Heat Acclimatization and Heat Illness Prevention Position Statement - April 2022

The Fundamentals are included in this key document and should be used as a guiding document by member state associations and member state associations are strongly encouraged to incorporate all of the “Fundamentals” into any heat
acclimatization plan to improve athlete safety

1. Physical exertion and training activities should begin slowly and continue progressively. An athlete cannot be
   “conditioned” in a period of only two to three weeks. Rationale: The majority of heat-related deaths happen during the first few days of practice, usually
   prompted by doing too much, too soon, and in some cases with too much protective gear on too early in the
   season (wearing helmet, shoulder pads, pants and other protective gear). Players must be allowed the time to
   adapt safely to the environment, intensity, duration, and uniform/equipment.
2. Keep each athlete’s individual level of conditioning and medical status in mind and adjust activity accordingly. These factors directly affect exertional heat illness risk.
   Rationale: Athletes begin each season’s practices and training activities at varying levels of physical fitness and varying levels of risk for exertional heat illness. For example, there is an increased risk if the athlete is obese, unfit, has been recently ill, has a previous history of exertional heat illness, or has Sickle Cell Trait.
3. Adjust intensity (lower) and rest breaks (increase frequency/duration), and consider reducing uniform and
   protective equipment, while being sure to monitor all players more closely as conditions are increasingly warm/humid, especially if there is a change in weather from the previous few days.
   Rationale: Coaches must be prepared to immediately adjust for changing weather conditions, while recognizing that tolerance to physical activity decreases and exertional heat illness risk increases, as the heat and/or humidity rise. Accordingly, it is imperative to adjust practices and/or competitions to maintain safety and performance. Coaches can monitor the athletes’ weights pre and post practice to ensure adequate fluid
   replacement, and can follow guidelines for hot and humid weather including using Wet Bulb Globe Temperature (WBGT) readings.
4. Athletes must begin practices and training activities adequately hydrated.
   Rationale: While proper hydration alone will not necessarily prevent exertional heat illness, it will decrease risk. Athletes can observe the color of their urine, which should be straw yellow or the color of
   lemonade, when adequately hydrated.
5. Recognize early signs of distress and developing exertional heat illness, and promptly adjust activity and treat appropriately. First aid should not be delayed! Rationale: An athlete will often show early signs and/or symptoms of developing exertional heat illness. If these signs and symptoms are promptly recognized and the athlete is appropriately treated, serious
   injury can be averted and the athlete can often be treated, rested and returned to activity when the signs and
   symptoms have resolved.
6. Recognize more serious signs of exertional heat illness (clumsiness, stumbling, collapse, obvious behavioral
   changes and/or other central nervous system problems), immediately stop activity and promptly seek medical
   attention by activating the Emergency Medical System (or Call 9-1-1). On-site rapid cooling should begin
   immediately. Rationale: Immediate medical treatment and prompt rapid cooling can prevent death or minimize
   further injury in the athlete with EHS. Ideally, pools or tubs of ice water to be used for rapid cooling of athletes
   should be available on-site and personnel should be trained and practiced in using these facilities for rapid cooling. Ice water baths are the preferred method for rapid cooling, however, if ice water pools or tubs are not available, then applying ice packs to the neck, axillae, and groin and rotating ice-water soaked towels to all
   other areas of the body can be effective in cooling an affected athlete. Remember, cool first, transport later.
7. An Emergency Action Plan (EAP) with clearly defined written and practiced protocols should be developed
   and in place ahead of time.
   Rationale: An EAP should be in place in case of any emergency, as a prompt and appropriate response
   in any emergency situation can save a life. The EAP should be designed and practiced to address all teams
   (freshman, junior varsity, and varsity) and all practice and game sites. For heat illness emergencies, emphasis
   must be placed on full body cooling prior to transport.