Heatstroke deaths prompt new high school football rules

As summers get hotter, coaches take greater care in high heat and humidity, especially in the Southeast.


August 31, 2012
MARIETTA, Ga. — The August afternoon was a merciful one. The sky above Marietta High School was overcast, and by 3:30 p.m., temperatures hovered in the low 80s as football practice began.

Still, like high school football coaches all over Georgia, Marietta's coaches were leaving little to chance.

Responsible for the health of the 100 students on the field, athletic trainer Jeff Hopp stood by a $2,500 sophisticated temperature gauge on the sidelines to measure the heat, humidity and solar radiation. He set up water stations and every 15 minutes or so coaches made the athletes stop and drink.

On the pavement above the fields, Hopp opened a white canopy, and under it, he set up a large black plastic bathtub filled with water and ice. If a player showed signs of heatstroke, the tub would be his first stop before an ambulance arrived.

Since the mid-1990s, summer football practice, especially the preseason tradition of two sessions a day, has turned more dangerous for high school athletes. From 1994 to 2009, the average number of high school football players who died every year from heatstroke tripled to three from one in the preceding 15-year period, according to a recent analysis of high school heat-related deaths. Last year, seven boys died.

Research suggests that two factors are converging to increase mortality: rising obesity among high school football players and hotter, more humid summers as the climate changes. And while Hurricane Isaac drenched other parts of the South this week, it brought little relief in Marietta, where thunderstorms were offset by temperatures that stayed in the high 80s.

Recognition is growing of the potentially profound health effects of climate change. Tropical diseases are spreading north from their normal geography. In Maine, public health officials are seeing Lyme disease more often, as the warmer summers make northern New England more hospitable for ticks. In climate adaptation plans, states such as California have included public health initiatives, including opening more air-conditioned cooling stations.

Georgia has had the most deaths of any state among high school football players, with eight from 1994 to 2011. Now, along with six other states, Georgia has issued practice plans to avoid heat exertion that all high school football teams must follow or face sanctions. The new rules call for teams to acclimatize players to the heat, as opposed to the old approach of drilling hard from the start of preseason, often for four hours a day and in full pads.

The new rules in Georgia, Arkansas and elsewhere do not mention climate change, but they amount to a detailed response to a public health problem exacerbated by rising temperatures. The rules show how communities can adapt to climate change, even without overtly acknowledging it, once they understand what's at stake.

"You can discuss the new rules as player safety, because if you bring up climate change, all of a sudden, it becomes political," said Andrew Grundstein, lead author of the football mortality study and professor of geography at University of Georgia. "But as a climatologist, I'm really pleased that states are starting to implement the rules because as you start seeing more hot days, I think it's smart policy."

In Georgia, coaches prefer not to discuss climate change. But to Patti James of Little Rock, Ark., the heatstroke her son Will suffered in August 2010, during a three-week stretch of 100-degree days, drove home new realities.

"We got the clue that every summer is going to be really hot," James said, adding that there have been more than 24 days with 100-degree temperatures in Arkansas this year. "This is becoming the norm in the South, and we can't do what we did 40 years ago. I'm so tired of old men coming up to me and saying, 'We never got to drink water when I played football.'"

Two days after Will James collapsed at his school, another 16-year-old, Tyler Davenport, crumpled during football practice in the small town of Lamar, Ark. The boys were brought to the same hospital in Little Rock, where the families got to know each other. Both boys had liver damage and were put in medically induced comas. Will survived. Eight weeks after the day his body temperature shot up to 108.5 degrees, Tyler died.

"When I say my son had heatstroke, people nod. But when I say he was on dialysis for three weeks and a coma for a week, people are like, 'What?'" James said. "There's got to be education on all fronts."

The recent push for new football practice rules has emerged after the deaths of players and the publication of research like Grundstein's.

His study shows that from 1980 to 2009, most of the 58 deaths occurred in the Southeast, where heat and humidity form an oppressive mix. Athletes died mostly during morning practices, considered safer because of the relative coolness. But humidity is higher then.

The nearly 2-degree rise in global temperatures since the late 19th century has contributed to "roughly 7% higher absolute humidity," said Steven Sherwood, director of the Climate Change Research Center at the University of New South Wales in Sydney, Australia.

"This means that a 1-degree temperature rise from global warming will have as much effect on athletes training in very humid conditions as would a 3- or 4-degree rise from normal weather variations," Sherwood said.

The majority of the students who died were linemen, who tend be overweight. And they died during the first week of preseason practice, usually in August, when most students are immediately thrown into two-a-day practices, running hours of plays in helmets and full pads, ostensibly to identify the fittest, most tenacious athletes.

"Football is a tough sport, but these kids aren't coming into the preseason as fit as you think they are, and they're not as acclimated to heat and uniforms," said Michael Bergeron, executive director of the National Youth Sports Health & Safety Institute and professor of pediatrics at the University of South Dakota. "You can't condition someone in a hurry, but you can hurt them a lot in one workout."

The National Football League and the National Collegiate Athletic Assn. adopted rules to reduce heat exertion years ago, but high school sports lack a national organization with enforcement authority. As a result, high school reforms happen state by state, often coach by coach, said Douglas Casa, chief operating officer at the University of Connecticut's Korey Stringer Institute, named after the NFL player who died of heatstroke in 2001.

"It's a long, grueling process with the states because you run up against this idea about practices that 'This is the way we've always done it and we don't want to change the way we do it,'" Casa said.

The Korey Stringer Institute worked with Arkansas, Georgia and the five other states to develop their rules. Coaches sign on when they discover that everyone must adhere to the same standards, so that no one gains a competitive advantage.

The new rules in Georgia change but do not abolish preseason practices in high heat and humidity. They require high school football programs to acclimatize players in preseason. If schools hold two practices on one day, they can hold only one practice the next day.

Desmond Bobbett, watching his son practice at Marietta, said he was pleased with Georgia's new rules.

"Even if you're in shape, the heat is a different animal," Bobbett said, as his son raced back and forth with teammates on the field. "I don't think this is coddling at all. There is no such thing as too safe when it comes to making sure kids don't die."