Schools are not keeping thousands of high schools athletes safe from dangerous levels of heat

The state of Georgia used to lead a category that made those involved in athletics cringe: deaths of high school athletes. 

Between 1994 and 2009, heat-related deaths among football players tripled across the country to nearly three per year. (The previous 15-year average was about one per year.)

Georgia had six fatalities in that time. Then two more high school football players died on the same day in August 2011. The Georgia High School Association (GHSA) — which oversees secondary sports around the state —  didn’t want to lead that list, so they asked researchers at the University of Georgia for help creating specific guidelines to prevent exertional heat illness.

A University of Georgia exertional heat expert, Bud Cooper, and UGA athletic trainer Mike Ferrera along with Jeff Hopp, then the president of the Georgia Athletic Trainers Association (GATA), collected heat and temperature data for five years and analyzed it. The results found that risk for exertional heat illness (EHI) was greatest during the first six days of practice, when the practice lasted more than two hours and when weather conditions were “hot.”

The team also recommended modifications be made to practice sessions — including the duration and intensity of workouts, equipment worn, and breaks for hydration and rest.

The state made those recommendations requirements. Georgia was the first state to have revised practice rules based on research-supported data.

One of the other changes: Georgia high schools take the wet bulb globe temperature (WBGT) before every practice, allowing them to know the exact environment conditions — heat, humidity, etc. — of the venue. They’re required to log the WBGT daily and report them. They’re also the only state that requires this, with consequences for lack of reporting.

Since adopted, no deaths have happened under the requirements. (Deaths of Georgia high school athletes have still happened but it was found that those schools haven’t followed the state’s requirements.) Georgia is the exception, not the rule. 

In Kentucky, high school teams practice — or don’t — in the heat based on the heat index. That’s a flawed metric for many reasons, including the fact it doesn’t take into consideration as many data points as a WBGT reading.

Heat is the leading cause of death of high school athletes, but only during the summer. The rest of the year, the leading cause is sudden cardiac arrest, according to the Korey Stringer Institute, which tracks data nationwide on the sudden death in high school athletes. The Institute is named after the former Minnesota Vikings All-Pro lineman who collapsed during training camp and died on August 1, 2001 from heat stroke.

So what are the gold standards? And who is requiring them?

For instance, Kentucky requires venue-specific emergency action plans (EAP), which state who to contact in an emergency at a practice or game venue. The Kentucky High School Sports Association (KHSAA) recommends a defibrillator within three minutes of a game or practice. (Data from the American Heart Association shows chance of survival goes down 10% for every minute of cardiac arrest.) 

But Kentucky didn’t require venue-specific EAPs until a Louisville-area high school football player named Max Gilpin collapsed and died during conditioning in August 2008. His death drew national attention. Kentucky State Rep. Joni Jenkins represented Gilpin’s district and created the law. She realized if change was going to happen, it had to start with her.

Changes don’t always happen because there isn’t always someone to implement it. That’s because nationally, only 37% of high schools have a full-time athletic trainer, leaving thousands of sidelines and thousands of athletes unprotected. An athletic trainer is considered the health care professional of a sideline. They are the ones to implement and enforce health care measures such as venue-specific EAPs and AEDs. They are educated and trained in emergency response and help athletic directors, superintendents and school administrators when it comes to the health and safety of a high school’s athletes.

For the last seven years, I’ve researched health care on high school sidelines for both newspapers and TV stations in Texas and Ohio, arguably two of the most sports-crazed states in the country. I’d like to identify which states legislatures and state sport associations require gold standard sports medicine protections for their athletes. As we learned with the coronavirus pandemic, there’s a large difference between a requirement or mandate versus a recommendation.

When I sat down to interview Joni Jenkins about the law she created to protect Kentucky high school athletes she said something that became the motto of this project: “You don’t know what you don’t know.” Many parents don’t know that there isn’t an athletic trainer on the sidelines of their high school athlete’s practice. But health care experts do know that heat stroke is 100% preventable.

So why do high school athletes keep collapsing?