Practicing during some of the year’s hottest months, fall sports athletes can be susceptible to heat-related illnesses.
The most serious are especially prevalent in football because of the frequency of contact and added heat from protective padding.
According to the American Council on Health and Science, at least 30 college football players died from heatstroke between 2000 and 2018. That number includes 19-year-old University of Maryland offensive lineman and former McDonogh star Jordan McNair, who died June 13, 2018, after overheating during a summer team workout.
In recent years, football coaches, school administrators and medical professionals have taken steps to ensure the safety of athletes.
One Howard County parent, Dr. George Garbis, teamed with business partner Viron Wildy to design a small piece of equipment that could make a big difference: a color-changing mouthguard.
On Friday, Garbis fitted the entire Glenelg varsity football team with the ThermoPact MouthShield, which aims to not only reduce the impact of collisions but prevent potential heat-related injuries. Garbis, a dentist, initially launched the product on Memorial Day, fitting 250 to 280 athletes at the Big 33 Football Classic, an all-star event featuring the top high-school football players in Pennsylvania and Maryland, in Pennsylvania, and hopes to eventually outfit as many varsity football teams in Howard County as possible.
According to Garbis, the ThermoPact MouthShield has been tested by the Canadian ballistics company Biokinetics to absorb 20% to 50% more impact energy than traditional boil-and-bite guards. The mouthguard also changes color when an athlete’s oral temperature reaches 102 degrees, warning coaches, trainers, teammates and other onlookers of potential heat-related danger.
There are various types of heat-related illnesses with differing levels of severity. According to Dr. Robert Huggins, Vice President of Athlete Performance and Safety at the University of Connecticut’s Korey Stringer Institute, named after the Minnesota Vikings offensive lineman who died in 2001 from heatstroke complications, heat exhaustion deals with the loss of fluids through sweating.
Exertional heatstroke, on the other hand, occurs when the core body temperature exceeds 105 degrees. Immersion therapy, in which an individual is placed in a tub with cold or ice water up to their neck, is one of the most effective ways to treat heatstroke and avoid long-term injury. Outside of increased core body temperature, dizziness, confusion and irritability are also indicators of heatstroke.
While the ThermoPact MouthShield measures oral temperature, that measurement is not a “suitable diagnostic tool” for determining core body temperature, according to Dr. Christianne Eason, Huggins’ colleague at the Stringer Institute. It is crucial to assess core body temperature when exertional heatstroke is suspected, she said.
“The only valid measures of core body temperature are via rectal thermometer, gastrointestinal temperature sensor or pill or esophageal temperature,” according to Huggins. Eason also pointed to a 2011 Journal of Athletic Training study that found that differences in oral and rectal temperatures were greatest when core temperature was highest.
Garbis stressed that the mouthguard is not a medical device and that the change in color is only meant to alert bystanders and athletes that they should get a more accurate measurement to confirm their core temperature, cool down and assess whether they are in danger and need medical treatment.
“My ultimate goal is a better fitting mouthguard that protects the teeth and the mouth better, but also giving a visual cue that there’s some elevation in temperature in the mouth,” Garbis said. “Maybe the athlete’s core temperature isn’t getting up that high, but maybe there is [an elevated] temperature or they’re sick. It’s just something that takes the athlete off the field for a moment to be checked.”
Garbis said he began thinking more seriously about mouthguards roughly five or six years ago when his middle son, Niko, played football at Glenelg. With his background as a dentist, Garbis grew dissatisfied with mouthpieces on the market. However, McNair’s death sparked a new conversation between Garbis and Wildy when he posed one simple question: Why can’t there be an easier way to tell when someone is overheating?
From there, the idea for the ThermoPact MouthShield developed. While designing prototypes, Garbis worked alongside a medical engineer, Dave Szabo, to figure out which material could change color at the appropriate temperature.
“All of my background has led me to this product,” Garbis said. “It’s funny how that works. I’ve been a dad, I’ve been a dentist and I’ve been a coach. I’ve been an athlete, I’ve seen it on all different levels whether I’m tending to a kid on the field, my own kid or in my office.”
During development, Garbis reached out to McNair’s father, Marty, founder of the Jordan McNair Foundation alongside Jordan’s mother, Tonya. Garbis explained that Jordan’s death was the catalyst for creating his product. ThermoPact sponsored one of the foundation’s camps in Baltimore on Aug. 7 and has continued to discuss potential ways to collaborate.
