MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Growing concern about heat-related illness and deaths in prep sports is prompting local schools to adopt national guidelines on dealing with heat. As a result, many coaches have to phase in both the duration of workouts and the amount of protective gear players wear to ease the transition from summer coach potato to fall athlete in training.

MR. KOJO NNAMDIThe guidelines also dictate when hot temperatures will force workouts indoors, how student should stay hydrated and how to cool players down fast in case of emergency. Virginia has been following these guidelines for years, but new rules adopted last month in Maryland have some coaches there scrambling to retool their workouts.

MR. KOJO NNAMDIJoining me to talk about taking the heat off prep sports is Jon Almquist. He is administrator of the Fairfax County Public Schools Athletic Training Program. He's also past chair of the National Athletic Trainers Association Secondary Schools Committee. Jon Almquist, thank you so much for joining us.

MR. JON ALMQUISTThank you.

NNAMDIJoining us by phone is Ned Sparks. He is executive director of the Maryland Public Secondary Schools Athletic Association. Ned Sparks, thank you for joining us.

MR. NED SPARKSMy pleasure.

NNAMDIThis is a conversation that you, too, can join by calling 800-433-8850. Were you a high school athlete? How did your coach deal with practicing in hot weather? 800-433-8850. You can send email to kojo@wamu.org, send us a tweet, @kojoshow, or simply go to our website, kojoshow.org, and ask a question or make a comment there.

NNAMDINed Sparks, last month, the Maryland State Department of Education told public high schools that they have to adopt rules to ease students into the team practices that begin this weekend. You chaired the committee that developed the state's heat safety guidelines. Why is this an issue now?

SPARKSWell, Kojo, this is an issue that's been swirling around for a number of years, and, obviously, over that period of time, while we've been aware of what's been happening regarding heat acclimation and hydration and things like that, unfortunately, the death rate has not changed. And these are really preventable things.

SPARKSAnd so the Maryland General Assembly, the state legislature, passed a law back in the previous session that required the Department of Education to work in collaboration with other groups to form a model policy. And then, from that, individual school systems are going to have to adopt individual guidelines, individual school system guidelines. So it's something that we've known about. You know, we've, I guess, maybe not put as much effort into addressing because, unfortunately, the rate of deaths has remained consistent for the last 15 or so years.

NNAMDIMost Maryland school districts are using the guidelines that your committee developed. What are the limits on the number of hours high school teams can work out starting on Saturday?

SPARKSWell, our limits are the same as the NATA limits, and, quite honestly, we took our cues from them. And those limits, you know, talk about the no two a days for the first fifth till the sixth day of practice. It talks about no more than three hours per day, talks about allowing for a walk-through after a three-hour rest and so forth. Jon, who was very instrumental in that, I'm sure can fill you in on all of those, but we simply felt like we weren't any smarter than the national experts. So we simply relied on what they provided.

NNAMDINed Sparks is referring to Jon Almquist, who joins us in studio. He is past chair of the National Athletic Trainers Association Secondary Schools Committee. He's currently administrator of Fairfax County Public Schools Athletic Training Program. And, Jon, Fairfax County was one of the first in the country to adopt heat guidelines for high school sports. What are the rules there about ramping up practices and equipment?

ALMQUISTWell, we started our heat guidelines probably about 1984, '85, and that basically had a wet-bulb temperature limitation of that if the wet -- if the temperature got that high, then there could be nothing performed outside. So, basically, the guideline, the heat guidelines overall were based on heat stress, and we used a wet-bulb temperature to calculate that using sling psychrometers.

ALMQUISTAnd, now, we're using digital psychrometers for that. More recently, we implemented a fall season practice guideline, which does limit the amount of time overall practices could take place during the two week -- actually, three-week preseason.

NNAMDIFor those who are unfamiliar with it, tell us a little bit more about what wet-bulb temperatures are.

ALMQUISTWet-bulb temperature is the temperature that takes into account the cooling effect of evaporation. So if the humidity is high -- let's say the ambient temperature is 90 degrees dry-bulb. The humidity is high. The air is already saturated with water. The evaporation of sweat will take place very slowly because it takes a long time for the water to get into the air, so, therefore, the evaporation cooling effect is going to be less.

