Placing a priority on preventing catastrophic heat illness in students

May 3, 2018 Staff Writer

The following article was written by the California Interscholastic Federation for EdCal.

Today, more than 90 percent of California high schools begin their fall semester in August. Athletic practices are occurring all summer and fall when it can be hot and humid in many parts of California. Exertional Heat Stroke (EHS) is preventable, but there are still tragic occurrences each year of “near-misses” with emergency room visits and hospitalizations.

According to the Center for Disease Control, heat illness during practice or competition is the leading preventable cause of death among U.S. high school athletes. With our wide and diverse climate zones from cool coastal beaches to mountains, valleys and deserts, it is imperative that education and training of administrators, coaches, parents and students play a vital role in this preventable illness.  Assembly Bill 2800 would authorize heat illness training to be fulfilled through entities offering free online or other types of training courses.  The California Interscholastic Federation, through the National Federation of State High School Associations (NFHS), offers a free online class that would fulfill this new proposed requirement. Upon successfully passing the class, the coaches are issued a certificate and added to a statewide data base that allows for school and school district verification of completion, identical to the free CIF NFHS Concussion program.

Why is this important?

Recently, California experienced extremely hot summer and fall seasons, and the aforementioned “near misses” and trips to the emergency room is disturbing. While there are more than 831,000 student-athletes participating on school campuses, none of these individuals should suffer or die from exertional heatstroke. In fact, EHS is the leading cause of preventable death in high school athletics.

What is heat illness?

Exercise produces heat within the body and can increase an athlete’s body temperature. Add to this a hot or humid day and any barriers to heat loss such as padding and equipment, and the temperature of the individual can become dangerously high. The body normally cools itself by sweating. But under some conditions, sweating just isn’t enough. In such cases, a person’s body temperature rises rapidly. Several factors affect the body’s ability to cool itself during extremely hot weather. When the humidity is high, sweat will not evaporate as quickly, preventing the body from releasing heat quickly.

There are progressive steps to Exertional Heatstroke.

• Heat stress: Heat stress occurs when a strain is placed on the body as a result of hot weather.

• Heat cramps: Painful muscle spasms in the abdomen, arms or legs following strenuous activity.

• Heat syncope: Sudden dizziness or fainting experienced after exercising in the heat.

• Heat exhaustion: A warning that the body is getting too hot. The person may be thirsty, giddy, weak, uncoordinated, nauseous and sweating profusely. The body temperature is usually normal and the pulse is normal or raised. The skin is cold and clammy.

• Heat stroke: Heat stroke is a serious condition, and is sometimes fatal, so immediate medical attention is essential when problems first begin. A person with heat stroke has a body temperature above 104° F. Other symptoms may include confusion, combativeness, bizarre behavior, faintness, staggering, strong rapid pulse, dry flushed skin, lack of sweating, possible delirium or coma. Heat stroke occurs when the body becomes unable to control its temperature. The body’s temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. Body temperature may rise to 106°F or higher within 10-15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not given.

Preventative steps

Minimizing risk and reducing injuries of California’s student athletes is of paramount importance, not only to administrators, but also the CIF and to the 70,000 high school coaches in California.  The CIF founded in 1996 a Sports Medicine Advisory Committee (CIF SMAC) that is comprised of 20 of the most preeminent sports medicine physicians, certified athletic trainers and health care providers in the state to enhance and promote policy decisions help minimize risks and reduce injuries, including heat illness.

The CIF continues to evolve its safety protocols at the recommendation of the CIF SMAC to best reflect the most recent advances in sports medical science. Reducing risks and minimizing injuries of California’s student athletes has been and remains CIF’s top priority.

Free online heat illness prevention training

Through the National Federation of State High Schools (NFHS), a free online course is designed to give information needed to minimize the risk of exertional heat stroke among your athletes. The course presents seven fundamentals, which, when followed, will minimize heat related illnesses of the students who participate:

• Start slow, then progress.

• Allow for individual conditioning, medical status.

• Adjust intensity and rest.

• Start sessions adequately hydrated.

• Recognize signs early.

• Recognize more serious signs.

• Have an emergency action plan.

Emergency action plans

The Education Code requires schools to have Emergency Action Plans (EAP) for the school day, but they are not required for before/after school activities. According to the CIF, 68 percent of the 1.9 million high school students participate in afterschool activities on our campuses and 72 percent of our coaches are “walk-ons,” meaning not members of the regular faculty. This makes it even more important that afterschool coaches have an EAP and know what to do when the campus may be empty and they are facing a situation such as heat illness, where seconds can make the difference in life or death. To assist schools to bridge this planning gap, the CIF mailed to all high schools in 2015 a nationally recognized Emergency Action Planning guide for athletics and activities. This guide helps schools establish their afterschool emergency procedure regardless of the venue; the gymnasium, theater, football stadium or softball field. The guide can be downloaded for free on the CIF website at http://bit.ly/2rgDZ3v.

Questions for consideration

• ho in the district is ensuring that all coaches have met the minimum Education Code requirements?

• Do our schools have an Emergency Action Plan for afterschool events? If yes, does our athletic director make sure that all coaches, including walk-ons, know and understand the district expectations?  How are they completing this task?

• Do our schools have a Certified Athletic Trainer available at practice and contests? If no, who is responsible to deal with student injuries, emergencies and treatment?

• Do our schools have quick and easy access to ice tubs in case of a heat illness emergency? (These tubs can be as simple as filling a kiddie swimming pool and adding ice, very inexpensive.)

• Do our schools have adequate water available at all practice locations?

Additional resources

CIF Heat Illness Prevention Material from the CIF SMAC: http://cifstate.org/sports-medicine/heat_illness/index.

CDC – Preventing Heat Illness: https://www.cdc.gov/features/prevent-heat-illness/index.html.

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