Heat policy revision for georgia high school football practices based on data-driven research

Earl R. Cooper*, Andrew J. Grundstein, Jessica D. Miles, Michael S. Ferrara, Patrick Curry, Douglas J. Casa, Yuri Hosokawa

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Context: Interscholastic heat policies for football have not been evidence based. Therefore, their effectiveness in mitigating exertional heat illness has not been assessed. Objective: To discuss the development of the Georgia High School Association heat policy and assess the effectiveness of revised guidelines. Design: Descriptive epidemiology study. Setting: Georgia high schools. Patients or Other Participants: Interscholastic football players in grades 9 through 12. Main Outcome Measure(s): Heat syncope and heat exhaustion (HS/HE) illness rates (IRs) were calculated per 1000 athlete-exposures (AEs), and relative risk (RR) was calculated as a ratio of postpolicy (POST) IR divided by prepolicy (PRE) IR. Results: A total of 214 HS/HE cases (172 PRE, 42 POST) and 341 348 AEs (178 230 PRE, 163 118 POST) were identified. During the first 5 days of the PRE period, approximately 50% of HS/HE illnesses occurred; HS/HE IRs doubled when practice sessions increased from 2 to 2.5 hours and tripled for practices ≥3 hours. The HS/HE IRs in the PRE period increased from 0.44/1000 AEs for wet-bulb globe temperatures (WBGTs) of,828F (,27.88C) to .2.0/1000 AEs for WBGTs from 878F (30.68C) to 89.98F (32.28C). The RRs comparing PRE and POST policy periods were 0.29 for WBGTs of,82.08F (,27.808C), 0.65 for WBGTs from 82.08F (27.88C) to 86.98F (30.58C), and 0.23 for WBGTs from 87.08F (30.68C) to 89.98F (32.28C). No HS/HE illnesses occurred in the POST period for WBGTs at .908F (.32.38C). Conclusions: Results from the PRE period guided the Georgia High School Association to revise its heat and humidity policy to include a mandated 5-day acclimatization period when no practices may exceed 2 hours and the use of WBGT-based activity-modification categories. The new policy reduced HS/HE IRs by 35% to 100%, depending on the WBGT category. Our results may be generalizable to other states with hot and humid climates similar to that of Georgia.

Original languageEnglish
Pages (from-to)673-681
Number of pages9
JournalJournal of athletic training
Issue number7
Publication statusPublished - 2020 Jul


  • American football
  • Exertional heat illness
  • Football practice policy
  • Interscholastic sports
  • Wet-bulb globe temperature

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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