The first day of high school football practice arrived with a heat wave in 2016. Tanner Scaife, then a senior, remembers the heat “beaming” off the Howard High School turf that mid-August day.
It wasn’t too hot for the Lions to practice in helmets and T-shirts, but for teenagers who had spent most of the summer in air-conditioned comfort, practicing outside on a hot, humid day could be a shock.
Just after practice ended, Scaife knew something was wrong. He had cramped a little during practice, but didn’t think much of it. Walking back to the locker room, he felt nauseated. The sunlight grew more intense. His eyes hurt and his head started to hurt.
“I felt very fatigued and I was sweating a lot,” Scaife said. “Once I got in the building, I sat on a cooler. Two or three minutes later, my whole body locked up. I was laying on the floor, literally from my chest down cramping. I just couldn’t move. Touching me just aggravated it.”
Gina Palermo, the Lions’ certified athletic trainer, arrived instantly, Scaife said, and started covering him with ice to bring his body temperature down. She said his temperature reached 101 degrees and could have kept rising without the ice.
Scaife spent the night in the hospital. Dehydrated, he said he received five or six IV bags of fluid and learned he needed to drink more to keep him hydrated — two or three gallons of water every day. Less than a week later, he returned to practice feeling lucky Palermo had been there to ice him down and have someone call an ambulance.
Not every high school football player is as fortunate as Scaife.
Since 1995, 47 high school football players in the United States have died from heatstroke, according to the National Center for Catastrophic Sport Injury Research’s 2017 annual football survey.
Earlier this summer, heatstroke once again made sports headlines when University of Maryland offensive lineman Jordan McNair, a McDonogh School graduate, died June 13, 15 days after suffering heatstroke during a team conditioning test. As high school football practice began in Maryland three weeks ago, McNair’s death was fresh in many minds.
“I’m certain that it raises the awareness,” said John Davis, coordinator of athletics in Howard County, “and just puts a little something in the back of our coaches’ minds that they’re going to be more vigilant when they’re monitoring the kids and themselves even, because they’re also at risk out there.”
According to the NCCSIR research, the number of heatstroke deaths among high school football players has declined as schools around the country became more aware of the potential for heat-related illness and mandated guidelines to try to prevent it or treat it quickly. From 2013 to 2017, an average of 1.6 heatstroke deaths were reported in football from the youth to professional levels, down from 4.4 during the previous five years. Three total football deaths were reported from heatstroke last year.
The Korey Stringer Institute, a nonprofit founded after the heatstroke death of Minnesota Vikings lineman Korey Stringer in 2001 and dedicated to preventing sudden death at all levels of sport, monitors and ranks the sports safety policies of state high school athletic associations. In 2018, Maryland ranked 39th among the 50 states and the District of Columbia.
Maryland’s ranking is low, because while the Maryland Public Secondary Schools Athletic Association provides guidelines for the counties and Baltimore City, there is no specific language stating they are mandatory. The state allows the local jurisdictions to set their own specific heat policies. According to William Reinhard, director of communications for the Maryland State Department of Education, all counties and Baltimore City follow the MPSSAA guidelines.
In 2012, Maryland state law required local jurisdictions to develop a heat acclimatization policy so players could gradually get used to the heat and humidity of August. The guidelines limit practice time for all athletes and gradually increase padding and contact for football players over the first six days of practice.
“Since the start of the 2013 season, all local school systems have adopted the model policy and tailored it to their local regulations,” said Reinhard.
Although they don’t fall under the MPSSAA and aren’t included in the Korey Stringer Institute research, Baltimore’s boys and girls private school leagues also adhere to the state’s acclimatization policy.
Public and private schools also have heat modification policies that call for limited practice, no pads and/or more frequent water breaks anytime the heat index climbs to the upper 90s or higher. Most also have to cancel games, scrimmages and outdoor practice when the heat index reaches about 105 degrees.
The Korey Stringer Institute, however, does not consider the language of the state’s law as making these polices mandatory, so it doesn’t give Maryland credit for them in its safety assessment, said Dr. Samantha Scarneo, vice president of sport safety for the Korey Stringer Institute.
