Planning Is the Key to Preventing Heat-Related Injuries
When I first wrote about heat-related sports injuries in 2015, I began by noting that July 2015 had been the warmest month ever recorded globally and that nine of the ten warmest months on record had occurred since 2005. At the time, those statistics were startling.
Today, they are almost difficult to put into perspective.
2024 was the warmest year in NOAA’s global record, and 2025 ranked as the third-warmest. More significantly, NOAA reports that all 10 of the warmest years in the historical record have occurred since 2015.
And the trend is not merely something occurring somewhere else in the world. In July 2026, the contiguous United States experienced its hottest month on record, surpassing the previous record set during the Dust Bowl era in July 1936. Every one of the 48 contiguous states recorded temperatures at least 1°F above the 20th-century average.
For athletes, that matters.
As training camps, preseason workouts and practices begin for high school and youth sports, heat is not an occasional consideration. It is a recurring environmental hazard that coaches, athletic departments, schools, parents and athletes must actively manage.
Football understandably receives much of the attention. Football players face unique risks because of the physical demands of the sport, protective equipment, body size and the intensity of preseason conditioning. But heat-related illness is not limited to football. Soccer, field hockey, lacrosse, cross-country, track and field and other outdoor activities can all expose athletes to potentially dangerous heat stress.
And unlike many sports injuries, exertional heat stroke is preventable when appropriate precautions are taken and an emergency is recognized and treated immediately. The National Federation of State High School Associations (NFHS) continues to identify exertional heat stroke as the leading cause of preventable death in high school athletics.
The question for high schools—and increasingly for youth sports organizations—is not simply whether they have a heat policy.
It is whether they have a comprehensive, practiced plan that actually works when an athlete begins to fail.
Knowing the Problem
Heat-related illness exists on a spectrum, from heat cramps and heat exhaustion to exertional heat stroke (EHS), the most serious form.
During strenuous exercise, the body produces substantial heat. Environmental conditions can make it increasingly difficult for the body to dissipate that heat. High temperature, humidity, direct sunlight and inadequate recovery can all contribute to rising core body temperature.
Dehydration can compound the problem, but it is important not to oversimplify the cause of heat illness. An athlete does not have to be dehydrated to suffer exertional heat stroke. The combination of intense physical exertion and environmental stress can overwhelm the body’s ability to regulate temperature.
Exertional heat stroke is a medical emergency. Warning signs can include confusion, altered mental status, collapse, dizziness, nausea or vomiting, headache and an abnormally high body temperature. A rectal temperature is considered the most accurate field measurement of core temperature, but treatment should not be delayed while waiting for a thermometer reading if EHS is strongly suspected.
The CDC emphasizes that athletes exercising in hot conditions are particularly vulnerable and recommends modifying activity, scheduling practices during cooler portions of the day, pacing activity, maintaining hydration and monitoring teammates for symptoms.
The numbers are still concerning
Research published in recent years confirms that heat illness remains a significant problem in secondary-school athletics.
A 2024 analysis of high-school sports injury surveillance data found that exertional heat illness rates were highest in football—4.42 cases per 100,000 athlete-exposures—followed by girls’ field hockey and girls’ lacrosse.
Even more concerning is what we know about fatal cases.
A study published in 2025 examining secondary-school exertional heat stroke fatalities identified 67 deaths among athletes ages 13–18. Sixty-six of the 67 victims were male, and 63 deaths—94%—involved football. The greatest number of deaths occurred in August, followed by July and September.
That timing is not surprising.
August is precisely when many athletes are returning to demanding preseason workouts, often after weeks or months away from organized practices.
That is why heat acclimatization matters.
Football’s Most Vulnerable Athletes
One of the most important developments since 2015 is that research has become much more specific about which football players are at greatest risk.
A 2024 analysis of the National Registry of Catastrophic Sports Injuries documented 159 exertional heat stroke fatalities among youth, high school and collegiate football players from 1955 through 2021—an average of approximately two deaths per season.
The research has also highlighted an especially vulnerable population: football linemen.
Linemen are exposed to repeated high-intensity bursts of activity while wearing substantial protective equipment, often with less opportunity for meaningful recovery. Their body size and the nature of their position can further increase heat stress.
