Preparing for the heat when high school sports and other activities begin

By the end of this month, high school students will return from summer vacation and begin preparing for another year of participation in high school sports and other activity programs.

In fall outdoor sports and activities such as football, cross country, soccer, field hockey and marching band, more than 3.5 million students will prepare for another season of competition and performances.

As is usually the case at this time of year, the heat and its effects dominate the headlines in many parts of the country. So, as practices begin in the coming weeks, preparations should include a return to one of the core principles of high school sports and other activity programs — minimizing the risk of injury for everyone involved in those programs.

Coaches, athletic administrators, and athletic trainers must have effective prevention plans in place so that student participants are fully protected from heat-related illnesses and injuries. Regarding heat-related deaths in football, the emphasis should continue on an annual basis.

According to the National Center for Catastrophic Sports Injury Research (NCCSIR), during the most recent five-year period (2017-2021), football averaged 2.4 deaths from exertional heat stroke (EHS) per year, compared to 1.4 per year in the previous five – annual period (2012-2016). This increase supports urgent efforts to educate coaches, school administrators, medical professionals, players and parents about proper procedures and precautions when practicing or playing in the heat.

Regarding heat stroke deaths over the past five years, the NCCSIR report urges proper supervision and monitoring of conditioning sessions and precautions for lineman positions in football. Five of the 11 deaths occurred during preparation sessions, and nine of the 11 deaths were linemen.

Although there are about one million high school football participants annually, one death from heat stroke is one too many because EHS is preventable. It is actually the leading cause of preventable death in high school athletics.

In addition to football and other outdoor fall sports, marching band members are just as susceptible to the effects of heat illness. Like their counterparts on the athletic field, bandleaders must ensure a slow and progressive acclimatization period before the marching season.

The NFHS, through its Sports Medicine Advisory Committee (SMAC) and the NFHS Learning Center, offers many educational tools to assist schools in developing an appropriate heat illness acclimatization and prevention program. In addition, many state associations have developed state-specific guidelines for addressing heat issues and safety challenges.

SMAC developed “Position Statement on Heat Acclimatization and Heat Illness Prevention,” which is available on the NFHS website. This document contains seven basic principles of a heat acclimatization program. In addition, “ of SMACPosition statement and recommendations for maintaining hydration to optimize performance and minimize the risk of overheating during exercise” is also available on the Sports Medicine page of the NFHS website.

In addition, NFHS offers a free online course titled Prevention of heat illnesses. This course, which is available on, also reviews the seven fundamentals of a heat acclimation program. In addition, to address the necessary safety precautions for marching band participants, the NFHS has a free course titled Lane safety.

Among the main principles of the heat acclimatization program are 1) slow progression in activity level – duration and intensity; 2) adjusting training as heat and humidity increase, including careful monitoring and rapid response to developing problems; and 3) adequate hydration.

Three other courses in the Learning Center should form part of the pre-season lessons for all key members of the school’s team: The collapsed athlete, Sudden cardiac arrest and Concussion in sports.

As an additional resource, earlier this year the NFHS Foundation announced a grant program to distribute 5,000 wet bulb globe thermometers (WBGTs) to high schools across the country. The WBGT measures heat stress in direct sunlight by taking into account temperature, humidity, wind speed, sun angle and cloud cover. High schools can use thermometer readings to determine whether the weather is suitable for outdoor activities.

While coaches only have a prescribed number of practices before the first competition in fall sports, the rush to get the team in perfect shape for the first game cannot come at the expense of players’ health. The different physical conditions of players must be taken into account and special attention must be given to students at higher risk.

EHS deaths will not be eliminated unless school leaders make it a top priority. We encourage every athletic trainer and track director to take the free online courses – Heat Illness Prevention and Track Safety – at This may be the best investment of time this year.

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