Social Circle City Schools

Revised June 2012

Exertional Heat Protocols

INTRODUCTION

This Social CircleCity School district protocol will apply to all athletic practices andactivities held within the Social Circle City School district. The Exertional Heat Protocol is designed to protect students/athletes from sustaining heat related illnesses or problems. This is a guide for Administrators, Certified Athletic Trainers, Teachersand Coaches to use and refer to when making decisions or modifying and/or suspending outdoorathletic practices and activities.

Throughout the months of June, July, August, September, and warmer days of October, a designated individual will determine thedaily Wet Bulb Globe Temperatureindex (WBGTi)using a WBGT Index Monitor device to access environmental and weather indicators. Administrators, Certified Athletic Trainers, Teachersand/or Coaches will then make a decision using the guide below on whether to make modifications for all outdoorathletic practices and activities to be held that afternoon. Officials at the appropriate schools will be notified of any unsafe conditions. Coaches/Teachers will then make the necessary modifications and notify their immediate Administrators and students/athletes.

I. GUIDELINES FOR EXERTIONAL HEAT MODIFICATIONS

Revise GHSA By-Law 2.67 - "Practice Policy and Heat and Humidity" as follows:

Schools must follow the statewide policy for conducting practices and voluntary conditioning workouts in all sports during times of extremely high heat and/or humidity that will be signed by each head coach at the beginning of each season and distributed to all players and their parents or guardians. The policy shall follow modified guidelines of the AmericanCollege of Sports Medicine in regard to:

1. The scheduling of practices at various heat/humidity levels

2. The ratio of workout time to time allotted for rest and hydration at various heat/humidity levels

3. The heat/humidity level that will result in practice being terminated

A scientifically approved instrument that measures Wet Bulb Globe Temperature (WBGT) reading must be utilized at each practice/outdoor activity to ensure that the written policy is being followed properly.

II. WBGT READING ACTIVITY GUIDELINES & REST BREAK GUIDELINES

Under 82.0 Green Flag; Normal activities--Provide at least 3 separate rest breaks each hour of minimum duration of 3 minutes each during workout

82.0 - 86.9 Yellow Flag; Use discretion for intense or prolonged exercise; watch at-risk players carefully; provide at least 3 separate rest breaks each hour of a minimum of 4 minutes duration each

87.0 - 89.9 Orange Flag;Maximum practice time is 2 hours. For Football: players restricted to helmet, shoulder pads, and shorts during practice. All protective equipment must be removed for conditioning activities. For all sports: Provide at least 4 separate rest breaks each hour of a minimum of 4 minutes each

90.0 - 92.0 Red Flag; Maximum length of Walk Through is 1 hour, no protective equipment may be worn and there may be no conditioning activities. There must be 20-minutes of rest breaks provided during the hour of practice(i.e. 20 minutes of Walk Through activity, then 20 minutes of rest break, then 20 minutes of Walk Through activity)

Over 92.1 Black Flag; No outdoor workouts; Cancel exercise; delay practices, walk throughs and activities until a cooler WBGT reading occurs

III.FOOTBALL PRESEASON PRACTICE REQUIREMENTS

1. Football practice may begin 5 consecutive weekdays prior to August 1. In the first 5 days of practice for any student/athlete, the practice shall not last longer than 2 hours, and the student/athlete shall wear no protective gear except for helmet and mouthpiece. Note: The time for a session shall be measured from the time the student/athlete reports to the field until they leave the field.

2. Beginning August 1, any student/athlete may practice in full pads and may practice 2 times in a single calendar day under the following stipulations:

a. A student/athlete must have participated in 5 conditioning practice days wearing no protective gear other than helmet and mouthpiece before being allowed to practice in full pads

b. If multiple workouts are held in a single day:

(1) No single session may last longer than 3 hours

(2) The total mount of time in the two practices shall not exceed 5 hours

(3) There must be at least a 3-hour time of rest between sessions

(4) There may not be consecutive days of two-a-day practices. All double-session days must be followed by a single-session day or a day off

c. These procedures are derived from recommendations created by the Inter-Association Task Force for Preseason Secondary School Athletics Participants in the research paper "Preseason Heat-Acclimatization Guidelines for Secondary School Athletics."

DEFINITIONS

1.Practice:the period of time that a participant engages in a coach-supervised, school-approved sport or conditioning-related activity. Practices are timed from the time the players report to the field until they leave the field.

2.Walk Through: a teaching opportunity with the student/athlete not wearing protective equipment or using other sport-related equipment. This period of time shall last no more than 1 hour, is not considered to be a part of the practice time regulation, and may not involve conditioning or weight-room activities.

