Implementing Exertional Heat Illness Prevention Strategies in US High School Football

Kerr, Zachary Y.1,2; Marshall, Stephen W.1,2,3; Comstock, R. Dawn4,5; Casa, Douglas J.6

Medicine & Science in Sports & Exercise:
doi: 10.1249/MSS.0b013e3182a11f45
Applied Sciences
Abstract

Purpose: Approximately 6500 high school football athletes are treated annually for exertional heat illness (EHI). In 2009, the National Athletic Trainers Association (NATA)–led Inter-Association Task Force (NATA-IATF) released preseason heat acclimatization guidelines to help athletes become accustomed to environmental factors contributing to EHI. This study examines compliance with NATA-IATF guidelines and related EHI prevention strategies.

Methods: The study used a cross-sectional survey completed by 1142 certified athletic trainers (AT), which captured compliance with 17 NATA-IATF guidelines and EHI prevention strategies in high school football during the 2011 preseason.

Results: On average, AT reported football programs complying with 10.4 NATA-IATF guidelines (SD = 3.2); 29 AT (2.5%) reported compliance with all 17. Guidelines with the lowest compliance were as follows: “Single-practice days consisted of practice no more than three hours in length” (39.7%); and “During days 3–5 of acclimatization, only helmets and shoulder pads should be worn” (39.0%). An average of 7.6 EHI prevention strategies (SD = 2.5) were used. Common EHI prevention strategies were as follows: having ice bags/cooler available (98.5%) and having a policy with written instructions for initiating emergency medical service response (87.8%). Programs in states with mandated guidelines had higher levels of compliance with guidelines and greater prevalence of EHI prevention strategies.

Conclusion: A low proportion of surveyed high school football programs fully complied with all 17 NATA-IATF guidelines. However, many EHI prevention strategies were voluntarily implemented. State-level mandated EHI prevention guidelines may increase compliance with recognized best practices recommendations. Ongoing longitudinal monitoring of compliance is also recommended.

Author Information

1Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; 2Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC; 3Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC; 4Department of Epidemiology, Colorado School of Public Health, Aurora, CO; 5Pediatric Injury Prevention, Education, and Research (PIPER) Program, Colorado School of Public Health, Aurora, CO; and 6Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT

Address for correspondence: Stephen W. Marshall, Ph.D., Injury Prevention Research Center, University of North Carolina, Bank of America Building, Suite 500, 137 East Franklin Street, CB# 7505, Chapel Hill, NC 27599-7505; E-mail: smarshall@unc.edu.

Submitted for publication May 2013.

Accepted for publication June 2013.

© 2014 American College of Sports Medicine