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The Heat is On – But Many States Are Leaving Us Out in the Cold

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The Association between Mandated Preseason Heat Acclimatization Guidelines and Exertional Heat Illness during Preseason High School American Football Practices

Kerr ZY, Reigster-Mihalik JK, Pryor RR, Pierpoint LA, Scareno SE, Adams WM, Kucera KL, Casa DJ, & Marshall SW.  Environ Health Perspect. 2019; 127(4).  DOI: 10.1289/EHP4163  
Take Home Message: Mandating the use of the National Athletic Trainers’ Association Inter-Association Task Force (NATA-IATF) “acclimatization” guidelines in high school football is related to fewer athletes experiencing exercise-induced heat illness. 

The authors of the 2009 NATA-IATF “acclimatization” guidelines aimed to reduce exertional heat illnesses, which include heat stroke, heat syncope, heat exhaustion, and heat edema. Some state high school athletic associations have implemented these guidelines, yet the effectiveness of these guidelines is unknown.  Kerr and his colleagues assessed the relationship between state high school athletic associations adopting the NATA-IATF guidelines and the rate of exertional heat illnesses among high school students during preseason American football practices. The authors used data from the High School Reporting Information Online system. They estimated an incidence rate ratio to compare exertional heat illness rates between years that states had adopted the mandates or not from 2005/2006 to 2016/2017. The authors identified 190 exertional heat illnesses during ~2.7 million athlete-exposures to American football preseason practices. Out of 48 states (455 state-years), only 32 state-years (7%) from 8 states met the NATA-IATF guidelines. The authors found that during years when a state adhered or partially adhered to the NATA-IATF “acclimatization” guidelines they experienced about 50% less exertional heat illnesses than years when a state failed to adhere to the guidelines.

These researchers are the first to examine the effectiveness of heat-illness prevention guidelines. The authors found that adhering to the NATA-IATF acclimatization guidelines is associated with reducing the number of reported exertional heat illnesses by ~55%. The authors also reported that partial compliance with the guidelines, which was a year when a state recommended compliance or mandated at least 1 of the criteria, related to ~50% less exertional heat illnesses. It would be interesting to see an analysis without heat cramping since they fail to follow the continuum of heat exhaustion and eventual heat stroke. Another interesting finding was that only 8 out of 48 states in the study have fully implemented these guidelines. Hence, healthcare professionals should become aware of the effectiveness of these guidelines, encourage their state associations to adopt the guidelines, and implement them in their high schools even if their state fails to mandate acclimatization guidelines. 
Questions for Discussion:  What barriers do you think exist to implementing the NATA-IATF guidelines?  Where should we focus our efforts to facilitate the implementation of these best practices?
                                                                                        
Reviewed by: Jeffrey Driban
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