On a 100-plus-degree day, the sweat is dripping down the face of the football players. The heat and humidity has worked on them through the drills and the runs. Their feet feel hot with the reflections coming up off the turf. The water breaks help, but some still vomit. One takes a knee and in moments shuts down.
Sometime in the next month, someone will die. As NFL camps open, followed by college, high school and youth practices, the temperatures will often creep above 100 degrees, with humidity and equipment adding to the issue. Despite nearly universal awareness, the problem still exists and the downside isn't a strained muscle or a missed game, but death.
In the last five years, 18 players around the country have died—the highest level since these statistics were collected. Even one is too many, but the increase is terrible. The problem is much more widespread than most imagine. Over 9,000 athletes were treated for heat illness symptoms in 2010, according to the Centers for Disease Control and Prevention, and 75 percent of those were football players.
Heat illness is still poorly understood, but the management of conditions like this makes it a fixable issue. For less than $20, a team could have the materials needed to keep an athlete from significant problems due to heat illness, including brain damage and death. While some programs are beginning to use ice baths for competitive and recovery reasons, they could be lifesavers.
The National Athletic Trainers' Association (NATA), along with the Korey Stringer Institute at the University of Connecticut, has instituted new guidelines for dealing with heat illness. In a position statement released at its national convention, the organization is calling for changes in how heat illness is managed in athletic settings, though the standards do work for any situation, including youth football settings that are unstructured.
Dr. Douglas Casa, the director of the Korey Stringer Institute and considered the leading expert on heat illness, told me that there is no real cost to implementing the protocols in the new guidelines. "There's nothing controversial. We're talking about common sense. Acclimatization, cooling, hydration and being a little flexible with scheduling and activities. We have to remember that these are largely preventable with easy steps and a plan of action in the event something does happen."
One key component to managing heat illness happens before the players get out on a hot field. NATA has called for structured acclimatization for athletes. Simply put, players have to be eased into activity in the heat. Those first days of practice are the most dangerous, especially for players who are unaccustomed to activity or who have fallen out of conditioning. Most schools do this, but far too many don't have a structured plan or use "conditioning tests" as a manhood check—not a true functional test.
The simplest answer to heat illness is as simple as a kiddie pool. While there are specialized devices and containers available, having a simple container like a kiddie pool or large plastic container available with adequate ice could save a life. I went to Home Depot to check the prices and found several that retail for under $20.
Once an athlete's core temperature rises above 105 degrees, the key is to cool them as rapidly as possible. The best method for this is an ice bath. A player can be put into any container and covered in ice and water to rapidly cool them. If ice is not available, water works, but having several bags of ice handy is not expensive for any team.
In a situation a few years ago at an Indianapolis high school, an athlete was saved by the quick action of Betsy Bradley, an athletic trainer from St. Vincent Sports Performance. An ice bath dropped his temperature quickly, and he showed no consequences just a few days later. I met the young man just a week after the incident and he missed no time, showed no consequences and was walking around like any normal teenager would. I'm not sure he even understood how close he came to death.
One element of the new position statement that could create some controversy is the focus on reducing the temperature over transporting the athlete. Dr. Casa and others say that it is more important to get the body temperature down rapidly, rather than allowing the athlete to go in an ambulance. "They can't cool him in there, and it's more important to get the temperature down rapidly," explained Dr. Casa.
Another study funded by NATA showed that heat index, calculated by the National Weather Service, is as accurate as specialized wet bulb devices that can cost hundreds, even thousands of dollars. Sometimes called the misery index, this simple "feels like" number can be accurately used to adjust practices. Not wearing full pads, not going at full speed or even canceling practice if the temperature is too hot simply makes sense, though coaches resist this.
Another key to preventing heat illness is the presence of an athletic trainer. Less than half of high schools will have one at all their practices, and the number is significantly less at lower levels. Still, managing heat illness with ice immersion is not something that requires training. "When in doubt, ice 'em out" is a good mantra.
NATA's position paper still calls for a core temperature to be taken rectally. While this is clearly the most accurate way to do it, it's still uncomfortable to ask a coach or non-medical personnel to perform this. Even the embarrassment factor may make a coach reluctant. While I understand why the position is written this way, I feel that it's more important to cool immediately and hand off to qualified professionals.
NATA is looking into high-tech solutions, such as cool shirts and hand-cooling devices. (Interestingly, a study done on hand cooling by the Denver Broncos showed promise in the technique.) However, the last thing any program needs is a big expense. The easiest solution in this case is also the cheapest: ice and a place to dump it.
It's clear that with the ease the problem could be addressed, the low cost and the exceptional results, every team at every level should follow this immediately. However, some won't, which will lead to more deaths and perhaps significant lawsuits, like these filed against high schools. It would be smarter to just switch now.
We've come a long way from the Junction Boys and withholding water breaks, but we also have to remain vigilant. At the Minnesota Vikings training camp in 2001, with medical staff available, the late Korey Stringer found himself in a terrible situation and lost his life. Perhaps his memory and the work of the institute bearing his name will make it possible to save other athletes from the same fate.
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