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Prep football players battle an old foe in heat exhaustion. The solution? Drink up.
By JOHN SCHWARB
© St. Petersburg Times, published August 29, 2000
Under a blazing sun, he was frigid. Teammates were taking swigs of water and making idle conversation between drills, but he was curled up in a fetal position away from the group, not saying a word.
Heat exhaustion was taking its toll on a Citrus High football player, and the clock may have been ticking on his life.
For Larry Bishop, the name has faded away, but the memory has not. A coach need only see heat's extreme consequences once.
"It scared me to death," said Bishop, a Citrus assistant eight years ago and now head coach. "It's 102 degrees out there, the humidity's 100 percent, and the kid's ice cold."
With a quick ice-down and a move out of the sun, the player's temperature was restored to normal, and he returned to the field by week's end. Heat exhaustion, treated promptly and properly, did not escalate.
Jeremy Tarlea was not so lucky. A 250-pound junior lineman training for his first varsity season at Saline (Mich.) High, Tarlea completed a 11/2-mile run during practice Aug. 9 and passed out in hot, humid conditions.
He never regained consciousness, and died a week later.
Heatstroke, the most serious of heat-related conditions, is once again a serious threat in football. From 1985 to 1994, six high school and college players died of the condition that is as likely to afflict 150-pound receivers as it is 300-pound linemen.
In the past four years, however, 13 players -- including high school athletes from California to Georgia -- have succumbed, according to a University of North Carolina study on catastrophic injuries in football. Three more died this month alone.
The symptoms are varied: headaches, nausea, dry mouth, followed by anything from a violent explosion to an incoherent rant to fainting. But all cases ultimately share common bonds: They are preventable, though only when their victims recognize their own limitations, and they do not discriminate across geographic lines.
Floridians -- even young, native-born ones -- are just as susceptible, despite the belief that living in the heat somehow makes exercising in it easier.
"There should be no reason why we have a death that's attributable to heat," said Jerry Diehl, assistant director of the National Federation of State High School Associations. "It's a known problem that's out there. There's nothing worse than losing a youngster in a situation that could have been avoided with just a little bit of planning."
Yet the deaths continue.
In Indiana, a University of Indianapolis player died Aug. 15 from heatstroke after a morning workout. Michael King, a 6-foot-4, 307-pound sophomore, had a body temperature of 110 degrees when he arrived at the hospital.
A Tennessee Tech freshman suffered systemic hyperthermia and died Aug. 13 while running wind sprints on the first day of practice. Preston Birdsong, a 190-pound defensive back, had passed a physical about an hour before the practice.
Tarlea, the 15-year-old from Michigan, remained in a coma for a week after passing out from heatstroke and died after sustaining liver and kidney failure and severe neurological damage.
Overall, heatstroke has killed 101 football players, including 83 in high school, since 1955.
St. Petersburg High coach Dusty Boylson has seen it, too. It was 17 or 18 years ago, to the best of his recollection, but he remembers it well.
A Boca Ciega player was in the throes of heatstroke.
"As soon as we looked at him, we knew," said Boylson, then an assistant coach. "He was delirious, he was violent. Very aggressive, loud. It took four or five of us to hold him down. We got on the phone and called 911."
The player was treated and fully recovered, despite experiencing some of heatstroke's most extreme symptoms. Disorientation is very possible and in this player's case he may have partially lost his ability to hear, resulting in the loud, violent outburst.
Boylson is entering his 12th season at the helm at St. Petersburg, and on the first day of practice every summer he is very clear with his players. Practice and heat will go hand in hand, and only drinking water and eating properly will allow players to perform.
Whether the message gets across is another matter.
"These kids, they don't eat right," Boylson said. "You watch these kids in the lunchroom, it's a piece of pizza, that's it. That's not enough to sustain. We tell the kids, you've got to eat twice as much as you normally do during the season. You've got to force yourself to eat, you've got to force yourself to drink."
The Boca Ciega player in the early 1980s, it turned out, had been away from home for two days. He had almost nothing to eat or drink over that time.
"There are definitely people that aren't in shape and aren't ready to be out in the sun," said St. Petersburg senior Nick Bevilacqua, a 6-4, 280-pound lineman who admits to drinking "gallons" of water a day. "Coaches are telling us constantly to drink water, but some people just don't listen."
Under the blazing sun, is there a boiling point? Could it ever be simply too hot to hold a football practice?
Athletic officials in Cobb County, Ga., think so.
This season, in the wake of a heatstroke death at a local high school last August, coaches must carry a psychrometer, a device costing about $50 that measures temperature, humidity, wind speed and heat radiating from the ground. The device creates a wet bulb temperature, and if it reads 82 degrees or higher, football practice -- and practice for band and other sports -- is prohibited.
An air temperature of 92 degrees and a relative humidity of 60 percent would equal a wet bulb temperature of roughly 80 degrees, and in Cobb County that would require teams to practice in helmets, shirts and shorts only.
But in Florida and other areas that experience steady heat waves, those conditions could exist every day during preseason.
Some coaches, in an attempt to avoid what are considered the day's hottest times, will practice as early as 7 a.m. or, if possible, work under the lights at night. Others make no distinction on the time of day.
