Sweltering practices under hot, hazy and humid conditions might be more than four months away, but they are very much on the minds of state legislators this session.
While athletic programs around the state have adapted to concussion protocols and coaches have gone through hours of training to better protect their athletes, another equally dangerous aspect of youth sports does not yet require the same training.
With that in mind, Connecticut lawmakers have proposed a bill requiring high school coaches go through heat-related illness training alongside their concussion education.
In fact, House Bill No. 5431, proposed by the Public Health Committee, rewrites the concussion legislation from 2010 and 2014, adding sections on making training for heat-related illness mandatory for all high school coaches and players.
The bill, which is in committee, would require coaches to complete a course in the management of heat-related illness that includes training in the recognition of signs and symptoms of overheating.
The bill would require anyone issued a coaching permit by the State Board of Education to complete an exertional heat illness educational program prior to the start of their season and to annually review the program, just as is done with concussion training now.
“Coaches play an important role in helping prevent exertional heat illnesses because they can structure their practices and workouts in ways that can reduce risk,” said Christianne Eason, vice president of sport safety at the Korey Stringer Institute. “It’s also important that coaches are educated on the typical signs and symptoms associated with exertional heat stroke so they could recognize when an athlete is in distress and activate their emergency action plan to help ensure the athlete receives appropriate care. Sadly, exertional heat stroke is one of the leading causes of death in sport. If coaches are educated in strategies to help prevent incidence of exertional heat stroke, it can go a long way in mitigating the risk of catastrophic injury/illness and death.”
Exertional heatstroke, or EHS, is a severe form of heat-related illness that can result in brain damage, organ failure and in some cases death. It occurs when someone’s body temperature rises to 104 degrees or higher, according to the American Council on Science and Health.
According to the CDC, heat illness during practice or competition is a leading cause of death and disability among high school athletes in the United States. Forty-seven high school players died from 1995 through 2018, making up the majority of the 64 players who died in that time frame, according to the National Center for Catastrophic Sports Injury Research.
The National Center for Catastrophic Sport Injury Research reports there have been 148 heat stroke cases that resulted in death from 1960 through 2018. The report says 90% of the recorded heat stroke deaths occurred during practice.
Coaches say they are seeing the benefit of the raised awareness around concussions and feel additional knowledge regarding heat issues can be just as critical.
“The concussion training has improved things 1,000 percent. It made the game so much safer,” Guilford football coach Anthony Salvati said. “Having required training for heat issues makes sense. I coach in youth football as well and we go through training on heat issues there through USA Football. It’s very important that anytime you can look out for a player’s best interest that you do that. If we are taught what to look for, it can only make everyone safer.”
Salvati said the trainer at Guilford has been on top of heat issues in the past, alerting coaches when humidity is too high and asking the football team to not practice in pads those days.
EHS has proved to be highly survivable when immediately recognized and athletes are immediately cooled on site, according to the Stringer Institute.
Last year, the Connecticut Interscholastic Athletic Conference made it easier for schools to immediately treat heat-related illness when it donated 73 cooling tubs to member schools.
The tubs will be used by school athletic departments as a means of emergency treatment for athletes who suffer heat illness through participation in sports.
“We at the CIAC make student safety our first priority,” CIAC Executive Director Glenn Lungarini said in a press release. “We are glad to purchase and distribute these tubs to our schools that need them in order to help them keep kids safe during an emergency.”
Lungarini recognized the collaborative effort of the Connecticut Athletic Trainers Association (CATA), the Stringer Institute and the CIAC working together to provide schools with the most up-to-date training to be prepared for all athletic emergencies.
The Korey Stringer Institute at UConn is named after the Minnesota Vikings Pro Bowl offensive tackle who died from an EHS during training camp in August 2001.
The Institute provides research, education, advocacy and consultation to optimize safety and prevent sudden death for athletes and others working or playing in extreme heat.
They worked closely with legislators, CATA and the CIAC to draft language for the proposed bill.
Emergency medical guidance requires that victims of heat illness are cooled as soon as possible to prevent EHS and death.
While most other serious emergencies and injuries require stabilization and rapid transport to the hospital, stabilizing an overheated athlete on site could be the difference between life and death.
The revised guidelines still require calling 911 immediately; however, the new regulations stipulate that for heat illness the victim’s body temperature must be lowered before transportation, and cold tubs are the most effective way to do that quickly.
“As far as heat illness, the gold standard is to cool them before you ship them. The best way to lower their temperature is for ice and immersion,” Stamford athletic trainer Jordan Napolitano said. “We had a whirlpool tub we could use but that required getting the kid to the tub. These cooling tubs from the CIAC are big, but we can move them to the field where the athlete is. Having this option is better and could potentially save a life.”
Stamford put in water spigots at the upper soccer/lacrosse, baseball fields and in Boyle Stadium so the tub could be brought with ice to the field in need and filled with water.
Having cold immersion tubs on site is critical to saving lives, according to the Stringer Institute.
“I cannot overstate how important cold water immersion tubs are in the treatment of exertional heat stroke,” Eason said. “Exertional heat stroke is 100% survivable if cold water immersion is initiated within 15 minutes of collapse. We advocate for cool first, transport second because rapid cooling is the most important determinant of exertional heat stroke outcomes.”
The CIAC purchased the tubs with support from H.W. Hine Hardware in Cheshire, an ACE Hardware affiliate.
Napolitano said while the tubs are critical, educating coaches as they were for concussions is the biggest factor in keeping athletes safe.
“Education is great. Coaches have already come a long way from years ago. Most coaches now are rarely going to push kids to that extreme,” Napolitano said. “It makes me feel better if I have to step away from a field that the coaches know what to look for. More training and awareness makes my job and all trainers’ jobs easier.”
More education can only be a good thing. Connecticut was ranked 39th in the 2020 State High School Sports Safety Policy Evaluation, according to the Stringer Institute.
“Education is a crucial component of preventing exertional heat illnesses,” Eason said. “We always advocate for the presence of a health care provider, such as an athletic trainer, on site at practices and games. Whether that’s possible or not, it’s important for coaches to have this education to help protect the health and safety of student-athletes. The more eyes that are looking out for the well-being of these young athletes, the better.”
In addition to cold tubs, some trainers are now equipped with Wet Bulb Globe Thermometers.
Wet bulbs provide trainers with a composite temperature used to estimate the effect of temperature, humidity and solar radiation on people. This instrument determines a true heat stress temperature by accounting for air flow, humidity and the strength of the sun, in addition to air temperature and relative humidity.
If the wet bulb indicates the weather is not conducive to outdoor sports, trainers can alert coaches to halt practice.
“Any fancy technology we can use to reinforce our decisions is wonderful,” Napolitano said. “Wet bulbs take the guesswork out of it. It helps a lot on days when it’s close as to whether they should practice or not because it’s too hot. The more we know, the less mistakes will be made.”
SCHOOLS RECEIVING COLD TUBS FROM CIAC
A.I. Prince Tech
EC Goodwin Tech
New Haven-Wilbur Cross
University High School of Science and Engineering