ALMQUISTIf the air is very dry, then the cooling effect will actually be greater because there's a greater difference. So 90 degrees outside in a very humid condition -- the air is already wet -- we may go down to about 80, 79 or 80. If it's dry air and the cooling effect is faster, then the -- or the evaporation is faster, the cooling effect is going to be greater and, therefore, could probably go down to 75 or 70. So that's the key on the wet-bulb. It takes into account the heat stress, and that's really what the body is relying on, is the evaporation of sweat to cool the core.

NNAMDIIn case you're just joining us, we're talking about respecting the heat, so to speak, in high school sports and inviting your calls at 800-433-8850. Do you have a child who plays a fall sport? How do you make sure he or she is hydrated and doesn't get too hot during practice or a game? 800-433-8850. Ned Sparks, the Maryland guidelines say students cannot wear all the pads and helmets on the first day of practice but can slowly add gear as the days go by. What does that accomplish?

SPARKSWell, I think that gradually works them into -- acclimating them, so they don't start up in full pads the very first day. They can gradually get used to it by wearing their helmet for the first couple of days and then adding shoulder pads to that and then, finally, by the sixth day, adding the shoulder pads, the helmet and the pants. So it's a gradual entry into rather than, you know, shocking the body, so to speak, for some of the students.

SPARKSNow, I have to point out, too, that, you know, many, many, many, and probably the majority of our students, are working out in the summer time and so forth and are, you know, in pretty good shape and so forth. So this isn't a period -- this isn't a matter of, you know, kids coming that are fat and never did anything. This is a question of trying to make sure we reach all of those students, especially those students who might be playing for the very first time, that haven't this kind of exposure.

NNAMDIAnd, Jon, the most dangerous time for parents -- for players, apparently, is in the first days of practice when students are not in the top form and coaches might tend to push them hard. What do you tell your coaches about looking out for potential problems?

ALMQUISTWell, that's -- it's a tough thing because the -- one of the coach's job is to make sure they get everything out of kids that they can, and that's part of the benefits of having -- being involved in sports as well. But in the very first couple of days, it is important to make sure that the pushing is limited in the sense that it's smart. It's done with some understanding that some of these kids are going to try to go out there, and they've never perhaps been chased.

ALMQUISTThey may have ran out running every day this summer, but they haven't actually been chased by their teammate who's, you know, ready to take them down and try to make themselves look better in front of the coach. So these are all things that we're working with the coaches on. And the gradual entry into this, as Mr. Sparks said, it's not only for the heat because, obviously, the more equipment you have on, the less ability your body has to cool due with the evaporation effect because you're covered with plastic, basically, with the pads and things, but you're also dealing with overall contact.

ALMQUISTSo with helmets only, it's really a no-contact practice, and so you're learning -- working more on skills development, timing, things like that and cardiovascular work. And then you also get into the more contact practices, and that also is a way to acclimate to that extra activity.

NNAMDIOn to the telephones now. We will start with Stephen in Germantown, Md. Stephen, you're on the air. Go ahead, please.

STEPHENHello, Kojo. I have a question and then a comment kind of question. One, the question is the commentator said that the death rate has stabilized. That could be that you're not advancing in the techniques, but it could also mean it's kind of a natural death rate of the -- other factors in the environment these people live in beyond that. And the comment, the follow-up is that it alarms me to think that guidelines are needed for this basic commonsense acclimation of students. Are Maryland schools really putting coaches in charge of students that don't know these things already?

NNAMDIYou're saying that, by the time a student begins to compete in high school, he or she or the coaches should already know all of these things about heat?

STEPHENWell, certainly, the coaches should know. I mean, these are basic acclimation training...

NNAMDII'm glad you brought that up because it allows Jon Almquist to tell us about the difference between being a coach and being a national or being an athletic trainer.

ALMQUISTWell, you know, the coaches should be aware of these issues of safety and the newer science that has come out, but two things in sports medicine have actually made changes in science. And that's concussion -- issues on concussion, as well as heat illness. And so some of the folks that may have gone through school and -- several years ago and learned about the heat illness and heat strokes and heat exhaustion and what to do about them, literally, the definition of heat stroke has changed in the last couple of years.

ALMQUISTSo they haven't kept up on top of things, and they could be a little bit behind, which then could also paint a very, very dangerous picture. But, ultimately, coaches are expert in learning, knowing their skills, their sport and identifying and teaching them to younger kids. But the athletic trainer is the sports medicine educated individual who is licensed by the Board of Medicine in most of states, and they're dealing with the actual science behind the illnesses and the injuries that occur. So that's why...

