By Ruth SoRelle
Texas Climate News

It’s hot outside, very hot, and you’ve decided to skip your usual three-mile jog. Not everyone has the luxury of missing a workout in the Texas heat, however.

On the first Monday in August each year, all smaller high schools and larger schools that did not take part in spring training traditionally begin fall football practice across the Lone Star State. This year, that happened on Aug. 6.

High school athletes in the other 49 states are following suit, but states’ responses to the risks of extreme heat vary. A recent analysis of schools’ preventive measures against heat illness assigned a very low rank to Texas – a hot place that climate scientists say is getting hotter thanks to global warming.

The ranking by the website Inside Climate News was based on a broader assessment of states’ high school football safety policies by the Korey Stringer Institute, a heat-illness prevention organization at the University of Connecticut that was developed by the widow of an NFL player who died of heat stroke.

Based on Stringer Institute ratings, Texas ranks 41st in measures taken to reduce the risks of heat stroke – tying with Alaska, Louisiana, North Dakota, Pennsylvania and Washington in third-to-last place. (By contrast, Texas ranks in the middle of the institute’s evaluations of states’ approach to overall athletic safety measures.)

In a state where football is king and high schools build multi-million-dollar stadiums to house the sport, Texas’ comparatively poor showing with regard to risk reduction measures for heat-related illnesses may be surprising.

The Stringer Institute’s recommendations and Texas guidelines for interscholastic athletics do coincide in some areas – for instance, both advise use of a special device called a wet bulb globe thermometer to assess weather conditions beyond just air temperature.

However, the heat guidelines of Texas’ University Interscholastic League (UIL), which oversees athletic and other competition, are at odds with those of Stringer Institute in several instances.

While the Stringer Institute recommends three-hour rests between practices on double-practice day, for example, Texas mandates only two hours. There is a similar difference in the time recommended between full practice and a lighter “walk-through” practice. Texas also does not count weight-lifting activities as part of the practice time. Most importantly, the University Interscholastic Leagues does not require each school to have a policy for modifying activities based on how hot it is.

Kate Y. Hector, media coordinator for the UIL, told Texas Climate News that the UIL Medical Advisory Committee “reviews all rules related to health and safety and will continue to monitor heat-related rules moving forward.”

The advisory panel “has not specifically discussed climate change, but [it] will continue to monitor rules related to heat and make any necessary recommendations,” Hector added.

She noted that UIL schools have not recorded a heat-related fatality since 2004.

To deal with heat, the Stringer Institute advises several measures to protect youngsters, including cooling tubs of water and ice, heat-stress monitors, air-conditioned practice breaks and policies that ease players into strenuous summer activity. UIL does not recommend the cooling tubs or heat-stress monitors.

Houston physician and medical educator Albert Hergenroeder, a member of the UIL advisory committee, told TCN he had not seen any recommendations for using cooling tubs with ice in Texas, but both the Stringer Institute and the Sports Medicine Advisory Committee of the National Federation of State High School Associations recommend them as the preferred cooling technique. (Ice packs on the neck, armpit and groin, along with ice-water soaked towels applied to the rest of the body, are an acceptable alternative, according to the high school association committee.)

Hergenroeder, chief of the Adolescent Medicine Service and Adolescent Medicine Clinic at Texas Children’s Hospital and chief of  Adolescent Medicine and Sports Medicine at Baylor College of Medicine, said he is not sure water in the tubs would remain cool if they’re left out in the hot Texas sun. If they are kept inside, they may lose their value as an immediate cooling aid, he said.

Stringer Institute, like the UIL, also suggests that heat policies be based on a wet bulb globe thermometer reading (WGBT) or on the heat index if the WGBT is unavailable. Guidelines, the institute says, should rely on epidemiological data for the region in which athletes are practicing. The high school association’s advisory committee and other sports groups also recommend having a plan about what to do in a heat emergency that is practiced routinely.

Hergenroeder said Texas UIL’s recommendations are good ones as long as coaches and trainers follow them.

