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

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

Earl R Cooper  1 , Andrew J Grundstein  2 , Jessica D Miles  3 , Michael S Ferrara  4 , Patrick Curry  5 , Douglas J Casa  6 , Yuri Hosokawa  7
Affiliations

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

Earl R Cooper et al. J Athl Train. .

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.

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Figures

Figure 1
Figure 1
Georgia High School Association regions (North, Metro, Central, Southeast, and Southwest) and participating high schools (circles).
Figure 2
Figure 2
Cumulative heat-syncope and heat-exhaustion incidents (percentages) over the first 20 practice days during the prepolicy period.
Figure 3
Figure 3
Heat-syncope and heat-exhaustion illness rate per 1000 athlete-exposures (AEs) during practice days 1 to 5 and 6 to 10 in the prepolicy period.
Figure 4
Figure 4
Comparison of, A, overall heat-syncope and heat-exhaustion illness rates in the prepolicy and postpolicy periods and, B, percentage of decrease in heat-syncope and heat-exhaustion illness rates in the postpolicy period relative to the prepolicy period.
See this image and copyright information in PMC

References

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