STEPHENSo...

ALMQUIST...where the athletic trainers got involved with developing these guidelines and trying to put the science together, the empirical data together that supports the recommendations.

STEPHENBut no guidelines can replace judgment, and you're putting these kids out with coaches without medical training. Is that what I understand here?

NNAMDICoaches are not required to have medical training. Athletic trainers are.

STEPHENThe care of these students, and you say the death rate isn't going down and go, oh, well, let's not train the coaches in medical safety techniques. Let's just give them guidelines. That creates a situation where they technically comply with their guidelines. They may feel they can push the students in other ways and can actually create more harm.

NNAMDINed Sparks, what do you say to that?

SPARKSWell, a couple of things. First of all, every coach in Maryland is required to take a care and prevention of athletic injuries course. All right? So they do receive some overall rudimentary training. The regulation, the new regulation, as was concussion, also requires our coaches to take a specific course and show that they have proof that they have taken that particular course, so those things.

SPARKSNow, in regard to heat stroke, heat stroke, from what we understand, is probably 99.9 percent preventable. All right? And so if you have -- I think the figure was about, like, 35 deaths over the period of 15 years or so. I mean, those are 35 students, and that could be, you know, your child, my child, all right, that didn't needlessly or needlessly didn't, you know, need to have that happen to them. And so if that's possible, I think that's part of the change, and that's part of the rationale behind some of (unintelligible).

NNAMDIAnd why guidelines would be necessary, Stephen. On to Becca in Storrs, Conn. Becca, you're on the air. Go ahead, please.

BECCAHi. I'm from the Korey Stringer Institute. For those that may not know, our entire mission and goal here is to help prevent sudden death in sports. So the reason I'm calling in is because we have worked with a lot of the other states who have passed similar guidelines and followed the NATA guidelines in terms of the heat acclimatization protocols.

BECCASo the reason I was calling in is because the Maryland guidelines, while very proactive and definitely helping the state to move forward, should be pointed out that they are simply a model policy. So it's important to note also that each county can choose to follow those or not. So the important thing in why we advocate for these policies and for states to adopt them is that we know that during the first five days of practices is the most -- or the highest incidents of heat illnesses and the riskiest time period for those athletes.

BECCASo all of the data that we've seen and all of the data that we've tracked is actually showing that the death rate of exertional heat stroke is on the rise, but the NCAA, for example, has had great success with the heat acclimatization policies which they implemented in 2003. And they actually haven't had any deaths within the football division one level from practicing or playing since 2000.

NNAMDIBecca, thank you for very much for calling. You may want to remind our listeners about exactly who Korey Stringer was.

BECCAYep. Korey Stringer was a lineman for the Minnesota Vikings. And he passed away in 2001 from an exertional heat stroke. And we are created as a result of that to help prevent deaths in the future from athletes participating in sports.

NNAMDIBecca, thank you for very much for call. We're going to take a short break. But you too can call us. 800-433-8850 is the number. Do you have a child who plays a fall sport? How do you make sure your child is hydrated, doesn't get too hot during practices or games? Do you think high schools and coaches are aware of the dangers of heat exhaustion? 800-433-8850. You can send us a tweet, @kojoshow, or email to kojo@wamu.org. I'm Kojo Nnamdi.

NNAMDIWelcome back. We're talking about the heat in high school sports and guidelines for coaches about what to do about that for their young players and inviting your calls at 800-433-8850. Were you a high school athlete? How did your coach deal with practicing in hot weather or if there are concerns you have in general about high school practicing in hot weather? Call us, 800-433-8850. You can go to our website, kojoshow.org. Join the conversation there, send email to kojo@wamu.org, or send us a tweet, @kojoshow.

NNAMDIWe're talking with Ned Sparks. He is executive director of the Maryland Public Secondary Schools Athletic Association. He joins us by phone. And Jon Almquist is administrator of the Fairfax County Public Schools Athletic Training Program. He's also past chair of the National Athletic Trainers Associations Secondary Schools Committee. Ned, you've said that your committee that adopted the new heat guidelines grappled with this dilemma. How do you keep from pushing athletes too hard in the heat, on the one hand, but still get them ready in time for the first game on the other?

SPARKSYeah. And that certainly was an issue, and that was an issue especially with our coaches who felt like, hey, you know, we're responsible for, A, bringing them along slowly, but then, B, getting them ready for actual competition. And, quite honestly, we looked long and hard for any materials that we could find that might support, you know, the point of view that there, you know, where does the happy balance come out?

