Heat Policy Revision for Georgia High School Football Practices Based on Data-Driven Research

Earl R Cooper; Andrew J Grundstein; Jessica D Miles; Michael S Ferrara; Patrick Curry; Douglas J Casa; Yuri Hosokawa

doi:10.4085/1062-6050-542-18

Heat Policy Revision for Georgia High School Football Practices Based on Data-Driven Research

J Athl Train. 2020 Jul 1;55(7):673-681. doi: 10.4085/1062-6050-542-18.

Authors

Earl R Cooper¹, Andrew J Grundstein², Jessica D Miles³, Michael S Ferrara⁴, Patrick Curry⁵, Douglas J Casa⁶, Yuri Hosokawa⁷

Affiliations

¹ Department of *Kinesiology, The University of Georgia, Athens.
² Department of Geography, The University of Georgia, Athens.
³ The University of North Georgia, Dahlonega.
⁴ University of New Hampshire, Durham.
⁵ Greenwich Country Day School, CT.
⁶ University of Connecticut, Storrs.
⁷ Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan.

Abstract

Context: Interscholastic heat policies for football have not been evidence based. Therefore, their effectiveness in mitigating exertional heat illness has not been assessed.

Objective: To discuss the development of the Georgia High School Association heat policy and assess the effectiveness of revised guidelines.

Design: Descriptive epidemiology study.

Setting: Georgia high schools.

Patients or other participants: Interscholastic football players in grades 9 through 12.

Main outcome measure(s): Heat syncope and heat exhaustion (HS/HE) illness rates (IRs) were calculated per 1000 athlete-exposures (AEs), and relative risk (RR) was calculated as a ratio of postpolicy (POST) IR divided by prepolicy (PRE) IR.

Results: A total of 214 HS/HE cases (172 PRE, 42 POST) and 341 348 AEs (178 230 PRE, 163 118 POST) were identified. During the first 5 days of the PRE period, approximately 50% of HS/HE illnesses occurred; HS/HE IRs doubled when practice sessions increased from 2 to 2.5 hours and tripled for practices ≥3 hours. The HS/HE IRs in the PRE period increased from 0.44/1000 AEs for wet-bulb globe temperatures (WBGTs) of <82°F (<27.8°C) to >2.0/1000 AEs for WBGTs from 87°F (30.6°C) to 89.9°F (32.2°C). The RRs comparing PRE and POST policy periods were 0.29 for WBGTs of <82.0°F (<27.80°C), 0.65 for WBGTs from 82.0°F (27.8°C) to 86.9°F (30.5°C), and 0.23 for WBGTs from 87.0°F (30.6°C) to 89.9°F (32.2°C). No HS/HE illnesses occurred in the POST period for WBGTs at >90°F (>32.3°C).

Conclusions: Results from the PRE period guided the Georgia High School Association to revise its heat and humidity policy to include a mandated 5-day acclimatization period when no practices may exceed 2 hours and the use of WBGT-based activity-modification categories. The new policy reduced HS/HE IRs by 35% to 100%, depending on the WBGT category. Our results may be generalizable to other states with hot and humid climates similar to that of Georgia.

Keywords: American football; exertional heat illness; football practice policy; interscholastic sports; wet-bulb globe temperature.

MeSH terms

Adult
Athletes
Female
Football / injuries*
Georgia / epidemiology
Health Policy*
Heat Stress Disorders* / etiology
Heat Stress Disorders* / prevention & control
Hot Temperature / adverse effects*
Humans
Male
Risk Assessment* / methods
Risk Assessment* / standards
School Health Services / standards