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Outdoor Practice: Precautions to Keep in Mind During Hot, Humid Days

Heat emergencies are preventable. Here's what parents, coaches, and caregivers can keep in mind.

By Linda Goelzer

Heat illness during sports practice or competition is among the leading causes of death in the U.S. for high school athletes, according to the Centers for Disease Control and Prevention (CDC). Scorching summer sun and high temperatures put athletes at increased risk for heat illness, no matter their fitness level. 

Coaches and directors of marching bands are currently conducting practices, rehearsals and scrimmages ahead of football season. This summer, North Texas experienced lengthy stretches of triple-digit temperatures and drought. Rainy days have tampered down the heat, but the humidity is still high.

Students’ primary preparation begins with hydration – not just during and after practice. Drinking water and clear liquids must begin hours, even a day, before the exercise and exertion, said Jason Terk, M.D. of Cook Children’s Pediatrics Keller Parkway.

“If you're not dealing with a full tank, you are not going to be able to catch up or keep up,” Dr. Terk said. “Those leading the practices must also build in enough breaks for rest, shade and hydration.”

Keeping pace with science and research, the University Interscholastic League (UIL) sets guidelines around heat stress and athletic participation for high schools. Their recommendations follow research from the American Academy of Pediatrics Committee on Sports Medicine. UIL now recommends water availability for athletes in unlimited quantities. Cold water is best. Additionally, practice schedules should include 10-minute water breaks for every 20-30 minutes of exercise in the heat.

Dr. Terk is a self-proclaimed marching band nerd and is an unofficial chaperone for Keller High School’s marching band.

Guidelines Make Sense

“In 15 years of doing this, the last nine of them at Keller High School, I have no reported heat-related emergencies,” said Ryan Heath, director of the marching band.

There are two parts to Heath’s preparation for marching season, the music-only rehearsals indoors and the music-plus-marching outside.

“Our district has great guidelines related to temperatures and that dictates what our hours are,” Heath said. “We work to schedule the outdoor part in early morning or in the evening before sundown.”  

Keller Independent School District bases decisions on the National Weather Service’s Wet Bulb Globe Temperature Forecast. Its measurements can help manage workload in direct sunlight and capture temperature, humidity, wind speed, sun angle, and cloud cover (solar radiation). Many of us are more familiar with the “heat index” that only measures temperature and humidity, and does so in the shade.  

Heath starts the discussion with his students in the spring, about summer training for the fall marching band season. When rehearsals get underway, he expects students to have done enough summer activity so they can complete a one-mile run in 10 minutes. Heath says the measurement ensures band students have the cardiovascular endurance required, to play an instrument successfully and march simultaneously. He came up with it after consulting medical professionals and other  experts.

“We don’t have a certain training regimen,” Heath said. “But this is an athletic activity as much as sports and my expectation of participants is they maintain good physical health and stay hydrated.”

For safety precautions, he requires students to have a hat, sunglasses, a gallon of water, and sunscreen when they report for outdoor marching rehearsals. Without those, they cannot participate. He also says, during the first weeks of marching practice many parents show up with extra pop-up tents, ice packs and more water to help monitor students’ response to the heat. Many of the parents are doctors, nurses, nurse practitioners and others with professional expertise.   

Ease Into Practice  

“I played high school football and we practiced for three hours with one water break,” said Daniel Guzman, M.D., pediatric emergency medicine physician with Cook Children’s Medical Center. “I’m happy to see that we have advanced from the archaic ‘it will toughen you up’ to water breaks are important for players’ safety.”

Dr. Guzman’s youth sports career included summer practices in South Texas. He knows now just how dangerous it was and how preventable heat emergencies are.

“Exertional heat illness is one of the leading causes of death each year. Parents need to be aware and informed about their children’s practice schedules and the team’s policy on modifications of practice depending on the level of heat that day,” Dr. Guzman said. “At what temperatures do we modify our practice schedule?  It is within a parents’ right to know what these policies are and what are children being taught about rest and hydration to keep them safe.”

Dr. Guzman says coaches and band directors can help student athletes by acclimatizing to heat during the first seven to 14 days of practice. He says athletes can become more heat tolerant, but are never out of danger. Coaches should be careful and watch closely, while athletes need to self-restrict activity if they begin feeling badly – the sooner the better – to avoid emergencies.

“It’s important to be careful when pushing these young athletes to their limit and be mindful that most kids won’t say they feel bad or need to stop,” Dr. Guzman said.

Early Warnings

What are the earliest signs of heat illness? Dr. Guzman says it usually begins with muscle cramps, lightheadedness, headache, abdominal cramps and nausea. If you ignore these early signs, your condition could become emergent quickly. If you are too sweaty and looking pale, Dr. Guzman says that means it is time to get in the shade and drink something with electrolytes, like a chilled sports drink, to replace salts. It’s really important to treat the symptoms quickly, especially if the athlete is confused.

The color of urine is a good monitor for sufficient hydration. Dr. Guzman says it should be clear and not dark. If urine begins to look brown, red or tea-colored, there could be serious issues underway, like the medical condition called rhabdomyolysis (rhabdo). Rhabdo occurs when injured muscle tissue breaks down rapidly and releases proteins and electrolytes into the bloodstream. In large amounts, the substances can damage kidneys and other organs, cause rapid heart rate and even death.  

“The process makes the blood sluggish. Everything just aches and patients often say it’s too painful to move, they have achiness everywhere, flu-like discomfort,” Dr. Guzman said. “Kids can complain of feeling sluggish and weak. They should skip practice if this occurs and seek medical attention.”

Athletes that have dark-colored urine with or without any other symptoms should consider it a significant cause for concern. Blood tests can measure the level of substances released into the blood stream to diagnose rhabdo. One measurement important to Dr. Guzman is creatine kinase (CK). Normal ranges can vary among patient populations. Generally, he wants to see it under 300-350 micrograms per liter (mg/L). In the emergency department, he has seen patients whose CK is 1,000-2,000 mg/L range and he recalls one athlete with over 10,000 mg/L.

“The treatment is to continue IV hydration two times the normal amount until the patient feels better and the creatine kinase begins to decrease to normal levels,” Dr. Guzman said “Big muscular kids are the ones that concern us the most. Working out vigorously can break down all that muscle and create a dangerous situation.”

Avoiding heat illness among sport and marching-band athletes is a group effort among coaches, band directors, parents and kids. Respecting any outdoor activity for the possibilities and concerns related to heat stress is vital to the safety of student participants. Be cool this summer – literally!

Early Signs of Heat Stress

  • Muscle cramps
  • Lightheadedness
  • Headache
  • Abdominal cramps
  • Nausea

Reminders for Athletes and Parents

  • Monitor your body’s need for water or cooling breaks.
  • Avoid worrying about being the ‘weak link.’
  • It is okay to say, “I can't go anymore.”

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About Cook Children's

Cook Children’s Health Care System embraces an inspiring Promise – to improve the health of every child through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community. Our not-for-profit organization is comprised of nine companies, including our Medical Center, Physician Network, Home Health company, Northeast Hospital, Pediatric Surgery Center, Health Plan, Health Services Inc., Child Study Center and Health Foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. For 100 years, we’ve worked to improve the health of children from across our primary service area of Denton, Hood, Johnson, Parker, Tarrant and Wise counties. We combine the art of caring with leading technology and extraordinary collaboration to provide exceptional care for every child. This has earned Cook Children’s a strong, far-reaching reputation with patients traveling from around the country and the globe to receive life-saving pediatric care. For more information, visit