SPARKSAnd the only thing that we were able to really zero in on and determine that was, you know, the way to go which was the NATA guidelines that were already issued. Having said that, we might have to go back and rethink about the number of practice days that we allow prior to the start of the first game. Right now, it's a three-week window. But we might have to consider maybe making that window a little bit wider to give the coaches and the teams a little bit of a head start, a little bit running start, so when they hit those first few days, they have some time to acclimate themselves to the conditions.

NNAMDIWhat's the window in Fairfax County, Jon Almquist?

ALMQUISTThere is a limited number of days. They have to have helmets only for three days and then their -- and the shoulder pads for two, and then they can't do full contact with full pads until the sixth day. You also have practice limitations on how many time -- they have to have a minimum number of practice days before they actually get into the first game as well. So that's already been established, and it seems to be working. Like I said, we have had -- we've been lucky we haven't had any problems with heat, catastrophic problems with heat.

ALMQUISTBut, you know, it's a part of the -- it's not just the guidelines. It's also education. It's education to everybody. The parents, the kids and the coaches all have to be involved in this, and they also have to be able to recognize symptoms. And the more eyes you have looking at these kids to see those subtle little changes not only for the heat but also the concussions, 'cause some of these symptoms are very, very similar between the two, bringing it to somebody's attention that knows what they're doing.

ALMQUISTAnd that's why we have certified athletic trainers at all the practices, home and away games and all practices. So then they're able to do the right thing. If we notice any problems with heat, first, we're going to get equipment off. We're going to immediately and aggressively cool on site. So we have that plan in place, and we're going to chill this kid down immediately. And that's the key thing. The research shows that it's not necessarily the temperature the core reaches, but it's the time at that temperature that causes the death. So it's very important to make sure that they are treated immediately.

ALMQUISTEven if you are headed -- were in an area that had fast EMS service, that could be a death sentence right there because, by the time that the ambulance gets there, even if it's 10 or 15 minutes, the additional time that the body core is at a high temperature is a real danger. So we immediately cool them. We're not aware of anywhere in literature that shows where a person suffering heat illness that has been aggressively cooled -- and that's basically been submerged in ice cold water, 40-degree water -- that has caused them to have any complications from hypothermia.

ALMQUISTSo the reality is we're going to cool them aggressively, and then we're going to call 911, get them to the hospital appropriately. And I think that's one of the key things, to have everything in place. It's not just one, like, the guidelines, and it's not just education alone. It's got to be a combination of all factors that are really going to keep the kids safe.

NNAMDIWhat role does drinking fluids and staying hydrated play in keeping athletes from overheating?

ALMQUISTWell, the hydration -- if you're dehydrated, obviously, you're -- you are more at risk for heat illness and also, you know, heat cramps and et cetera, muscle cramps. So the combination of making sure there's enough sodium in your fluids and if you're -- depending upon how much you actually sweat. People sweat at different rates, so you need to be replacing those fluids at your sweat rate, not just -- you know, if everybody is able to drink eight ounces every 20 minutes, then that would be perfect.

ALMQUISTIt'd be a lot easier thing to manage, but that's not the case. So some kids will need twice that, and some kids just cannot keep up in a hot environment with drinking enough to replace the water that they lose in sweat and the sodium. So these are other issues that you have to know your system, and that also the acclimatization period gives the athletes time to understand that when they have the education to go along with it.

NNAMDIBack to the telephones. Here is Jeff in Damascus, Md. Jeff, your turn.

JEFFHi. Can you hear me OK?

NNAMDIYes, we can.

JEFFOK. You know, an earlier caller suggested that the head coaches are already clear with these guidelines and should be following them anyway. I think that -- then there was an interjection that the trainers are the ones who are really certified to do this. But what I would point out in terms of the familiarity of these guidelines is that some of the top teams, the ones that win years after -- year after year are under a great pressure to continue that tradition. And I think sometimes it's not a matter that the coaches don't know but rather just that they're under a -- they're in a pressure cooker, so to speak.

NNAMDIWell, Ned Sparks, what happens if a coach wants to win so badly that he or she does not follow these guidelines? What's the penalty?

SPARKSWell, right now, there is no actual penalty. You're talking about, you know, forfeiture of games and things like that and so forth, and that really wasn't the purpose of what we wanted to do. We certainly understand that. But, obviously, I wouldn't want to be a coach in that position. I've had guidelines, had model policies.