IV. GUIDELINES FOR HYDRATION AND REST BREAKS

1. Rest time should involve both unlimited hydration intake (water or electrolyte drinks) and rest without any activity involved

2. For football, helmets should be removed during rest time

3. The site of the rest time should be a "cooling zone" and not in direct sunlight

4. When the WBGT reading is over 86:

a. ice towels and spray bottles filled with ice water should be available at the "cooling zone" to aid the cooling process

b. cold immersion tubs must be available for practice for the benefit of any player showing early signs of heat illness

V. RECOGNITION OF HEAT EXHAUSTION

Most critical criteria for determination are:

1) Athlete has obvious difficulty continuing intense exercise in heat,

2) Lack of severe hyperthermia (usually < 104F) and

3) Lack of severe CNS dysfunction. If any CNS dysfunction is present, it will be mild and symptoms will subside quickly with treatment and as activity is discontinued.

Other possible salient findings include physical fatigue/dizziness, dehydration and/or electrolyte depletion, ataxia and coordination problems, syncope, profuse sweating, pallor, headache, nausea, vomiting, diarrhea, stomach/intestinal cramps, persistent muscle cramps, and rapid recovery with treatment.

VI. EMERGENCY TREATMENT OF HEAT EXHAUSTION

The following procedures are recommended if heat exhaustion is suspected:

1) Remove athlete from play and immediately move to an air-conditioned or shaded area

2) Remove excess clothing and equipment

3) Cool athlete

4) Have athlete lie comfortably with legs propped above heart level

5) If athlete is not nauseated, vomiting, or experiencing any CNS dysfunction, rehydrate orally with chilled electrolyte drink or water

6) Monitor heart rate, blood pressure, respiratory, core temperature, and CNS status

7) CALL 911, INITIATE Emergency Action Plan if rapid improvement is not noted with prescribed intervention and treatment

VII. RECOGNITION OF HEAT STROKE

The ability to rapidly and accurately assess core body temperature and CNS functioning is critical to the proper evaluation of Exertional Heat Stroke. Medical staff should be properly trained and equipped to assess core temperature via rectal thermometer when feasible.

Most critical criteria for determination are

1) Hyperthermic (rectal temperature > 104F) immediately post-incident

and

2) CNS dysfunction (altered consciousness, coma, convulsions, disorientation, irrational behavior, decreased mental acuity, irritability, emotional instability, confusion, hysteria, apathy).

Other possible salient findings include nausea, vomiting, diarrhea, headache, dizziness, weakness, hot and wet or dry skin (important to note that skin may be wet or dry at time of incident), increased heart rate, decreased blood pressure, increased respiratory rate, dehydration, and combativeness.

Aggressive and immediate whole-body cooling is the key to optimizing treatment of Exertional Heat Stroke. The duration and degree of hyperthermia may determine adverse outcomes. If untreated, hyperthermia-induced physiologic changes resulting in fatal consequences may occur within vital organ systems (e.g., muscle, heart, brain, etc.).

VIII. EMERGENCY TREATMENT OF HEAT STROKE

Immediate whole-body cooling is the best treatment for Exertional Heat Stroke and should be initiated within minutes post-incident. It is recommended to cool first and Medical Transport second if onsite rapid cooling is possible. Cooling can be successfully verified by measuring rectal temperature. If onsite cooling is not an option, the student/athlete should be immediately transferred to the nearest medical facility via the Emergency Action Plan.

The following procedures are recommended if Exertional Heat Stroke is suspected:

1) Remove clothing and equipment

2) Move athlete immediately to air-conditioned facility or shaded area if possible

3) Cool athlete immediately by:

  • immerse athlete in tub of cold water; stir water and, if necessary, add ice throughout cooling process

or

  • place ice bags or ice over as much of body as possible, cover body with cold towels (replace towels frequently), fan body or spray with cold water

4) Monitor ABCs, Core temperature, and CNS (cognitive, convulsions, orientation, consciousness, etc.)

5) CALL 911, INITIATE Emergency Action Plan and continue to monitorvital and trending signs

* Ice/cold water immersion has proven to have superior cooling rates to other modes. However, oftentimes with heat stroke the athlete is unresponsive. This may complicate airway management and other emergency interventions if the athlete is immersed in water. The medical staff should make the decision on the most feasible mode of cooling based upon athlete’s physical presentation. Choice of cooling modes may also be dependent on other factors, such as size limitations, availability of cooling options and maintaining safety of athlete.

IX. ROLE OF SCHOOL REPRESENTATIVES

It is the responsibility of all Coaches/Teachers in all sports and outdoor activities within the Social Circle City School System to provide ample supplies of water to our students/athletes. It is recommended that all guidelines be followed in such a way that the best interests of our students/athletes be made our number one priority. It is also recommended that Coaches/Teachers constantly teach the students/athletes about proper hydration throughout each day. It is important that the student/athlete be allowed to carry water with them during and throughout the day and hydrate themselves, on days of activity, practice and games; particularly on those days when the weather has the possibility of reaching critical levels in relation to the heat, humidity and solar load.

Approved by: ______Medical Director Date: ______Garey Huff, MD