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Heat Injury Prevention Practices in High School Football

Luke, Anthony C MD, MPH*; Bergeron, Michael F PhD; Roberts, William O MD

Clinical Journal of Sport Medicine: November 2007 - Volume 17 - Issue 6 - p 488-493
doi: 10.1097/JSM.0b013e31815889f2
Original Research

Objective: To survey high school American football programs regarding current prevention measures for reducing heat injuries during the football season.

Design: Web-based survey of 27 questions based on consensus statement guidelines by the American College of Sports Medicine on reducing heat injury risk in youth football.

Setting: National (United States) and community-based.

Participants: High school programs receiving survey distribution from their state athletic association and the National Federation of State High School Associations.

Main Outcome Measures: Responses (percentage and incidence) to questions on preseason acclimatization procedures, practice modification protocols, preparticipation risk factors, hydration management strategies, rest period strategies, heat injury education and policies, and preparation for heat-related emergency care.

Results: A total of 540 high school football programs from 26 states completed the survey. The reported number of preseason heat injuries per program (1.38 ± 2.08) was greater (P < 0.001) compared to during the regular season (0.98 ± 1.84). Programs modified equipment configurations during preseason (no helmets or pads, 31.3%; just helmets, 57.0%; helmets and shoulder pads only, 33.5%) or altered the practice schedule when there was excessive heat. Hydration management, education, and preparation for dealing with an acute heat injury varied among programs.

Conclusions: Greater implementation of effective prevention measures to reduce the incidence of heat-related injury and death in high school American football is needed. Strategies should focus on modifying practices appropriately on a day-to-day basis to minimize heat strain and optimize hydration, identifying and educating at-risk individuals during the preparticipation period, and developing an emergency action plan for effectively managing heat injuries.

From the *Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California; †Environmental Physiology Laboratory, Department of Physical Therapy, Medical College of Georgia, Augusta, Georgia; and ‡Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.

Submitted for publication January 8, 2007; accepted July 18, 2007.

The authors state that they have no financial interest in the products mentioned within this article.

Reprints: Anthony Luke, MD, MPH, Departments of Orthopaedics and Family and Community Medicine, University of California, San Francisco 500 Parnassus Ave MU-320W San Francisco, CA 94143-0728 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.