Every year the start of summer football practices around the country is accompanied by horror stories of coaches forcing young athletes to practice in hot, humid conditions [1] without taking appropriate precautions against heat-related illness [2] and of the deaths of youth athletes from heat stroke.

According to the Annual Survey of Football Injury Research,  four or five players die every year from heat stroke.  Unfortunately, that proved true again last year, as at least five athletes and a coach (most in the South) died from heat-related illness in the summer of 2011.

To prevent heat illness (i.e. heat cramps, heat exhaustion, or heat stroke) during summer football practices, especially heat stroke deaths, it is important that your child's coach follow the following guidelines for summer football practices:

1. Limit practice duration. Summer football practices should be a maximum of three hours long for the first week (this is total length of practice, including warm-up and cool down periods), with the practice length increased gradually over a two-week period to allow players to become acclimatized to the heat [3] (remember, children adjust more slowly to exercising in the heat (a child may require five or six sessions to achieve the same degree of acclimatization acquired by an adult in two or three sessions in the same environment).
2. Conduct weigh-ins. Players should be weighed before and after football practices. Since the volume of sweat loss varies by child, this is the most accurate way to determine how much fluid an individual has lost during practice and needs to replace [4] (the general rule of thumb is to replace 150% of weight lost in fluids during the first two hours after sports and another 25% to 50% of the weight lost in the first 6 hours after sports to fully rehydrate.  
3. Allow lighter clothing. Studies have shown that football uniforms cause additional heat stress by decreasing dry heat loss by 42% and tripling the resistance to heat loss through evaporation similar to what an athlete would experience by wearing a heavy, three-piece men's business suit. During the first weeks of practice, players should therefore wear limited football practice gear (i.e. light-colored, lightweight cotton or mesh shorts with helmets and shoulder pads only, not full uniform). Athletes should be given a chance to remove their helmets whenever possible (e.g. during instruction, water and cool down breaks).  In addition, a 2008 study [5] funded by a grant from the National Football League suggests that blowing cool dry air underneath football shoulder pads during short rest periods and after practice is a useful additional preventative measure for football programs to consider in order to reduce the risk of heat-related illnesses in football players.  It  is not, however, a treatment for heat stroke.
4. Provide frequent fluid breaks. One of the keys to preventing dehydration [6], heat exhaustion and heat strokes is to provide players cool down and fluid breaks in a shaded area at least every thirty to forty-five minutes, or more frequently, depending on heat and humidity level [7]. Each athlete should drink at least the recommended minimum amount of fluids [8] before returning to practice. Sports (not "energy") drinks [9] are recommended instead of water because they replace electrolytes [10] lost in sweat and contain carbohydrates for energy, especially for athletes who perspire heavily (white rim on cap or armpit of shirt). Make sure the water does not come from a hose lying on the ground, as bacteria tend to breed in hoses. The water should also be free of lead. Fluids should never be restricted.
5. Provide shade and ice water bath.  If the field has no shaded areas, put up an EZ tent so players have a place to get out of the shade during their water breaks.  Fill a kiddie pool with water and ice, which athletes should walk through during breaks and after practice and in case of suspected heat stroke (see #6).
6. Monitor athletes closely. The staff, including the athletic trainer, should know and be on the lookout for signs and symptoms of heat stroke and heat exhaustion [11]. A buddy system should be used, with players monitoring each other.  If heat illness is suspected, the player should be immediately removed from practice. If heat stroke is suspected, ice-water or cold-water immersion is the definitive treatment [12], and, if not feasible, the athlete should immediately and continually be doused with water (either from a hose or multiple water containers), continually fanned and wet cold towels applied to the athlete's head and neck until immersive cooling can occur or emergency medical personnel arrive. [13]
7. Rehydration. After football practices, athletes should rehydrate to replace lost fluids. [10]

Domino effect

"Watching weight loss, not just after that day's practice, but on an ongoing basis, is also important," says Susan Yeargin, Ph.D., ATC, [14] an Assistant Professor Assistant Professor in the Physical Education and Athletic Training Department at the University of South Carolina and MomsTeam's heat illness and hydration expert. "If a player loses two pounds in a practice but only replaces one pound with fluids, he is essentially going into practice the next day 1 pound of fluid down.  In and of itself, this is not a big deal.  But if he loses another two pounds the next day in practice, he essentially is down three pounds in fluids, though a parent or coach using the pre-practice weight will only think he is down 2 pounds of fluid instead of three.  This can create a domino effect until the athlete is very dehydrated." 

Goal is no heat stroke deaths

Making sure that coaches follow these guidelines could go a long way towards achieving MomsTeam's goal of going through an entire summer with no heat-related deaths during high school and youth football practice. 

For the NATA guidelines for pre-season acclimatization to the heat, click here [3].

For guidelines issued by the Tennessee Secondary School Athletic Association on cancelling or modifying practices depending on the heat index [7], click here [15].

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Adapted from "Preseason Football Practice Guidelines" in the book Home Team Advantage: The Critical Role of Mothers in Youth Sports [16] (HarperCollins 2006) by Brooke de Lench, founder and editor-in-chief of MomsTeam.com.

References:

1. Youth Football: Heat Stress and Injury Risk; American College of Sports Medicine, Roundtable Consensus Statement; Medicine & Science in Sports & Exercise 37, no 8 (August 2005): 1421-1430.
2. Pre-Season Heat-Acclimitization Guidelines for Secondary School Athletics, Journal of Athletic Training (June 2009); 332-333. [3]
3. Prevention of Heat Illness, NCAA 2008-2009 Sports Medicine Handbook, pp. 30-32.
4. Guide to Heat and Dehydration Injury Prevention [17], Maryland Sports Injury Center.

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Revised and updated June 30, 2012

For more tips on how parents and coaches can prevent heat stroke, click here [18]