By David H. Janda, M.D.

With the return to school fast approaching, it is imperative that we get our families’ house in order as it relates to return to school, as well as return to recreational and organized sports activities. Over 12 million student athletes between ages 5 and 22 will sustain a sports related injury this year. In addition, 20 million school days will be lost by students as a result of an injury related either to sports or recreational activities. As I have outlined in the past, the vast majority of these injuries are completely preventable. In my book, The Awakening of a Surgeon, I outline a prevention checklist that each and every parental activist should implement on a rigorous basis. Included in the list:

1. A pre-participation physical examination for every student athlete.
2. Conditioning at an age appropriate level.
3. Utilizing equipment and apparel that has independently been found to be effective at preventing and reducing the risk of injury.
4. A thorough evaluation of playing fields, as well as facilities, to make sure they are well lit, free of holes, free of broken glass, and other hazardous debree.
5. Making sure the coaches involved in sporting activities are certified and trained to condition athletes at an age appropriate level.
6. Ensuring that emergency first aid equipment, including defibrillators, are accessible for each field or each gymnasium.
7. Making sure that practices and game situations include appropriate warm up and cool down periods.

In addition, in light of the recent tragedies from throughout the country as it relates to heat stroke, it is imperative that we as parents become focused on preventing this completely preventable, yet tragic, scenario. Just in the past several weeks a high school student in Indiana died of heat exhaustion, as did a college football player at the University of Florida, as did a professional football player with the Minnesota Vikings. Between 1997 – 2001 eighteen student athletes have succumbed to this completely preventable scenario. Some very logical and easily implemented guidelines could completely alleviate fatalities related to heat stroke. As immediate past chairman of the Sports Injury Advisory Group to the Governor of the State of Michigan, Mr. John Engler, our group developed a number of recommendations as it relates to football - but could be easily applied to every sport and recreational activity.

These recommendations include :

1. Acclimatize to heat gradually. The early practices such as the first 7-10 days should be shorter and less intense, as should practices on abnormally hot or humid days. In addition athletes should be encouraged to initiate their own conditioning program several months prior to the beginning of the season. During the hottest weather practice sessions should be scheduled in cooler parts of the day.
2. Both the temperature and relative humidity should be taken into account in determining the length of practice sessions. It has been suggested that if the sum of the temperature and relative humidity are greater than or equal to 160, precautions must be taken. If the sum is greater than 180, practice and or games should be cancelled.
3. Adjust the activity level and provide frequent rest periods during hot weather. Rest should be accomplished in shaded areas, helmets removed, and jerseys should be loosened or removed. In addition, rest periods should consist of 15 minutes each hour of workout.
4. Cold water should be available in unlimited quantities to players. Scheduled water breaks should be strictly enforced.
5. Salt should be replaced through salting of food, not salt tablets.
6. Athletes should be weighed before and after each practice to monitor water loss. Weight loss greater than 3% indicates a substantial risk and 5% a significant danger to the student athlete.
7. During practice athletes should wear cooling clothing such as shorts and fish net jerseys. Sweat saturated t-shirts should be changed often because they do retain heat. Helmets should only be used sparingly in hot weather.
8. Parental involvement, such as observing practices, should be done on a rotating basis between all the parents of the student athletes. A monitor for practices, as well as game situations, can only lead to potential alleviating this ultra tragic scenario of heat illness.
9. It should be noted that some athletes are more susceptible to heat illness. Identify and observe closely those at greatest risk of heat illness, including those that are poorly conditioned, overweight, have an acute illness, have cystic fibrosis, diabetes, or mental retardation. In addition, student athletes that have a previous history of heat illness should be watched closely during practices and hot weather.
10. It is imperative that all coaches, parents, and players be on the lookout for this all to common scenario and with the signs of fatigue, lethargy, inattention, stupor, and/or awkwardness the athlete be immediately removed from participation, cooled down and placed in a shaded environment.

With implementation of the above ten steps, I believe the entirety of heat illness would be eliminated. However, it is mandatory that parents become more activists in their student athletes practices and games to make sure that the fatality scenario that we have just seen in the past several weeks in Indiana, Florida, and Minnesota do not occur in our own backyards.

Dr. David H. Janda, M.D. is an Orthopedic Surgeon, Director of The Institute for Preventative Sports Medicine and author of the critically acclaimed book,
The Awakening of a Surgeon, One Doctors Journey to Fight the System and Empower Your Community.