11 Ways To Prevent Heat Illness

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By Douglas Casa, PhD, ATC, FACSM, FNATA and William Adams, MS, ATC

Coaches play an instrumental role in the prevention of heat illness. Although there are some factors that are out of the coach’s control in terms of prevention of heat illness, there are 11 important actions that can be addressed:

  1. Implementing appropriate rest/recovery breaks that are based on exercise intensity, fitness level and environmental conditions.
  2. Allowing proper hydration opportunities based on exercise intensity and environmental conditions. Athletes should have unlimited access to water throughout a practice and be allowed to drink throughout an entire water break.
  3. Be aware and knowledgeable about pre-existing medical conditions such as sickle cell trait, asthma, or diabetes.
  4. Modify practice duration/intensity and time of day based on environmental conditions. Coaches should be flexible and consider different times of day for practice to avoid the hottest part of the day.
  5. Phase in activity and equipment, and allow heat acclimatization to occur. This has been proven to be successful at the NCAA level. Heat acclimatization has been shown to increase performance, especially in the heat, and it dramatically decreases the risk of catastrophic outcome. Nearly all the deaths that occur during high school football occur during the first three days of practice.
  6. Be aware of “nutritional” supplements that contain “everything but the kitchen sink.” Most of these supplements have never been tested and supplements that contain ephedra and other amphetamine type substances can be lower an athlete’s heat tolerance.
  7. Be proactive: Supporting and dialoguing with your athletic trainer can help improve your school’s health and safety plan. Athletic trainers are medical professionals who are very knowledgeable in the prevention, recognition, and treatment of emergency situations.
  8. Back down when signs/symptoms of heat illness are observed—an obvious warning sign is often presented before a catastrophic event occurs. Give the ATC the autonomy to stop an athlete during practice if signs/symptoms of heat illness are present. If an ATC is not present, the coach should proactively remove the athlete from activity.
  9. Encourage conditioning and fitness development prior to the start of August practices. These sessions must be monitored and modified (if deemed necessary) by an ATC, as the risk for problems is high in hot conditions, especially when appropriate medical staff is not present.
  10. Create an environment where the coaching staff conveys that they value the student’s health and safety just as much as winning a game.
  11. Make attempts to avoid body temperature increases during practice. Keeping the athlete cool during practices can help avoid the risk of heat illness. Cooling can be accomplished in a variety of ways. The timing of cooling includes before exercise, between bouts of exercise, during exercise and during recovery from exercise.

In addition to enhancing the safety of athletes, the previous items will also enhance athlete performance during sport. A proactive coach cannot only help create a safe environment for athletes, but will also help reduce the risk of a catastrophic event from occurring during the season.


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