As a result, the NFHS has developed specific heat-acclimatization guidance for high-school football linemen rather than assuming that all football players face identical risks.
The National Athletic Trainers’ Association has also made prevention of exertional heat stroke in football linemen a specific area of current guidance, reflecting the growing recognition that prevention strategies need to account for position-specific risks.
The lesson is important:
A heat policy should not simply exist. It should account for the athletes actually participating in the program.
Heat Acclimatization Is Not Optional
One of the most effective ways to reduce heat-related illness is gradual acclimatization.
Athletes who are suddenly exposed to intense exercise in hot and humid conditions are at greater risk than athletes who have had an opportunity to progressively adapt.
The Korey Stringer Institute continues to emphasize a structured acclimatization period, particularly during the initial days of preseason practice.
A comprehensive plan should address:
- Gradually increasing practice duration and intensity.
- Limiting equipment during the earliest practices.
- Providing frequent rest and hydration breaks.
- Avoiding unnecessary conditioning in full equipment.
- Monitoring athletes closely during the first several days of practice.
- Paying particular attention to athletes returning after an absence.
- Considering environmental conditions before and throughout each practice.
- Having appropriate cooling equipment immediately available.
Pennsylvania provides a useful example. The PIAA requires five consecutive days of heat acclimatization before football contact drills begin.
But a calendar requirement alone is not enough.
Acclimatization must be combined with environmental monitoring, appropriate workload management and an emergency response plan.
Don’t Just Look at the Temperature
In 2015, I recommended that athletic programs use Wet Bulb Globe Temperature, or WBGT, rather than relying solely on the air temperature.
That recommendation remains important—and the tools available to schools have improved.
WBGT considers temperature, humidity, wind speed, solar radiation, sun angle and cloud cover. Unlike the traditional heat index, which assumes shaded conditions, WBGT is designed to better assess heat stress for people exercising or working outdoors. The National Weather Service specifically identifies athletes and other people performing strenuous outdoor activity as populations for whom WBGT is useful.
The National Weather Service now provides WBGT forecasts that can be used for planning, including forecasts extending several days into the future.
That means a school does not have to wait until athletes are already on the field to determine whether conditions may be dangerous.
Plan ahead.
If the forecast indicates dangerous conditions, modify the practice schedule, move activities indoors when possible, shorten the practice, reduce equipment or postpone the activity.
The best heat emergency is the one that never occurs.
The Most Important Change: Cool First
Perhaps the most important evolution in heat-illness guidance since 2015 concerns what happens when prevention fails.
If an athlete is showing signs of exertional heat stroke, time is critical.
The CDC recommends immediately beginning cooling while emergency medical assistance is being summoned. Rapid cooling can include cold- or ice-water immersion, a cool shower, spraying with cool water or other effective cooling methods.
The practical message for athletic programs is simple:
If you suspect exertional heat stroke, begin cooling immediately. Do not wait for the ambulance to arrive.
A properly equipped athletic facility should have a method for rapidly cooling an athlete. For many programs, that means a cold-water immersion tub or another appropriately designed cooling system.
This is also why emergency medical services and the athletic program need to understand their respective roles before an emergency occurs.
An emergency action plan should clearly address:
- Who recognizes and declares the emergency.
- Who calls 911.
- Who begins cooling.
- Where the cooling equipment is located.
- Who retrieves it.
- Who meets EMS.
- The quickest route to the athlete.
- The location and access points for the athletic venue.
- How transportation will occur.
- Who communicates with parents or guardians.
- What happens if the athletic trainer is not present.
Every second matters.
Emergency Action Plans
In my original article, I emphasized the importance of an Emergency Action Plan (EAP). That recommendation is even more important today.
An EAP should be written, specific to the venue and practiced—not simply filed away in an office.
A good EAP should identify the personnel responsible for each aspect of the response, the location of emergency equipment, communication procedures, transportation arrangements and directions for emergency responders.
It should also be reviewed regularly.
A football field, soccer complex, track facility and gymnasium may all require different plans because access points, equipment and emergency response routes may differ.
And the plan should account for the possibility that the athletic trainer is not present.
