Bryan Hutson saw the football player reach for his calf. Other cramps followed, seemingly engulfing his body all the way to his neck.
By the time the player was transported to a training table, his body was so stiff it resembled a board. That was Hutson’s introduction to a heat-illness episode as a student trainer at Southeastern Louisiana University. Hutson, now the head athletic trainer at Central High, recalls the vivid details 18 years later.
“In a few seconds, his stomach was cramping and there were cramps in every part of his body,” Hutson said. “I had never seen anything like that, and it was scary looking. It was heat-related, and we were able to provide the right treatment.”
As Louisiana high schools prepare for fall practice two constants are in play. Seasons for football and other fall sports begin in a month. Heat and humidity will be present for practices, scrimmages and games. Combine those factors and the possibility for heat-related issues, including exertion heat stroke and other heat illnesses, become an invisible elephant in the locker room.
Education and preparedness are pivotal. An understanding that heat-related illnesses can happen when least expected is equally important.
“If there is only one thing I would want people to understand it would be this — heat stroke or a heat-related illness to can happen to anyone. It can happen in any state,” said Samantha Scarneo of the Korey Stringer Institute. “There are so many factors that can lead to a heat-related illness. Obviously, July and August are months when we get the most inquiries. We do know this — if proper treatment and steps are taken, these events are 100 percent survivable.”
The Korey Stringer Institute at the University of Connecticut is a leading source of education and research about heat-related issues and other causes of sudden death in athletes. It was formed in 2010, nine years after the heat-related death of Stringer, a Pro Bowl offensive lineman for the Minnesota Vikings.
Scarneo helped conduct a workshop attended by area athletic trainers and several members of the Louisiana High School Coaches Association last month. The workshop happened days before 15-year-old Amite High football player Terrance Allen collapsed after an evening workout and later died. Whether Allen’s death was heat-related or related to some other health-related issue has not been revealed. Regardless of specifics, local health-care professionals solemnly call it a cautionary tale.
“We live in a very sub-tropic climate that is dangerous. In addition to hydration, you have to be able to cool players down,” St. Amant High head athletic trainer Scott Arceneaux said. “There is so much information out there. You have to arm yourself with a plan and know what to do if a kid collapses. And you should practice it.”
Watching over teams
Not all Baton Rouge area high schools have a full-time athletic trainer on staff. Gaps in care are being closed in some key areas. Last fall, Ochsner provided athletic trainers as part of an outreach program for most East Baton Rouge Parish schools and several other area schools.
The program is expanding this year, said Ochsner’s Dr. Matthew Bumgardner. Ochsner athletic trainers will split time between fewer schools with the eventual goal of having a one-to-one ratio.
Ascension Parish’s Class 5A schools have three full-time athletic trainers on staff this fall. Catholic High is adding a second full-time position. Zachary and Central employ multiple athletic trainers, while Livingston Parish’s 5A schools have full-time athletic training services.
Like Ochsner, the Baton Rouge Orthopedic Clinic and Our Lady of the Lake continue to increase their footprint on the high school sports medicine landscape. While these advances are good, coaches play a major role in prevention and treatment.
“I think we’re getting past that old school mentality where coaches berate players, telling them they’re not tough if they slow down during a drill,” Bumgardner said. “Continuing to train coaches to see the signs of health situation is crucial. Practices are shorter now. They understand the importance of taking breaks and hydration and that knowledge should continue to grow.”
The LHSAA required its schools to file Emergency Action Plans a year ago. EAPs detail plans and personnel roles during medical emergency situations at games or practices. These plans identify who calls 911, who is certified/on site to perform CPR and where the nearest AED defibrillator is located.
The job for athletic trainers and coaches includes educating players and parents about avoiding heat-related issues. A diet with fruits and vegetables, rather than fried or spicy food.
“The toughest part is the unknown,” Hutson said. “We can’t control what a kid eats or doesn’t eat. We don’t always know if they’re getting enough fluids before practice. The kids have to be honest with us about how they feel. Have they been sick? What medicines are they taking? All that is important and makes a difference.”
