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Preventing Heat Illness During Summer Football Practice

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 without taking appropriate precautions against heat-related illness and of the deaths of youth athletes from heat stroke (According to the Annual Survey of Football Injury Research, 29 high school football players have died from heat-related causes since 1995, with about four or five players dying every year).

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:

Read more: http://www.momsteam.com/sports/football-tackle/safety/preventing-heat-illness-during-summer-football-practice#ixzz0vNEAPtei

Every year the start of summer football practices around the country is accompanied by stories of young
athletes practicing in hot, humid conditions without taking appropriate precautions against heat-related illness
and of the deaths of youth athletes from heat stroke. According to the Annual Survey of Football Injury
Research, 29 high school football players have died from heat-related causes since 1995, with about four or five
reported players dying every year. Now, thanks to technology coaches, parents, athletic trainers and athletes have two ways to get some help
monitoring the risk of heat-related illness and hydration status. One is worn as a watch and is a full-functioning
stopwatch with a programmable heat index alarm which also displays the temperature and humidity. It is called
the HeatWatch by Extech and sells for around $49.00

The other is an iPhone and iPod app called iHydrate ™. The iHydrate™ app:
• Provides the apparent temperature on the basis of the current temperature and relative humidity at the
user’s current location;
• Displays the level of heat-illness risk under the National Oceanic and Atmospheric Administration
(NOAA) heat index;
• Allows parents, coaches and athletic trainers to schedule hydration reminders for before, during and after
sports; and helps facilitate the replacement of fluids lost during sports based on urine color and/or amount of weight
lost.
In addition to these tools, iHydrate™ includes a helpful reference section, including basic information on
dehydration and heat-illness prevention, signs, symptoms and treatment, and the Pre-Season Heat-
Acclimatization Guidelines recently issued by the American College of Sports Medicine and seven other
medical groups.
In the interest of full disclosure, I and a number of experts at YouthSportsParents.com (formerly
MomsTeam.com) researched and developed this app to specifications on our wish list of functions needed to
monitor the hydration needs of athletes. The app sells for $3.99 through itunes or is able to be down loaded
through the app store. If you are a coach using an iphone or ipod we will send a free promo code to the first ten
coaches who reply to my email.
In the meantime 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 guidelines issued
by the American College of Sports Medicine for summer football practices:
1. Limited 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
(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. 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 (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. 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).
4. Frequent fluid breaks. One of the keys to preventing dehydration, 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 . Each athlete should drink at least the
recommended minimum amount of fluids before returning to practice. Sports (not "energy") drinks are
recommended instead of water because they replace electrolytes lost in sweat and contain carbohydrates
for energy. 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. Close Monitoring. The staff, including the athletic trainer, should know and be on the lookout for signs
and symptoms of heat stroke and heat exhaustion. 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, 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.
6. Rehydration. After football practices, athletes should be required to rehydrate to replace lost fluids
In addition, a new 2008 study 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.
Making sure that coaches follow these guidelines could go a long way towards achieving YouthSportsParent's
goal of going through an entire summer with no heat-related deaths during high school and youth football
practice.
For a new set of guidelines for pre-season acclimatization to the heat visit the Hydration Safety channel at
http://www.youthsportscoaches.com/ health-safety/hydration-safety

Gatorade Coach's Library The following list contains links to the most accurate and up to date information about hydration from the experts at Gatorade. Keep Your Motor Running: Fuel Before and After Competition Hydration: Critical to Athletic Performance Heat Illness: Staying Cool on the Inside Heat Illness Prevention Tips Football Coaches' Guide to Heat Illness and Hydration Refueling for Stop-and-Go-Sports Strength and Conditioning Programs: Answers From the Experts The Right Way to Play - Injury Prevention Tips Taking it to the Next Level Communicating with the Athlete and Their Readiness to Change Strength Training for Young Athletes First-Class Fuels Traits of Successful Coaching Motivating Young Athletes Building Teamwork Making Youth Sports Safe and Enjoyable

Most athletes drink less fluid during exercise than they lose as sweat, that is, they become dehydrated. Severe dehydration can even be life threatening.
Even a small degree of dehydration can lead to diminished performance in sports. Why don't we drink enough during exercise to replace our body fluids? For one thing, drinking during exercise can be a bit awkward, and in some events drinks are not readily available. Moreover, as soon as the first sips of a beverage moisten our mouths, nerves in the mouth send signals to the brain to reduce our sense of thirst. Also, large volumes of fluids in the stomach lead to discomfort, especially during running events. Finally, we may not drink enough simply because we don't like the taste of the available beverages.
Here are some ideas that can help you improve your fluid intake during exercise:

Determine your typical "fluid shortfall" during exercise by measuring your body weight before and after practices and competitions with your normal fluid intake. (Measure your fluid intake, too). For each pound of weight you lose during the exercise period, your fluid shortfall is about 16 oz. For
example, if you lose three pounds during a two-hour training run, you have sweated away 3 lb. x 16= 48 oz. more of fluid than you have consumed.
Your body can adapt to increased fluid intake, so during future training sessions, gradually increase your fluid intake-even when you don't feel thirsty-until you can replace at least 80% of your sweat losses during the exercise. In the example above, this means that you would need to increase your drinking during exercise by 0.80 x 48 oz. = 38.4 oz. (If you can replace your entire fluid shortfall, that's even better, but don't drink so much fluid that you gain weight during the exercise.) Use an alarm wristwatch or some other method to remind you when it's time to take a drink.
Ask athletic trainers, teammates, or friends to have drinks available at appropriate places and times during training and competition.
Experiment with different beverage containers to determine which one makes it easiest for you to drink while exercising. Some athletes may do better with a squeeze bottle, others with a widemouth bottle. Drink smaller volumes more frequently (every 15-20 min) to minimize stomach discomfort.
Choose a beverage that tastes good and contains carbohydrate plus a small amount of sodium chloride. The carbohydrate can help improve performance, and the sodium is important to minimize dehydration and maintain body sodium balance.