Athletic trainers are healthcare professionals trained to prevent, recognize and manage injuries and medical emergencies, including heat stroke. Yet access to athletic trainers remains inconsistent across secondary schools. KSI’s national data demonstrate significant differences in athletic-training coverage among schools and states.
The absence of an athletic trainer, however, cannot mean the absence of a plan.
Coaches and other personnel should know how to recognize an emergency, activate the EAP and begin appropriate first aid while professional medical care is being summoned.
Education Is Prevention
Every person involved in an athletic program has a role in preventing heat illness.
That includes:
Athletes. They need to understand that pushing through confusion, dizziness, weakness or other symptoms is not toughness. It can be dangerous.
Coaches. Coaches control practice intensity, duration, equipment and breaks. They must be empowered—and expected—to modify or stop activity when conditions become unsafe.
Athletic trainers and medical personnel. They should be involved in developing heat policies, assessing environmental conditions and establishing emergency procedures.
Parents. Parents should know the signs of heat illness and understand the school’s procedures.
Administrators. Administrators must provide the resources necessary to implement the policy, including appropriate equipment and personnel.
The CDC specifically recommends educating coaches, teachers, parents and high-school athletes about heat safety and recognizing heat-related illness.
The Legal Responsibility
There is another reason schools and youth sports organizations need to take heat safety seriously: preventable injuries can create legal exposure.
Sports injuries will happen. No reasonable safety program can eliminate every injury from athletic competition.
But heat stroke is different.
When an organization knows that athletes will be exercising in potentially dangerous environmental conditions, it has an opportunity—and arguably a responsibility—to take reasonable precautions.
That means having appropriate policies, following applicable state athletic-association requirements, educating personnel, monitoring environmental conditions, providing adequate hydration and rest, properly acclimatizing athletes, maintaining appropriate emergency equipment and having a practiced emergency action plan.
A written policy that is not followed is not a meaningful safety program.
From a risk-management perspective, schools and organizations should be able to demonstrate not only that they had a policy, but that they:
- Adopted appropriate standards.
- Communicated those standards to coaches and staff.
- Trained the people responsible for implementing them.
- Provided the necessary equipment and resources.
- Monitored environmental conditions.
- Documented modifications when conditions required them.
- Maintained and rehearsed an emergency action plan.
- Reviewed the plan regularly and updated it when circumstances changed.
The precise legal duties and potential liability will vary depending on the jurisdiction, the organization and the circumstances of the injury. But from both a safety and risk-management perspective, failing to prepare for a known and foreseeable hazard is difficult to defend.
Plan Ahead
The most important lesson has not changed since I wrote this article in 2015:
Planning is the key to preventing heat-related injuries.
But in 2026, we know considerably more about how to do it.
Schools and youth sports organizations should enter every season with a comprehensive heat-safety program that includes:
- A written heat-acclimatization policy.
- Environmental monitoring using WBGT or another appropriate system.
- Clearly defined practice and activity modifications.
- Special consideration for high-risk athletes and positions.
- Adequate water and hydration opportunities.
- Frequent rest and cooling breaks.
- Appropriate shade and cooling resources.
- Immediate access to effective cooling equipment.
- An emergency action plan specific to each athletic venue.
- CPR/AED and first-aid training for appropriate personnel.
- Education for athletes, parents, coaches and administrators.
- Regular review and rehearsal of the emergency plan.
- Documentation demonstrating that the policies are actually being followed.
Most importantly, everyone involved needs to understand one fundamental principle:
An athlete suffering from exertional heat stroke needs immediate cooling—not simply a trip to the hospital.
EMS should be activated, but cooling should begin immediately while waiting for emergency responders.
The science has advanced considerably since 2015. Our ability to forecast heat, measure environmental stress, acclimatize athletes and treat heat stroke has improved.
Yet athletes are still suffering—and some are still dying—from a condition that can often be prevented.
That means the responsibility belongs to all of us.
The best defense will always be proactive offense.
Plan for the heat. Recognize the warning signs. Have the equipment ready. Practice the emergency response. And never assume that an athlete will be safe simply because a policy exists.
When it comes to heat-related sports injuries, preparation is not just good practice.
It can save a life.
