Engaging in outdoor athletics in high heat can be challenging and potentially dangerous. Here is some important information to ensure safety. 

Purpose

The following policy on fluid replacement, rehydration, prevention, and heat illness has been developed in accordance with the National Athletic Trainers Association Fluid Replacement Position Statement (2017), the NATA Exertional Heat Illness Position Statement (2015), recommendations from the Korey Stringer Institute, and Missouri State High School Athletic Association (MSHSAA) guidelines. This information is intended to assist in protecting the health of student-athletes participating in both indoor and outdoor sports.

Rationale of Fluid Replacement

When participating in hot humid environments, student athletes may become deprived of essential fluids, carbohydrates, and electrolytes, leading to dehydration and possibly heat illness. Dehydration can occur with as little as a 1-2% drop in body weight due to loss of fluids. Student-athletes who are not properly hydrated before the start of physical activity can notice signs of dehydration in as little as an hour or sooner. Dehydration places student-athletes at risk for heat-related illnesses such as heat cramps, heat exhaustion, and heat stroke.

Signs and Symptoms of Dehydration

Signs and symptoms include:

• Thirst
• Irritability
• General discomfort
• Headache
• Weakness
• Dizziness
• Nausea
• Cramps
• Chills
• Vomiting
• Decreased performance

Rehydration Guidelines

It is the expectation of the Morgan County R-II School District athletic department that all athletes have freely accessible water during practice, regardless of temperature. The athletic trainer, coaches, and other staff will promote the consumption of water during practices and games.

Before Exercise

• 17-20 fluid ounces should be consumed two to three hours before exercise.
• 7-10 fluid ounces should be consumed 10-20 minutes before exercise.

During Exercise

• 7-10 fluid ounces should be consumed every 10-20 minutes during exercise.
• Student-athletes should drink before becoming thirsty.

After Exercise

• Fluids should be replaced within two hours of the end of physical activity.
• 20-24 fluid ounces should be encouraged for every pound of weight lost.

Definition of Heat Illness

Heat illness is closely associated with physical activity and its occurrence increases with a rise in temperature and relative humidity. It is usually classified into four categories: heat syncope, heat cramps, heat exhaustion, and heat stroke. Although most often occurring in hot, humid weather, heat illness can also occur with the absence of both heat and humidity.

Heat Syncope

• It occurs during high heat and humidity due to inadequate blood flow to the brain, resulting in loss of consciousness.
• Signs and symptoms include loss of consciousness or fainting, light-headedness, fatigue, and pale/clammy skin.

Heat Cramps

• It occurs during or after intense exercise as an acute, painful, and involuntary muscle contraction.
• Causes may include dehydration, electrolyte imbalances, neuromuscular fatigue, or a combination of factors.
• Signs and symptoms: dehydration, thirst, transient muscle cramps, and fatigue.

Heat Exhaustion

• It occurs most frequently in hot, humid conditions and causes an inability to continue to exercise.
• It may be caused by dehydration, heavy sweating, sodium loss, and energy depletion.
• Signs and symptoms: fast and weak pulse, persistent muscle cramps, urge to defecate, weakness, fainting, nausea, decreased urine output, cool and clammy skin, diarrhea, core body temperature between 97-104℉.

Heat Stroke

• It occurs when the core temperature is elevated at greater than 104°F and central nervous system dysfunction.
• This is caused by the body's inability to cool itself due to environmental conditions and due to heat production which overwhelms the body’s temperature regulation system.
• Signs and symptoms: fast heart rate, low blood pressure, sweating, skin may be hot and dry, hyperventilation, altered mental status, vomiting, diarrhea, seizures, central nervous system changes, altered consciousness.
• Life-threatening if not promptly recognized and treated!

