Football teams must take steps to prevent heat-related deaths

Two-a-days have long been a part of high school athletics. But the National Athletic Trainers' Association recently asked that teams eliminate these football practices, at least during the first week of August when high temperatures can make extra practices deadly for athletes.

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More than 25 heat-related deaths have occurred on high school fields since 1995. During twice-a-day workouts, the average football player can lose up to 14 liters of fluid in 24 hours. Furthermore, it is not uncommon to lose between five and seven pounds during a single practice.

Football players are particularly prone to dehydration. The physical demands of the sport predispose them to higher body temperatures and increased sweating. The helmet, shoulder pads and other padding act as insulation, keeping the heat close to the body and increasing fluid losses from sweat.

The key to avoiding dehydration and heat injuries that can accompany dehydration is to be proactive about hydration and heat safety. Coaches, athletes and parents should understand and practice the following heat safety guidelines to keep players healthy on the field:

Require athletes to have a physical and find out if an athlete has a medical condition or history of heat-related illness. Such players are more susceptible to heat stroke, as are overweight players.

Acclimatize players to the heat slowly by working out just in a helmet for the first three days of practice. Then, the next three days of practice, add the shoulder pads followed by full pads three days later.

Do not have two-a-day practices during the first week of practice. When you do begin two practices a day, alternate the schedule with one practice on one day followed by two practices the next day, followed by one practice, and so on.

Practices should not exceed six consecutive days. Also, alter practice schedules to avoid long workouts in high humidity.

Limit excessive activity by scheduling regular breaks and allow for fluid replacement. Provide shaded rest areas with circulating air. Remove helmets and shoulder pads during the breaks and provide cold water and a sports drink before, during and after practice in unlimited quantities.

Athletes should weigh in before and after practice, and their weight charts should be monitored each day to identify excessive weight loss. If an athlete loses 3 percent or more of his body weight, he should not be allowed to practice until he has replaced what was lost.

Know the symptoms of heat illness, which include nausea, incoherence, fatigue, weakness, vomiting, muscle cramps, weak rapid pulse and vision problems. Contrary to popular belief, heat stroke victims may sweat profusely.

Have an emergency plan in place. Educate your team on how to prevent, identify and treat heat injuries annually, and make sure adequate staff and medical support are available on-site to effectively monitor participants during practices and games.

Athletes often get used to the "no pain, no gain" mentality, so they might not always acknowledge their fatigue. That's why it's important for coaches and parents to responsibly and carefully observe their behavior and protect them from heat injuries.

Dr. Steven Greer is medical director of the MCGHealthSports Medicine Center.