“I think that [the mouthguard] is just a good indicator to really keep folks accountable or just give them another tool not to miss the signs and symptoms,” said Marty, who noted that the foundation’s medical advisory board has yet to review the product but that he hopes to bring it up at the next meeting.
During Friday’s fitting, Marty spoke to the Glenelg team about Jordan’s death and the dangers associated with pushing your body too far.
“It’s a really sad and scary story,” Glenelg quarterback-linebacker Brett Stouffer said. “I think it’s a great thing that he’s doing for his son, making nationwide awareness of his son’s incident and trying to prevent that from happening to other young kids.”
The Jordan McNair Foundation focuses on educating youth, high school and college athletes, as well as parents, about heat-related illnesses and the dangers associated with them.
“We do a lot of clinics,” Marty said. “We do a ton of parent education because I think that’s where it starts, at home. You have to teach your child first to advocate for themselves, to speak up if they don’t feel right. ... You want to empower your child to make good decisions, especially about their own health.”
Outside of Garbis’ mouthguards, the Gladiators remain committed to player safety in other ways. Coach Tim Cullen and Glenelg athletic and activities manager Daniel Sageman recently practiced their emergency action plan in the event an athlete suffers from heatstroke, and there are several mandated water breaks throughout practice.
“They have to be able to trust us that if they ask for a break, it’s not going to be held against them,” Cullen said. “Vice versa, we know that they’re asking for a break because they need it, not because they’re just trying to dog it.”
To minimize potential tragedies, area football teams have strict safety protocols to follow. Howard County has had a multitude of preventive measures in place for more than 15 years.
One focuses on acclimatization, as it usually takes someone about two weeks for their body to grow accustomed to a new climate. Weigh-ins are also an important safety step, as they allow coaches and athletic trainers to monitor an athlete’s hydration levels.
“In football, the kids weigh in for the first 10 practices,” said Allison Hammond, Wilde Lake athletic trainer and Pivot Physical Therapy’s Howard County regional coordinator. “That’s part of the two-week acclimatization period. The coaches from the teams are monitoring the heat as well. We all have it on a Google form, so I can monitor it if something happens.
“They have specific days where they’re practicing in helmets, the third day they go to shoulder pads and the sixth day they go to full pads. We’re monitoring that through their heat acclimatization.”
This year, the state provided more sophisticated heat monitors that work through Bluetooth technology and provide more information than usual. The monitors measure the outside temperature and alert trainers and coaches if the heat index gets too high and alterations to practice need to be made.
Despite those precautions, in the event of heatstroke, an emergency action plan exists. A key component of that plan includes the presence of some sort of cooling tub, a method medical experts have called a “magic elixir” in treating heatstroke.
“We have pools in different types of forms,” Hammond said. “People have some type of dunking pool at school where we have the water and the ice ready, so we can cool them down. Ideally, we would like the temperature of the body to be [less than] 102 [degrees], but we try to not even get to that point.”
In Baltimore County, Dulaney coach Daron Reed has cooling tubs ready if the need arises, but also goes through several precautions to prevent the need for them in the first place.
“We have tarps with ice and ice tubs with water near our practice field that if a guy overheats, we can quickly get him in there,” Reed said. “We will practice in helmets only if it’s extremely hot and we give extended break time in the shade. We keep a couple of towels in two of the tubs with just ice so they guys can place them on their necks during breaks.”
Hydration is key
One of the most important safety measures football coaches have taken focuses on hydration. Particularly during midday practices when the heat index can be at its highest, coaches make a concerted effort to ensure their players are staying hydrated.
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“Every time we change something minor, whether it’s a coach setting up cones or the boys getting their pennies or bags, they go get water,” North Harford coach Justin Martinek said.
“We’ve been bringing two full-size Gatorade coolers full of just ice to the field every practice,” Patapsco coach Tyler Clough added. “We also offer the boys water throughout drills and give them complete three-to-five-minute water breaks throughout practice.”
Some coaches minimize time the players are in pads. Patterson Mill coach David Huryk said that his players are instructed to not have their helmets on during teaching periods, only during practice when it’s absolutely necessary.
The heat index on turf fields is often significantly higher than grass, as the turf and black pellets absorb the heat. To counteract that, some programs adjust both the time and location of their practices.
“We actually practice in the evening from 5 to 8 p.m.,” Havre de Grace coach Brian Eberhardt said. “We found that with that time frame we’ve had maybe one or two pop-up thunderstorms, but the heat has actually been manageable.”
Eberhardt also noted that when the team works out on a grassy space, the field is basically half shaded.
“We’ve certainly been fortunate in that regard,” he said.