Prevention of Heat Illness Guidelines

• Pre-participation examinations should ask if a student-athlete has a history of heat-related illness.
• Athletic trainers and coaching staff will encourage water consumption during practices and will be aware of signs and symptoms of heat illness and how to intervene.
• Student-athletes will follow acclimatization guidelines outlined by MSHSAA.
• An athletic director or athletic trainer will use a Wet-Bulb Globe Temperature (WBGT) to determine what “zone” the site is in and the need for any practice modifications or terminations as recommended by MSHSAA. If conditions change significantly after the initial WBGT is taken, then it will be reassessed. Ideally, these readings are taken at the practice site.
• Cold immersion tubs will be ready anytime the weather is above 80°F. If no tub is available, a tarp or other device with ice and water for filling is adequate. 

Activity Recommendations

The recommended measurement practice and device for measuring acceptable heat/humidity levels for practices and contests approved by the Missouri State High School Activities Association (MSHSAA) is the Wet Bulb Globe Thermometer (WBGT).

For further information on activity recommendations please review MSHAA’s Recommended Use of Wet Bulb Globe Thermometer (WBGT) for Heat and Humidity Monitoring during Activity document. 

Treatment of Heat Illness

Heat Syncope

• Move the student-athlete to a cool area and elevate the legs above the heart.
• Have the athlete drink water if conscious.
• Monitor airway, breathing, and circulation.
• No return to play until evaluated by a medical professional.

Heat Cramps

• Remove the student-athlete from play and replace lost fluids.
• Begin mild stretching and massage of the contracted area.
• The student-athlete can return to play once cramping has ceased and fluids have been replaced.

Heat Exhaustion

• Move the student-athlete to a cool area and assess cognitive function and vital signs.
• Remove excess clothing and equipment, start fluid replacement, and cool the student-athlete with fans, and ice towels on their extremities and in their armpit and groin.
• If possible, assess core body temperature utilizing a rectal thermometer.
• The student-athlete should not return to activity for 24-48 hours.
• If signs and symptoms aren’t improving, activate emergency medical services.

Heat Stroke

• Activate emergency medical services and the emergency action plan.
• Assess vital signs and, if possible, core body temperature using a rectal thermometer.
• Remove excess clothing and equipment and place in a cold water immersion tank (50°F) until the core temperature is 101-102°F.
  • Make sure to circulate water.
• Cool first, transport second!
• Must be cleared by a physician before returning to activity.

Heat stroke has a 100% survival rate if proper cooling is initiated within 10 minutes of collapse.

• Interscholastic Youth Sports Brain Injury Prevention Act
• CDC Concussion Information
• MSHSAA Concussion Awareness Handout
• MSHSAA Return to Learn – Background and Suggestions
• NFHS Learning Center – Concussion in Sports (Free Course in English and Spanish)
• NFHS Learning Center – Concussion for Students (Free Course)
• NFHS – A Parent’s and Guardian’s Guide to Concussion – 2023

What is Sudden Cardiac Arrest?
Your heart is an amazing muscle that beats over 100,000 times per day to keep blood and oxygen pumping around your body, and beats continuously throughout your entire life without taking a break or stopping to rest! The beating of the heart is controlled by an electrical conduction system that causes the heart muscle to contract rhythmically and in an organized manner. Sudden Cardiac Arrest (SCA) occurs when there is a problem with the heart’s electrical conduction system which causes the chambers of the heart to beat irregularly and start to quiver or “fibrillate.” When the heart fibrillates, blood stops pumping throughout the body, and within minutes, the heart stops beating and the person experiences sudden cardiac arrest. The person stops breathing, becomes unconscious, and collapses. Without quick intervention including cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator (AED), the person will die.

Who is at Risk for Sudden Cardiac Arrest?
Sudden cardiac arrest can happen to anyone, and while rare in children it unfortunately does happen. Sudden cardiac arrest tends to occur in children during exercise or athletic sports activities and is a leading cause of death in student-athletes between the ages of 10-19 years old. Risk factors for children include being male, having heart disease or structural abnormalities of the heart, or having an abnormal heart rhythm. Other risk factors include being overweight or obese, having high blood pressure, exposure to drugs (especially illicit drugs that cause the heart to beat quickly), and family history such as having a family member who experienced sudden cardiac death before age 50. Occasionally a sudden hard blow to the chest can cause the heart to fibrillate and cause sudden cardiac arrest; this is known as “commotio cordis.”

