NFHS Voice: Preparations Must Begin Now to Prevent Heat-Related Illnesses in Fall Sports, Activities

The heat is on – and so is the smoke and haze – as millions of middle school and high school student-athletes and participants in activities like marching band get set to begin the fall seasons in our nation’s schools.

In addition to football, coaches in many other fall sports, such as volleyball, soccer and field hockey – are beginning their preparations for the upcoming seasons. And a successful season starts with taking the necessary steps to reduce the risk of illness and injury for student participants.

Later this month and throughout August, triple digit temperatures and heat indices are ever present in many parts of the country, and coaches, athletic trainers and other team leaders MUST take appropriate steps to ensure that practices are altered or shut down when conditions warrant. In addition, air quality has been impacted in several states by wildfires.

Earlier this month, the NFHS Sports Medicine Advisory Committee (SMAC), led by Dr. Alex Diamond, chair of the committee, distributed resources to member state associations to share with schools in their state. Historically, late July and early August have been the highest-risk times of the year for heat-related illnesses and deaths, so the NFHS wants to make sure schools stay aware of weather issues on a daily basis.

It may sound like a broken record, but simply put, heat-related illnesses and deaths are preventable. With preseason practices on the horizon, now is the time to ensure plans are in place for proper hydration, stopping practices and enactment of Emergency Action Plans (EAP). Coaches may not like shortening or stopping practices, but the health and well-being of students MUST come first.

And the NFHS Sports Medicine Advisory Committee emphasizes that heat illness is not limited to football. Any student participating in outdoor activities or exercising in hot environments is vulnerable, including those involved in marching band, cheer, cross country, soccer and even indoor activities held in non-air conditioned gymnasiums.

The NFHS SMAC and the NFHS Learning Center continue to offer many educational tools to assist schools in developing a proper heat acclimatization and heat illness prevention program. In addition, many state associations have developed state-specific guidelines for dealing with heat issues and safety challenges.

Most recently, the NFHS SMAC convened an expert task force this past spring to address a critical and persistent safety issue in high school football: exertional heat stroke (EHS), the leading cause of preventable death in high school football players. Nearly all EHS fatalities occur during sustained, high‑intensity conditioning sessions in the first week of practice, and 97 percent involve football linemen.  In response, the task force has developed Preventing Exertional Heat Stroke (EHS) in High School Football Linemen – position‑specific guidance designed to fundamentally shift how football linemen are trained and conditioned.

In addition, the SMAC has developed a “Heat Acclimatization and Heat Illness Prevention Position Statement” which is available on the NFHS website.  This document contains seven fundamentals of a Heat Acclimatization Program. In addition, the SMAC’s “Position Statement and Recommendations for Maintaining Hydration to Optimize Performance and Minimize the Risk for Exertional Heat Illness” is also available on the sports medicine page of the NFHS website.

Venue and sport/activity specific emergency action plans (EAP) for interscholastic activities play a pivotal role in preemptively addressing and responding to potential risks and emergencies. The SMAC’s “Emergency Action Plan (EAP) for Interscholastic Activities Position Statement” is also available on the sports medicine page of the NFHS Website.

Through the NFHS Learning Center, the NFHS offers a free online course entitled Heat Illness Prevention. This course, which is available at www.nfhslearn.com, also reviews the seven fundamentals of a Heat Acclimatization Program. More than four million Heat Illness Prevention courses have been accessed. In addition, to address the necessary precautions for participants in marching band, the NFHS has a free course entitled Band Safety.

Among the fundamentals of a Heat Acclimatization Program are 1) a slow progression in activity level – duration and intensity; 2) adjusting workouts as heat and humidity increase, including close monitoring and a prompt response to developing problems; and 3) proper hydration.

Four other NFHS Learning Center courses should be a part of the preseason planning for all key members of the school’s team: The Collapsed Student, Sudden Cardiac Arrest, Concussion in Sports and Emergency Action Planning for Afterschool Programs.

As an additional resource, the NFHS Foundation previously distributed more than 5,000 Wet Bulb Globe Temperature (WBGT) devices to high schools across the country. The WBGT measures the heat stress in direct sunlight, accounting for temperature, humidity, wind speed, sun angle and cloud cover. High schools can use the thermometer’s reading to help determine if the weather is appropriate to hold outdoor activities. The NFHS Foundation provides a

 on proper use of WBGT. If the available devices indicate that the weather is a risk to the health of students, practices must be cancelled.

More and more states are using the WBGT devices, including the Texas University Interscholastic League (UIL), which has mandated use of WBGT monitoring effective with the 2026 football season. The UIL’s new rules for combating heat issues require four rest breaks per hour.

In an article by Jon Poorman in the Houston Chronicle, Joe Martin, executive director of the Texas High School Coaches Association, emphasized the need to keep kids safe above all else, even if it means dealing with inconveniences caused by the heat. In a state where football reigns supreme, we say “Amen.”

As we noted earlier, in addition to heat concerns, many states are dealing with air quality issues from wildfires. During periods of suspected or forecasted high air pollution, the Air Quality Index (AQI) should be checked prior to all practices and contests. Local AQI information can be found at: https://www.airnow.gov.

School leaders must also make sure that AEDs (Automated External Defibrillators) are available in key locations in the school, and that an Emergency Action Plan has been established and rehearsed. There have been several cases on high school sports fields and courts the past few years where quick action on the part of individuals saved lives, and we hope that trend continues. As a part of preseason planning, coaches and administrators should consider another NFHS Learning Center course – CPR & AED Training.

We encourage high school coaches, athletic trainers, band directors, athletic directors and others involved in the care and supervision of high school student participants to make use of these valuable resources. This is indeed the most important ingredient to a successful season.