“If they leave it up to the individual districts, the counties, to put the policies into place then that wouldn’t be any type of mandate,” said Scarneo, a certified athletic trainer with a Ph.D. in kinesiology. “You would hope that in the schools they have the wherewithal to be able to put these policies into place independent of the state and we have some preliminary evidence of that.”
Reinhard argued the state law does mandate the heat acclimatization policy.
“Unfortunately, the Korey Stringer Institute does not acknowledge that mandate,” Reinhard said. “If it did, Maryland and MPSSAA would rank much higher on its rankings. But Maryland has found that the mandate through state statute provides the necessary tools for each school system to meet the requirement for heat acclimatization and keep our student-athletes safe.”
The Korey Stringer Institute website says Maryland could move up to No. 7 with improvements in heat safety.
While Maryland schools have their heat acclimatization and heat modification policies in place, there are areas in which some counties and the city could improve. The major factor in the safety of athletes when it comes to heat and all other issues is having a certified athletic trainer at the school, Scarneo said.
Anne Arundel, Carroll, Harford and Howard counties have an athletic trainer in each school. Baltimore County has them in some schools and will have them in all schools by next fall at the latest, said Mike Sye, coordinator of athletics for the county.
Some Baltimore City schools have trainers, but not all. Home teams at football games are required to provide “a medical attendant, formally trained in first-aid procedures,” said Tiffany Byrd, coordinator of athletics for the city schools.
“While the district does not currently work with an athletic training service provider,” Byrd said, “the athletics department is exploring the feasibility of providing athletic training services to schools with interscholastic athletics. Since school leaders have autonomy over their school budgets and partnerships, some schools may opt to hire a licensed, athletic trainer to work with their sports teams.”
While state public school coaches are required to take a heat illness course so they can learn to recognize the signs of heat stress, Palermo agreed there is no substitute for an athletic trainer.
“We are trained,” she said. “Most people think we take a course and that’s it. No. We have medical licenses. We have to take 50 hours of continuing education every two years to keep our licenses active. I also think it takes that [responsibility] away from the coach. The coach can focus on coaching and I can focus on the kids and providing the best care to them as well as just being the eyes and the ears. Sometimes the kids don’t want to tell the coach all the information and I can be that middle man.”
Palermo also said getting to know the players is important, so she can build a relationship with them and so she knows their health history, such as who has asthma that could cause more difficulty for an athlete playing in the heat. Heat stress might manifest differently in different athletes.
The Korey Stringer Institute also recommends schools use the WetBulb Globe Temperature to determine how hot it is, because, Scarneo said, it better measures the heat in a specific location. Many schools used the heat index and many coaches have phone apps to measure heat index. Those temperature gauges might be nearby, but they’re not measuring the temperature on the turf field where the surface absorbs more heat in direct sunlight that can make it hotter than a nearby grass field.
Another recommendation is a cold-water immersion tub. Immersing an athlete in cold water can bring his body temperature down quickly. Had McNair been immersed in cold water when, according to medical records, his body temperature reached 106 degrees, it might have saved his life.
“It’s the magic elixir,” Korey Stringer Institute CEO Douglas Casa told The Baltimore Sun earlier this month. “That’s the thing that’s going to allow the person to survive.”
Every school in Baltimore County got an immersion tub this fall. Sye said the tubs came from Tractor Supply Co. and were “nothing special,” just big enough to submerge a body in.
“We were making these decision despite what happened at Maryland,” Sye said, “but it just reinforces that we made the right decisions in terms of being proactive. You can’t be reactive in these situations, because you just never know.”
Scaife, the Howard football player who survived heatstroke, agreed. He said players need to be proactive, too.
“At the slightest sign of something wrong, tell the coach and stop no matter what the coaches say,” Scaife said. “Start hydrating if you feel the slightest bit nauseous. Talk to the trainer. She can ask you a couple questions to determine what’s wrong with you. Some players may need ice right away. I know players who can practice when it’s hot as I don’t know what all day and be fine, but don’t take the chance it you don’t feel right.”