"Everyone talks about going early-morning. I've worked construction down here; I think that's the hottest time of the day," said Clearwater coach Tom Bostic, who works his two-a-days from 9 a.m to 11:30 a.m. and 1:30 p.m. to 3:30 p.m. "I defy you to show me a whole lot of difference between (morning) and three or four o'clock in the afternoon, or sometimes seven o'clock at night.
"We just get out there and make sure they've got plenty of water. If it's too hot, and we've had days like that, we'll cut down the amount of work, cut down maybe the length of practice."
According the Florida High School Activities Association, there are no rules or guidelines on practicing in the heat, and according to Diehl of the NFHS, no other state associations have addressed the issue.
One common misconception about oppressive heat is that athletes who hail from where the sun beats down the hardest -- especially in Florida -- can handle hot-weather training far easier than northerners.
Heatstroke, however, has been found to be as unforgiving in Florida as other areas of the country. The University of North Carolina study uncovered two cases of football-related heatstroke fatalities in Florida, in 1962 and 1987, and there is at least one other -- in July 1984 a St. Augustine High freshman collapsed and died while running during a tryout.
Many area coaches today vow that the native sun and players' ability to deal with it is not taken for granted. Some remember what passed for "heat training" when they played, and are going in a completely opposite direction.
"Back in my day, you'd take a couple salt tablets before practice so your body retains the water," said Bishop, a Citrus player in the early 1980s. "Then you don't sweat as much, and you wouldn't have to drink as much water.
"Now we know that's dangerous. Our mode of thought today completely goes against that. Now it's hydrate the kids, hydrate the kids, hydrate the kids."
Bishop said that most off-season coaching clinics address the topic of heatstroke, and that more and more of his colleagues are learning at least basic first aid and the processes needed to handle heat-stricken athletes.
Dr. Donald Hensley agrees. Over his 26 years as Hernando High's team doctor, he said coaching education has improved from using water as "a reward" to "a commodity," and that it is nearly impossible to find coaches who do not know about working properly in the heat.
"With the way communications are, and all the publications on health science, if you're not more educated, it's your own fault," Hensley said.
But questions of how the messages are being received still remain in coaches' minds, especially in the wake of recent tragedies.
"It's the old thing, you can lead him to water but you can't make him drink -- unless you just stand over the top of him and say "drink, drink, drink,' " Boylson said. "We tell kids what the consequences are. (Heatstroke) is always going to happen, unless there's some miracle drug that comes out.
"Something like that, you're never going to get over. You just pray it doesn't happen to you."
- Times researcher Kitty Bennett contributed to this report.
HEAT SYNCOPE: Weakness, fatigue and fainting due to loss of salt and water in sweat and exercise in the heat. Predisposes to heatstroke
HEAT EXHAUSTION (Water depletion): Excessive weight loss, reduced sweating, elevated skin and core body temperature, excessive thirst, weakness, headache and sometimes unconsciousness.
HEAT EXHAUSTION (Salt depletion): Exhaustion, nausea, vomiting, muscle cramps and dizziness due to profuse sweating and inadequate replacement of body salts.
HEATSTROKE: An acute medical emergency related to thermoregulatory failure. Associated with nausea, seizures, disorientation and possible unconsciousness or coma. May occur suddenly without being preceded by any other clinical signs. Victims can have high body temperature and a hot, dry skin, or may be sweating profusely.
1. Athletes should have a physical exam with a medical history when first entering a sport. History of previous heat illnesses and type of training activities should be included.
2. Coaches should know the physical condition of their athletes and set practice schedules accordingly.
3. Acclimatization, the process of becoming adjusted to heat, should be provided. A graduated physical conditioning program is suggested, with 80 percent acclimatization expected after the first seven to 10 days. Final stages of acclimatization to heat are marked by increased sweating and reduced salt concentration in the sweat.
4. Water must be on the field, in unlimited quantities, and readily available at all times. Ten minutes are recommended for water breaks for every half hour of heavy exercise in heat. Drinking ample water before practice and games has also been found to aid performance in heat. Cold water is preferable.
5. Salt should be replaced daily, modest salting of foods after practices or games is enough. Salt tablets are not recommended.
6. Know both the temperature and humidity. The greater the humidity, the more difficult it is for the body to cool itself.
7. In extremely hot and humid weather, reduce amount of clothing covering the body as much as possible. Never use rubberized clothing.
8. Athletes should be weighed each day before and after practice and weight charts should be maintained. Generally a 3 percent weight loss through sweating is safe. More than 3 percent is in the danger zone and the athlete should not be allowed to practice in hot and humid conditions. Athletes should not be allowed to return until replacing that weight.
9. Observe athletes carefully for signs of trouble, particularly those who lose significant weight and the eager athlete who constantly competes at his/her capacity. Some trouble signs are nausea, incoherence, fatigue, weakness, vomiting, cramps, weak rapid pulse, visual disturbance and unsteadiness.
10. Know what to do in case of emergency and have emergency plans written with copies to all staff. Be familiar with immediate first aid practice and prearranged procedures for obtaining medical care, including ambulance service.
** In the event of heatstroke, immediately cool body while waiting for transfer to a hospital. Remove clothing and place ice bags on the neck, in the axilla (armpit) and on the groin area. Apply cool water to the victim's skin and vigorously fan the body. The fanning causes evaporation and cooling.
** In the event of heat exhaustion, cool body as you would for heat stroke while waiting for transfer to hospital. Give fluids if athlete is able to swallow and is conscious.
-- SOURCE: National Federation of State High School Associations