Jan 29, 2015
Coolest Team Ever

Looking for new ideas to prevent heat illness? This author suggests using a team approach.

By John Moyer, Jr.

John Moyer, Jr., LAT, ATC, has been Head Athletic Trainer at Wilson High School in West Lawn, Pa., for 35 years. He is also President of the Pennsylvania Athletic Trainers’ Society (PATS) and serves as its liaison to the Pennsylvania Interscholastic Athletic Association Sports Medicine Advisory Committee. He can be reached at: [email protected] or [email protected].

Think for a moment about the number of people it takes to get a football team on the field. The players typically come to mind first, followed by the coaches. Then, there are others behind the scenes who make it happen–from the athletic trainers and team physicians who treat injuries to the administrators who make the schedule to the parents who split their time between chauffeur and cheerleader. In many ways, it takes a team to field a team. Heat illness prevention, I believe, should take the same approach.

Despite educational efforts across the country, exertional heat stroke remains one of the top causes of death in athletes. It’s the most severe form of exertional heat illness, which also encompasses heat cramps, heat syncope, and heat exhaustion. I think it goes without saying that anything that can be done to keep athletes from experiencing heat illness should be done–and a team approach includes many factors that can lead to success.

With our knowledge about the topic and dedication to the safety of the players, athletic trainers are ideal candidates to make sure everyone understands their role in heat illness prevention. That means getting team physicians, administrators, coaches, parents, and athletes on the same page. How can you make this work at your school? By having clearly defined policies, educating all involved, raising awareness, and putting it all together before the dog days of summer hit.


The first step in a successful team approach is ensuring that all parties are educated about what heat illness is and the role they play in preventing it. To teach athletes and parents about the topic, I use preseason meetings, in which I spell out the signs and symptoms of heat illness and distribute handouts covering prevention guidelines. I also direct them to websites where they can learn more, such as the Korey Stringer Institute (www.ksi.uconn.edu), Gatorade Sports Science Institute (www.gssiweb.org), NATA (www.nata.org), and NFHS (www.nfhs.org).

Since one of the keys to preventing heat illness is ensuring athletes are hydrated by the time they get to practice, it’s important that athletes and parents are educated on proper hydration protocols. The easiest way for a player to know if they are properly hydrated is by checking their urine color. Tell them that if they are hydrated, the urine will be clear or light yellow. Darker urine is a sign of dehydration.

To remain hydrated, athletes should also be advised to avoid caffeinated beverages, alcohol, and certain supplements. Many supplements can raise blood pressure and heart rate, contributing to dehydration. Athletic trainers should make themselves aware of the supplements popular among their athletes and provide sound advice on those products’ effect on hydration.

I find athletes grasp the concept of hydration easiest when we get creative in presenting the facts. For instance, I’ll tell them that an automobile without proper coolant will eventually overheat and break down, sometimes causing permanent damage to the engine. I remind them that the human body works in a similar way–except when a player overheats, the damage can be life-threatening.

Two other groups to educate are coaches and administrators. One way to do this is through an in-service day. To vary up the presentation, ask others to speak, such as the school physician or an athlete who has experienced exertional heat illness in the past.

Coaches also need help with a plan for heat illness prevention during their practices. For example, coaches should include a hydration protocol within the daily schedule to make sure all athletes have numerous opportunities to replace lost fluids and cool down.

Athletic trainers should also teach coaches how weight charts are used to prevent heat illness. Athletes who lose weight after one practice and don’t regain it before the next should be held out. Athletes on the sidelines aren’t helping the team, so this usually motivates coaches to keep a closer eye on hydration.

A third tool coaches should understand is the Wet Bulb Globe Temperature (WBGT). Coaches must be made aware that depending on the WBGT reading, they might have to cut practice short or change the equipment the players are wearing. And they should know to cancel practice or move it indoors if the reading gets too high.


Once everyone is educated about heat illness, it’s time to get coaches, administrators, and your school physician involved in the construction of the heat illness portion of your Emergency Action Plan (EAP). The EAP should be specific to areas where the medical emergency will likely occur and cover all the steps of heat illness emergency care. The location of AEDs, the cold water submersion pool, ice towels, and emergency information cards are items to include in an EAP for heat illness emergencies.

Also construct a heat acclimatization plan, which should include any applicable state association rules. Make sure coaches and administrators are aware that athletes who participate in a proper heat acclimatization program develop a heat tolerance that enhances performance, while those who don’t are at a far higher risk for exertional heat illness.