A time-honored tradition schools use that parents should also consider is weighing athletes after practice. A loss of five or more pounds for two straight practices is a sign of a possible heat issues, according to Ochsner’s Baumgardner.
An athlete who weighs more after a practice, points to another possible issue, hyponatremia, a form of over hydration. St. Amant’s Arceneaux said 2018 deaths in Georgia and Florida were attributed to hyponatremia.
Peanut butter and jelly sandwiches were a long-time pregame staple that provided an easy alternative an athlete can make for themselves. Raman noodles and cans of soup also are inexpensive options. Bananas are a go-to fruit that provides multiple nutrients.
Instead of purchasing bottles of sports drinks, a powder version can be mixed with water. A cup of ice from a home or school machine also work.
A mix of water and electrolyte drinks is preferred. Both should be available at practice. Having an electrolyte drink before and after practice is recommended by multiple sources, including Arceneaux. Popsicles with electrolyte and nutrients are a “treat” option.
Where Louisiana ranks
The Stringer Institute ranks high schools in all states based on their safety measures. Louisiana is currently at No. 43, but is close to a higher ranking, thanks in part to its sports advisory committee. The LHSAA has suggested limits in place for its football schools to follow, including a three-hour time limit per day on practices, that are not written policy at this time.
“Louisiana is doing some good things and needs a push to get these practices into policy,” Scarneo said.
Wet Bulb Globe Temperature is the latest tool for determining heat risks. WBGT is combined measure of temperature, humidity, wind and solar radiation or direct sunlight.
Because of its innate heat and humidity, Louisiana falls into category 3 for measure. Being in category 3 allows for activity at higher temperatures than in other parts of the country. An WBGT gauge, which looks like a television channel selector, is now on the market.
A wet bulb measure of 82.0 allows for full practice with three breaks per hour, compared to 76.1 in another climate in a category 1 state. Practice time is reduced as the wet bulb measure rises. At 92.0, no outdoor practices are allowed.
“Humidity is the thing that scares us all,” Arceneaux said. “In Louisiana, we can practice at a higher heat index because we are used to the temperatures, but the humidity is what makes things uncomfortable and unbearable.
“That 92.0 is what you might get between noon and 2 p.m. That’s why most teams practice later or earlier. However, our most serious situation happened at 8:30 in the morning. You have to be careful, because the humidity can get high at night or in the morning.”
Climatization is a must. This process starts with summer conditioning. Arceneaux said St. Amant requires players to participate in summer conditioning. Three football days of practice in helmets and shorts are required at the start of fall practice before full gear can be added once official fall practice begins.
Schools/athletic trainers who do not have the equipment to use wet bulb measures will monitor heat index, temperature and humidity before notifying coaches to limit or halt practices.
Good to be cool
Providing methods to cool players down is vital. Some use towels drenched with cold water and ice. Towels can be donated by parents and reused. A makeshift sprinkler system cut out of PVC pipe and attached to a hose is another quick remedy.
Another key component? Shade. If a practice area has no shade, tents can be added. Fans are useful too, including industrial fans that can be purchased a a home improvement store.
Guidelines suggest an immersion pool or tank be used to cool core temperature quickly. If a school doesn’t have one, Arceneaux suggests getting a plastic tub from a feed store.
A living example
Ray Castle is one of Louisiana’s experts on emergency treatment. He works major events like the Louisiana Marathon and Boston Marathon and can explain how an immersion tank can be used effectively to circumvent a heat-related illness.
Castle also is a Professor of Professional Practice and the Athletic Training Program director at LSU and a certified athletic trainer. Most importantly, he is a heat-illness survivor.
“I was a junior at Tensas Academy 35 years ago,” Castle said. “I remember getting dizzy at practice, and I just didn’t feel well. My coaches had been to a clinic at Northeast (University of Louisiana at Monroe) the week before and treating a player who was overheated was a topic.
“They got me off the practice field, used cold towels and a fan to cool me down. They saved my life that day, I’m convinced. I owe them a thank you. I’m thankful for that every day.”