Adults are also at risk for sudden cardiac arrest, with more than 350,000 total adult deaths from sudden cardiac arrest outside of hospitals each year.

Are There Warning Signs or Symptoms of Sudden Cardiac Arrest?
Sudden cardiac arrest typically occurs without warning and is completely unexpected. However, in about a third of cases, warning signs are present but are frequently ignored or attributed to something else. Warning signs include chest pain during exercise, extreme fatigue with activity, feeling dizzy, lightheaded, or fainting, seizure activity that occurs with exercise, feeling like the heart is racing, or feeling a sensation of the heart beating hard or irregularly (“having palpitations”).

Can Sudden Cardiac Arrest be Prevented?
One of the best ways to prevent sudden cardiac arrest is to know if your child has a predisposing health condition or a family history of heart problems that increases their risk of a sudden cardiac arrest. Regular (annual) well-child checkups and sports physicals with a healthcare provider can help to identify risk factors or heart problems that need to be addressed, to make sure your student is healthy and ready for exercise and athletics. All student-athletes participating in middle and high school athletics must have a sports physical before being allowed to play, but children, especially student-athletes, may not tell an adult or coach they are having symptoms because they are afraid they will not be able to continue in their sport. They may also not know or recognize their symptoms are an indication of an impending life-threatening event. Educating and empowering our children to report when they don’t feel well is an important step in intervening before a problem occurs!

The Morgan County R-II School District opens its facilities at least once a year so that students and families have access to youth cardiac screenings. Check social media and district news outlets for information about these events throughout the year.

Treatment for Sudden Cardiac Arrest
When a sudden cardiac arrest occurs, responding immediately with CPR and defibrillation with an AED, along with activating the emergency response system by calling 911, can dramatically increase the chances of survival. High-quality CPR helps to keep blood and oxygen pumping through the body, and the AED can stop the heart from fibrillating and restore a normal heart rhythm. Olathe School District PE teachers, coaches, athletic trainers, and school nurses are trained in CPR and AED use and can respond to sudden cardiac arrest. Additionally, every district building has at least one AED. The district activity areas also have access to an AED. We highly recommend that everyone learn how to perform CPR and use an AED. There are a variety of resources (see below) in Morgan County and the Lake Area where anyone can learn how to perform CPR.

Resources:
More Information About Sudden Cardiac Arrest:

• Visit the National Academies website: Strategies to Improve Cardiac Arrest Survival: A Time to Act
• Visit the Simon’s Heart website: Sudden Cardiac Arrest in Children
• Video: Signs for Cardiac Arrest
• Visit the American Heart Association website: Cardiac Arrest vs. Heart Attack

Local Agencies Offering CPR/AED Training:

• Visit the American Red Cross - Red Cross Training in Missouri
• Visit the Morgan County Health Center
• Visit the MU Health Care Outreach Program – Save MO Hearts
• Visit the NFHS Learning Center website – A Guide to Sudden Cardiac Arrest

Eligibility

High school students planning to pursue athletics and athletic scholarships at the collegiate level must be aware of academic and other eligibility requirements. This page is intended to provide links to various resources to help students plan. This page is not comprehensive and students are always encouraged to communicate with academic and athletic advisors at the colleges they are interested in attending, to obtain accurate and complete information and requirements about those specific schools. 

Make sure you officially register with the NCAA and/or NAIA Eligibility Centers during your sophomore year if you are interested in playing college sports.

• Visit the NCAA Eligibility Center website
• Visit the NAIA Eligibility Center website

Resources

• Honest Game Eligibility Tracker

  Students and families may track their athletic eligibility by logging in using the student's Google account.

• National Junior College Athletic Eligibility

  The NJCAA Eligibility Rules pamphlet contains the NJCAA bylaws pertaining specifically to student-athlete eligibility.

• NCAA Student-Athlete Eligibility

  Resource for Division I and II incoming athlete initial-eligibility requirements.

• NAIA Home Page

  A good document here is the NAIA Guide for the College-Bound Athlete.

• NAIA Eligibility Center

  This links to the NAIA student registration page.

• NCAA Eligibility Center High School Timeline (PDF)