Administrators must approve the school heat acclimatization and emergency action plans to ensure compliance. Athletic trainers should be proactive by making an appointment with administrators to discuss EAPs as well as the equipment needed to carry out the plans.

The athletic trainer can also work one-on-one with the school physician to write Standing Operating Procedures (SOP), which provide direction for staff members in case of heat illness. The athletic trainer needs to inform the directing physician of athletes who present unique challenges to heat illness prevention and should be written into the SOP, such as those with asthma, diabetes, or allergies.

Besides collaborating with school physicians to develop written protocols, athletic trainers can produce contracts for coaches, parents, and athletes to sign, which mandate compliance with heat illness protocols. This is a great opportunity for administrators to be directly involved with the process by supporting the athletic trainer and holding athletes from practices when needed.

The collaboration on protocols can expand beyond the confines of your own school or district. Most state interscholastic athletic associations have a sports medicine advisory committee with representation from the state athletic trainers’ organization. Athletic trainers can team with physicians and other health care providers to produce evidence-based recommendations for exertional heat illness prevention. These individuals can offer a unique perspective about sports medicine issues that may move the state association to enact rules that ensure optimal athlete safety.


Beyond meetings and written protocols, consider finding other opportunities throughout the year to raise awareness for heat illness prevention. This can begin during preparticipation physical exams (PPE). When we offer PPEs at Wilson High School, an athletic trainer is present to report previous problems with heat illness to the physician and provide a screening that may reveal conditions requiring further evaluation. Athletic trainers can also use this opportunity to distribute educational materials about heat illness prevention to student-athletes and parents to ensure everyone is on the same page. Continuity results in compliance.

To raise year-round awareness with the team members on a more consistent basis, athletic trainers can utilize technology. Most secondary schools can easily e-mail all families in the school district to inform them about upcoming activities and important announcements. Athletic trainers can supply educational information for these e-mail blasts with updates on exertional heat illness and proper hydration guidelines. At Wilson, I do this through our weekly “Bulldog Blitz” that goes out to all school district residents.

For more sport-specific information, athletic trainers can team with head coaches, who also frequently use e-mail blasts to contact all of their athletes at the same time. This method is particularly helpful when athletic trainers need to address a specific sport’s needs or weather conditions for a practice.

Most athletic departments have general websites where athletes can go for information, but it is important for athletic trainers to have their own page on the site that provides information about heat illness. This allows parents, athletes, and coaches the chance to access the information at their convenience.

Besides more traditional methods of spreading awareness among team members about heat illness prevention, I encourage athletic trainers to get creative in their approach. For example, they can make T-shirts that have a catchy slogan on the front, such as, “Athletic trainers can lead athletes to water and MAKE them drink!” with proper hydration guidelines on the back. The athletic trainer can wear them around campus, and the shirts could even be sold to benefit the athletic training department.

I know athletic trainers that have used similar strategies with water bottles. By putting your school logo on one side and proper hydration guidelines on the other, you can sell these as a fundraiser and make sure your athletes stay hydrated.

I have found that athletes respond well to visual information. By hanging informational posters and documents about heat illness in all locker rooms, athletic trainers can be sure the players will see them on a daily basis. Most sports drink companies offer free posters that have recommendations for proper hydration.


The positive effect of the team approach is realized when every member thoroughly understands their role. This starts when the athlete is still at home with their parents. Athletes should ensure they are hydrated before leaving, and parents should send additional fluids to practice with them. Players should also eat a balanced meal and hydrate following practice to help the body recover and prepare for the next day’s session.

At practice, the coach should follow the heat acclimatization program and hydration plan that was agreed upon by the coach, administrators, and the athletic trainer in compliance with available state guidelines. This includes using the WBGT to determine whether or not it is safe to practice.

Finally, administrators should be prepared to provide disciplinary action at any step of the way if a coach, player, or parent is not complying with the heat illness prevention protocols. If an athlete has not undergone a PPE or submitted the necessary paperwork, the administrator should hold them from competition. In addition, coaches are subject to an evaluation by an administrator following each season. Non-compliance with athlete safety protocols should be a major part of the evaluation.

Developing a team approach to preventing exertional heat illness will make your job as an athletic trainer much easier. By spreading awareness and responsibilities among school administrators, school physicians, athletic trainers, coaches, parents, and athletes, the risk of heat illness is greatly minimized. When each party fulfills its role, the athletes are more likely to participate safely.


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