Can School Nurses Help Prevent Heat Stroke Fatalities in High School Football?

September 17, 2009

Shawn Kennedy, MA, RN, AJN editorial director & interim editor-in-chief

by Bludgeoner86, via Flickr

by bludgeoner86/via Flickr

Earlier this month, Diana Mason, AJN’s editor-in-chief emeritus, wrote here about head injuries in soccer. A related news story about high school sports should make all school nurses, coaches, and parents take notice: student athletes suffer—and sometimes die—from heat stroke during intense workouts in hot weather.

According to an Associated Press report, Fred Mueller, director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina, attributes 39 deaths since 1995 to heat-related causes. And that doesn’t count three deaths this past summer that he notes may also be associated with heat stroke.

Most of the deaths are associated with football preseason training in August. My middle son played high school football and every August he went to “preseason camp.” He and his teammates slept on air mattresses in the non-air-conditioned high school gym, and spent the last week of summer vacation in grueling drills and practices, wearing shorts, T-shirts, shoulder pads, and helmets. One year he arrived home looking thin and gaunt. He related stories of teammates vomiting on the sidelines during practices and of restricted water breaks. It took a player fainting during one session and an onslaught of parent complaints and pressure on school administrators (the word “lawsuit” does get attention) for coaches to change their methods.

Football practice seems to be the primary place where safe practice regimens are unheeded. I don’t know what it is about football (and I’m talking junior high and high school sports) that causes some adults to morph into win-at-all-costs coaches who use shame and intimidation as motivators and disregard players’ health. One junior football coach who knew I was a nurse asked me if I could “pop-in” the dislocated knee of his star running back.

The National Athletic Trainers’ Association, in conjunction with seven other training groups, has developed consensus guidelines, Preseason Heat-Acclimatization Guidelines for Secondary School Athletics, to guide coaches in conducting safe practices. They recommend graduated practice times, recovery periods following workouts, and graduated wear of helmets and protective gear until players are acclimated to training. For recreation leagues involving younger players, the National Alliance for Youth Sports has had standards for administration of youth sports since 1987. They take the position that youth sports programs “must be developed and organized to ensure, as well as to enhance, the emotional, physical, social and educational well-being of children.”

As evidenced by the three student athletes who died this past summer, parents and school nurses should not rely on others to enact safe practices for youth sports.

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  1. […] Can School Nurses Help Prevent Heat Stroke Fatalities in High School Football? […]


  2. A coach in Kentucky was just found not guilty of murder when a 15 year old boy died after being forced to exercise in the heat with no water.
    What kind of training do coaches get anyway?


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