This summer, a majority of the country is experiencing a severe heat wave. According to the National Oceanic and Atmospheric Administration (NOAA) more than 132 million people have been under an excessive heat advisories for long periods this summer, with record-breaking temperatures in the triple digits. Meteorologists have noted that the heat wave of 2011 is not only very hot and widespread, but also came with very high humidity.
This makes it very dangerous for young athletes starting fall sports practice this month. One of the most deadly combinations of sports and heat is football. In fact, recently there has been a string of heat-related football deaths occurring in the South. Two Georgia 16-year-old football players died from apparent heat stroke as well as a 14-year-old South Carolina football player and an assistant football coach in Texas. These deaths are all the more tragic and senseless because heat-related injuries and deaths are preventable.
A recent study in the International Journal of Biometeorology, analyzing heat-related football deaths from the last 29 years, found since the mid-1990s there has been an increase in heat-related illness and death among football players. Most of the cases in this paper were high school football players. I spoke with the study's lead author, Dr. Andrew Grundstein, Ph.D., associate professor of the Department of Geography at the University of Georgia. He said there is a correlation with the size and levels of obesity in football players, linemen being the most susceptible due the decreased surface area needed to dissipate heat when compared to body mass. Practices or scrimmages working out in helmets and full pads not only interfere with heat loss mechanisms, they also increases heat production. However Grundstein states, "that in this study we found many deaths were among athletes wearing minimal clothing with no pads or helmets." Most of the deaths occurred in August when fall practice typically begins. Interestingly he points out, many deaths occurred during morning practices, which have high humidity levels. He said, "In the morning there is this false sense of security that it is cooler, however the high humidity makes it just as dangerous when you are working out very hard."
As an emergency physician, I know this risk all to well. The way your body regulates temperature in hot conditions is by sweating. When the sweat evaporates it cools your body down. On very hot muggy summer mornings with high humidity in the air this mechanism doesn't work as effectively, thus putting you at a higher risk for heat stroke.
Heat illnesses are a spectrum that range from heat exhaustion to the life threatening condition called heat stroke. The warning signs of heat-related illness are cool, sweaty, moist skin with goosebumps, despite the heat. Dizziness, headache, muscle cramps with nausea and vomiting can also be present. Once you notice any neurological changes such as confusion and disorientation, hallucinations, seizures or the person becomes unconscious, those are the signs of the life-threatening emergency called heat stroke. These individuals are now incapacitated and unable to help themselves. You need to get them out of the heat and call 911 right away.
The American Academy of Pediatrics has just released new guidelines, which ironically are a bit less restrictive than older policy. The revised policy statement no longer supposes that school-aged children are more vulnerable than adults to heat illness. It states that healthy kids can safely participate outdoors in sports with sufficient hydration, adaptive training and rest periods. It also recommends that coaches, trainers and other adults receive education in the risks and conditions as well as the warning signs associated with heat stress. They need to closely monitor the children for any problems. They should also have emergency plans in place and be ready to modify training and games for weather conditions and individuals.
The American College of Sports Medicine (ASCM) and the National Athletic Trainers' Association (NATA) both have position statements on preventing heat-related injury and death in athletes. Their recommendations for high school football players emphasize good hydration and rest, plus slowly acclimatizing players to working out in the heat. They also recommended limiting or eliminating twice-a-day practices with full uniform scrimmages during summer tryouts month.
The other thing we can do as parents is to change the culture our young athletes. The idea of "no pain, no gain" is dangerous. Many young football players, either because they are actually trying out for the team during summer practice or because they want to be seen as tough, will push themselves too hard. We have to teach our kids about the warning signs of heat injury. They need to understand if they or their friends have any of these warning signs, they need to stop and get out of the heat. They should never keep going if they feel dizzy, have cramps, or have a headache with nausea or vomiting. By the time they become confused or disoriented it is often too late. Let them know that heat can be a killer; it is certainly not something to play around with.