Not following heat-safety recommendations can result in tragedy. University of Maryland football player Damon Evans died earlier this year of heat stroke. University officials acknowledged their plans and procedures for such events were not followed and they have now adopted  additional safeguards.

Maryland athletic director Damon Evans said the school has “changed how we practice and also how we train our staff. We have specifically changed how we practice in the heat by increasing breaks and adding cooling stations” – policies that apply to all sports, not just football.

The UIL web page on heat stress and athletic participation notes that most heat-linked problems in athletics occur in football and are associated with the stress of wearing uniforms and special equipment. The site lists the heat-related problems that can affect athletes:

• Heat cramps involving abdominal muscles, legs and arms that occur because of intense, prolonged exercise in the heat with sweating that depletes salt and water.
• Heat syncope, marked by weakness, fatigue and fainting caused by loss of salt and water in the heat. It predisposes the athlete to heatstroke.
• Heat exhaustion with water depletion that results in weight loss, reduced sweating, elevated skin and core body temperatures, excessive thirst, weakness, headache and even unconsciousness.
• Heat exhaustion with salt depletion causes nausea, vomiting, muscle cramps and dizziness related to loss of body salts.
• Heat stroke, an acute medical emergency that results from the inability to regulate body temperature. It is associated with nausea, seizures, disorientation and loss of consciousness. It may occur suddenly without previous symptoms. The victim is typically unconscious with high body temperature and hot dry skin. It is life-threatening.

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How young athletes can reduce heat risks

Medical experts offer plenty of advice for preventing heat-linked illnesses among young athletes.

The American Academy of Pediatrics’ Committee on Sports Medicine advises that each athlete undergo physical exams that include an annual medical history, including previous heat-related illness. Coaches should know the physical condition of their athletes and set practices accordingly.

The committee recommends acclimatizing athletes to the heat in the first five to 10 days of practices, as does Texas’ University Interscholastic League.

Their other advice includes: Athletes should be given access to water in unlimited quantities, including water breaks that last 10 minutes for every half hour of heavy exercise. Cold water is better. Ample water before a game or practice can improve performance. Salting food should be enough to replace salt.

“Dehydration is cumulative,” said Albert Hergenroeder, a Houston physician, medical educator and member of the UIL’s Medical Advisory Committee. “If the adolescent becomes dehydrated the first day and does not rehydrate, the dehydration mounts up. One good way to measure it is if you get up in the morning and your pee looks like apple juice, you are dehydrated. If it looks like lemonade, you are good.”

Drinking water before, during and after practices decreases the risk of dehydration, Hergenroeder added. A sports drink with no more than eight percent carbohydrates can be used when the athlete has not drunk enough before exertion, has a high sweat rate, is not eating enough before exercising or is not adequately acclimatized to the environment. He advises avoiding “energy” drinks that can contain stimulants such as caffeine or ephedrine.

Simple air temperature is not enough to determine potentially hazardous conditions, Hergenroeder said – it might seem that practicing in the early morning when temperatures are lower would be best, but that does not take into account the typically increased humidity at that time of day.

Temperature and humidity each play a part in heat illness. Greater humidity makes it more difficult for sweat to cool the body. The UIL recommends assessing the air before a game with a wet bulb globe temperature (WGBT) index, which combines air temperature, relative humidity, radiant heat and wind.

The National Federation of State High School Associations has recommendations of its own:

• Athletes should weigh daily before and after practice. A three percent weight loss through sweating is safe, but more than that puts the athlete in the danger zone. Athletes should not practice until they have replaced lost weight.
• Heat stroke is a medical emergency that requires immediate attention and then transfer to a hospital. Remove clothing and put ice bags on the neck, in the armpit and in the groin. You can also anoint the body with alcohol or cool water and fan the athlete.
• Obtain medical care at once in case of heat exhaustion, cooling the body while waiting for transfer to a hospital.

– Ruth SoRelle

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Ruth SoRelle is a contributing editor for Texas Climate News. A veteran medical and science writer, she is an independent journalist based in Houston.

Image credit: Rich McFadden / U.S. Air Force