Phoenix hit 110 degrees for the 19th consecutive day this week. Heat domes—vast areas of sweltering heat trapped under a “dome” of high pressure that lasts a week or more—have taken hold in several U.S. cities. In all, heat alerts currently affect an estimated 12 million people nationwide.
As high school athletic programs get set to ramp up pre-season fall workouts, the excessive heat poses a serious health risk to countless student-athletes.
No one, not even young and seemingly healthy athletes, is immune to the effects of the extreme weather. Sports medicine researchers in 2012 ruled heat illness the third leading cause of death among U.S. high school athletes. One of the biggest risk factors is practicing during hot and humid weather when athletes haven’t yet acclimated to physical exertion in heat. In 2011, six high school athletes, all football players, died as a result of heat-related exposure before the first full week of September.
The tragic deaths increased awareness, among both the public and high school administrators, of the risks that excessive heat poses to high school athletes. Health researchers have since learned more about the effects of heat on the body and translated this knowledge into digestible information and prevention strategies that are making their way into policies at the state and school district levels.
“As an educational community, we’re in a good place regarding education available to coaches and administration,” said Karissa Niehoff, the chief executive officer at National Federation of State High School Associations, a national advocacy organization that writes the rules of competition for most high school sports and activities in the United States.
Why heat-related events happen
Niehoff ticked off a number of safeguards intended to help high school athletic departments prevent heat-related illness. She noted that state [high school athletic] associations have guidelines around heat acclimatization and practices, each state has a sports medicine advisory committee, and some states have adopted laws on athletic practices around heat. But, Niehoff observed, it’s up to school personnel to take advantage of these preventative measures.
Case in point: In August 2019, Imani Bell, a high school junior and basketball player in Jonesboro, Ga., collapsed and later died after running up football stadium steps in extreme heat as part of a team drill. It happened on the first day of the team’s outdoor workouts. The temperature during the workout exceeded 92 degrees, a limit previously established by the Georgia High School Association as the maximum allowed for outdoor workouts, according to a newspaper report.
Sometimes, too, schools lack the professional personnel to enforce or inform coaches of preventive strategies, which can lead to problems, say experts.
“If you’re a high school athletic director in charge of overseeing high school sports, your first job is to make sure there’s an appropriate health-care provider,” said William Adams, adjunct assistant professor in the department of kinesiology at the University of North Carolina, Greensboro. “If it’s a brand-new athletics program, I believe that the second hire needs to be a medical provider [an athletic trainer].”
A 2019 study of 20,272 high schools by the Korey Stringer Institute, which is dedicated to the prevention of exertional heat stroke, found that 34 percent had no access to athletic training services.
Encouraging signs of prevention
The lengthy stretches of excessive heat in Phoenix this summer have made headlines.
In the Paradise Valley Unified School District in that city, the district’s preventative measures for athletes include daily temperature checks and, on extreme heat days, reducing the amount of heat-generating equipment that can be used, such as padding and helmets, or cutting short practices, which usually last a maximum of two and a half hours. Water breaks, implemented every 15 minutes, are increased on extreme heat days, a district spokesperson said.
The district also says it follows the Arizona Department of Health Services’ recommendation to avoid strenuous outdoor activity when the heat index reaches 105 F. Sports practices also don’t start until 6 p.m., to avoid high temperatures.
In Mt. Mansfield Union High School in Jericho, Vt., excessive heat means something different than in Phoenix. All outdoor workouts or events are canceled if the temperature reading is at or above 86.1 F. degrees, said Dave Marlow, the school’s director of student activities. To gauge the temperature, the school uses a Wet Bulb thermometer, which takes into account humidity, ambient temperature, and wind. (Niehoff said her organization can provide these high-tech thermometers, which normally cost about $400, for free to public school districts.)
Marlow, who will be starting his 12th year as student activities director this fall, pointed to a dramatic shift he’s noticed in the school leadership’s philosophy and practice regarding student-athletes and heat exposure.
“This is very different from when I first started,” he said. “We play football games where we’ve had to stop almost every play, kids have to take their helmets off and have a drink break,” he said. “At first, the purists said ‘We can’t have a water break during a game.’ ”
But now, he said, it’s become second nature.
Nationwide there’s also evidence of greater attention to the issue.
In 2017, the Korey Stringer Institute, at the University of Connecticut, conducted a review of state-level implementation of health and state policies within high schools around five specific areas, including exertional heatstroke. It repeated the analysis in 2021 and found that 38 states had increased their engagement in such policies, with those related to exertional heatstroke showing the most improvement.
Policies are a start, but they must be followed in order to make a difference, Niehoff said.
“We still have coaches who will not do the right thing,” Niehoff said. “We hear about horrible examples for kids—illnesses and even fatalities. They’re rare, but they’re out there. … We have to keep reiterating, over and over again, with our coaches, schools, state associations, and the general public: This is the data. These are the best practices. These are the resources and where to find them.”