Marshall Steele, orthopedic surgeon, author of Sideline Help and member of USA Football's health & safety committee, offers his advice on avoiding heat exhaustion.  Steele notes that prevention is a key factor. "Heat stroke and heat exhaustion are preventable," said Steele."Heat emergencies usually occur under conditions of extreme heat and humidity, so overweight, unconditioned, or overdressed players are at high risk, especially during preseason training. Coaches must allow players frequent water breaks."

Dr. Steele's Quick Tips for Avoiding Heat Stroke:

• Because the sensation of being thirsty lags behind the body's actual physical need for water,
• encourage players to drink even when they are not thirsty.
• Do not allow players to take salt tablets. Instead, provide them with electrolyte sports drinks.
• A player who develops cramps, weakness, fatigue, and nausea is exhibiting signs of heat exhaustion (a precursor to heat stroke) and should be made to rest in the shade and drink fluids to cool off.
• Remember, the player may have been sweating, so his or her skin may at first seem wet or clammyrather than dry.
• When treating a heat stroke victim for shock, keep the player cool rather than warm.

American College of Sports Medicine Calls for Caution in Preseason Practice. The American College of Sports Medicine (ACSM) re-issued its call for major caution in preseason practice and training for high school players during hot summer days.  ACSM emphasizes high heat and humidity represents a significant danger for heat illnesses and heat stroke
unless precautions are taken and guidelines are followed.  ACSM recommends fluid replacement and acclimatization to the heat, as well as practice uniform and other modifications in order to reduce the risk for heat exhaustion and exertional heat stroke in young football
players.  Severe incidents from heat-related complications are notoriously problematic for young football players, particularly during preseason practices. The overwhelming majority of serious heat illnesses occur in the first four days of preseason football practice (especially on the first and second days), when players are not acclimatized to the heat, the intensity/duration of practice, or the uniform.  "The primary reasons for a football player to overheat on the field are intensity and duration of practice, the environment, and the uniform," said Michael F. Bergeron, Ph.D., FACSM. "There's also a variety of problems that a football player can have related to sweat losses and consequent fluid and electrolyte
deficits. That can range from feeling a little 'off,' to not performing well, to heat cramps or heat exhaustion— or if it were unattended, even heat stroke. If a player's body temperature reaches a certain threshold and they no longer have the capacity to regulate temperature, it can run away from them and readily lead to death."

Among its recommendations, ACSM guidelines suggest high school football players and their parents be
aware and understand the impact of HEAT:

• Hydration
• Environmental Conditions
• Acclimatization
• Treatment

Hydration
Large sweat losses, insufficient water intake and consequent fluid deficits increase the risk of hyperthermia and heat injury. Players should begin practice well hydrated, well rested and well nourished, with a normal resting body temperature. Every practice should include regular water
breaks designed to replace the majority of sweat loss at least every 30 to 45 minutes. Breaks should be more frequent as heat and humidity rise.
Water should be chilled and easily accessible. Players should use shade whenever possible.  Body weight measurements should be taken before and after practice to help determine the amount of fluid that needs to be replaced. For recovery, sports drinks have an advantage over
water, as they replace electrolytes such as sodium (which is lost in sweat), as well as carbohydrates for energy.  "Young athletes are coming to practice dehydrated, they're getting more dehydrated as practice continues, and they're progressively even more dehydrated on each succeeding day of practice.  Athletes need to pay more attention to hydration in earnest, and make a stronger effort to be more
hydrated at the start of practice, to drink regularly during practice, and to recover sufficiently from
each practice so they can start the next day adequately hydrated," said Bergeron.
Environmental Conditions
The length of each practice session should not exceed three hours (including warm-up, conditioning, instruction, breaks, and cool-down) and should be modified appropriately, in accordance with the environmental conditions (heat, humidity, and exposure to direct sunlight) in
order to effectively reduce the associated risks and improve the overall safety for young football athletes.
Players should not use stimulants, including ephedrine and high-dose caffeine often found in dietary supplements or "energy" drinks.
Acclimatization
When players report to camp, they generally are not as well conditioned and acclimatized as college players, which may contribute to earlier fatigue and greater risk of injury. The body needs up to 14 days of progressive activity in the heat to undergo the physiological changes that allow for safe and sufficient acclimatization (the first three to five days are the most critical).  Players should practice in light-colored clothing, and wear shorts with helmets and shoulder pads only (not full equipment) or shorts only (with all protective equipment removed) for the first week of
practice. Helmets should be removed whenever possible (during instruction).
Treatment
Players should be closely monitored by the team support staff (including athletic trainers) for signs and symptoms of developing heat-related injury during practice.  Any changes in player performance, personality, or well-being should be sufficient reason to stop practice immediately for that individual. Teams should use the "buddy" system, by assigning two players to help monitor each other. If exertional heat stroke is suspected, players should be stripped of equipment and immediately cooled in a tub of ice water until emergency personnel can assume care and evacuate the athlete to the nearest emergency facility.

Parents, players, and coaches should all be aware of the warning signs and symptoms of dehydration and
heat illness:

• Thirst
• Irritability
• Headache and dizziness
• Muscle cramping and unusual fatigue
• Nausea and/or vomiting
• Hyperventilation
• Confusion and change in personality

Between 1995 and 2001, 21 high school football players died of heat stroke, and there have been other
fatalities since this time. Two severe incidents, one resulting in death, occurred last season during
preseason training in Oklahoma and Texas, respectively.