of 4 minutes each;
- For WBGT reading between 90.0 and 92.0: Maximum practice length is one hour; no protective equipment may be worn during practice and there may be no conditioning activities. There must be 20 minutes of rest breaks provided during the hour of practice.
- For WGGT reading over 92: No outdoor workouts; cancel exercise; delay practices until a cooler WBGT reading occurs.
Significantly, violations of the Georgia heat policy could result in fines imposed on the offending school of a minimum of $500.00 and a maximum of $1,000.00.
Based on UGA study
The new rules come after a three-year study at the University of Georgia three-year study that looked at the rate of exertional heat illnesses in 25 high schools throughout the state directed by Michael S. Ferrara, PhD, ATC, associate dean of research at UGA and Bud Cooper, EdD, ATC, CSCS, associate head, Department of Kinesiology.
The researchers used the Wet Bulb Globe Temperature (WBGT) Index, which measures air temperature, humidity and radiant temperature on a scale broken into categories on how to modify activity. Results showed that there is an increase in the number of exertional heat injuries when the WBGT reaches about 82 degrees.
Based on their findings, the scale was modified to include an increase in rest breaks, hydration periods, equipment modifications and duration of practice as heat stress rises.
The study was funded in part by the Georgia High School Association (GHSA), Georgia Athletic Trainers' Association, National Federation of State High School Associations Foundation and NATA Research & Education Foundation, and led the GHSA to consider the NATA task force guidelines. It was initially presented at the NATA Annual Meeting in June 2011 and to the GHSA football rules subcommittee in January 2012.
The GHSA previously had a policy that every school was required to monitor the environment, but there was no guideline as to the type of device used to measure weather conditions, the length of practice duration or the number of practice sessions. In addition there were no guidelines dictating these items as they relate to acclimatization or heat stress.
"We wanted to develop a policy that would be practical and allow student athletes exposure to the environmental conditions but be as safe as possible," said Swearngin. "We are confident that we are taking the right steps and passing the right measures to provide the best care for our young athletes."
"This provides schools, medical staff and
coaches with flexibility in designing their practice to be as safe as
possible," added Cooper.
"Putting these protocols into place is vital to the continued well-being of student athletes in Georgia and across the country," said Albohm. "We know there is still much work ahead to ensure all states have appropriate guidelines and sports safety legislation."
For state-by-state information on the adoption of the heat guidelines, click here.
Sources: National Athletic Trainers' Association, Korey Stringer Institute.
Posted March 22, 2012; most recently revised May 2, 2013