SPARKSI had policies that my school system was following, and I didn't follow and any youngster had some serious problems, I think, you know, that's certainly, you know, grounds for firing and probably grounds for some other legal action. So I think there's some things out there that make this thing pretty serious in regard. But, as far as from the athletic point of view, I don't see our regulations coming into play as far as punishment, but obviously there are some greater and more important issues out there that could be brought to bear.

NNAMDIJeff, thank you for your call. You, too, can call us at 800-433-8850. Let's go to Lee in Silver Spring. Lee, you're on the air. Go ahead please.

LEEHi. Yes. I have three boys that play youth football. And I just wanted to make a comment that this isn't just an issue for high school level on up, although I was wondering if there was an age correlation with the heat-related injuries and stroke and that type of thing. But also, I wanted to make the comment that my husband is a youth coach, has already been through some concussion and heat-related training prior to the start of my sons' season.

NNAMDIOh, good. Good for your husband and presumably for all of the kids who are playing for him. But is there any link between the age of the player and the heat-related injuries as far as you know, Jon Almquist?

ALMQUISTWell, I think the -- there hasn't been as many heat-related deaths in the younger youth levels that we know of, that we're aware of. But -- they are still susceptible to that, and so I think the concerns are still out there. And the guidelines need to be implemented across the board. Obviously, the intensity changes a little bit, and it was mentioned that, you know, you have a really good team. You have really strong coaches under a lot of pressure.

ALMQUISTBut usually most coaches in the youth leagues, we hope anyway, that are there to help develop these kids for serious participation later in their lives as the competition increases. You know, to win you a third grade Pee Wee football, you know, trophy, everybody should get one. And that's very good. And it's a great feeder system for our high school athletes, and even travel team athletes in other sports. But the reality is the younger you are, we're hoping that these coaches aren't pushing that hard.

NNAMDIHow can coaches and players tell if they're dehydrated? You mentioned that it can be different in different persons.

ALMQUISTYeah. It's -- you know, there's a couple different issues you have to deal with. One is that we know that the thirst mechanism to understand that you are dehydrated, it doesn't kick in till you're way dehydrated. Your thirst mechanism doesn't kick in, so that doesn't really work that well. One of the best ways is to measure how much you take in and then how much you weigh at the end of the day after a high energy workout. But also, you're looking at the urine color. When it's dark brown, that's very, very dangerous.

ALMQUISTYou are dehydrated. The more yellow -- darker yellow or dark brown the urine is, then you know that you're already past the point where it's dangerous. You are suffering some health risks. Three percent of your body weight lost in water -- and if you're using the scale to assess that -- that's really the greatest -- the best way to go about it, then that's going to start to deal with health risk. Two percent actually is all you need to have some performance deficits according to literature.

ALMQUISTSo you want to make sure you're well hydrated. And if you end up cramping, you know, it's the sodium that you need, not necessarily the potassium. Used to say eat a lot of bananas and things, but now it's been shown that it's more the sodium issues that you're low on. So there are some salty snacks that you can eat in pretzels and things like that. And those are the things -- some other things that can help. And then the sodium also -- the salt also causes you to be -- drink more because you are -- you feel thirstier, so that has advantages as well.

NNAMDIThat's Jon Almquist. He is administrator of Fairfax County Public Schools Athletic Training Program and past chair of the National Athletic Trainers Association Secondary Schools Committee. He joins us in studio. Ned Sparks joins us by phone. Ned Sparks is executive director of the Maryland Public Secondary Schools Athletic Association. You can join the conversation by calling 800-433-8850 if you have concerns about heat and young people playing sports. Here is Doc in McLean, Va. Doc, your turn.

DOCOK. Here I am. My main comment is the fact that I think there has to be some common standards to determine the maturity of the coaches. Frequently, coaches are themselves not grown up, and they take out their immaturity by their severity. I've coached over 50 years, and the kids taught me more about how to behave myself. In fact, I would have the captains at times give me a spanking if I exceeded the boundaries of good sense.

NNAMDICare to comment on that, Ned Sparks?

SPARKSWell...

NNAMDIThe maturity of the coaches themselves.

SPARKSThat's certainly, you know, a point well taken. I used to coach myself and go to coaching clinics and look around and see that all the people at the coaching clinics were all, you know, younger guys. And I didn't know if the older guys knew it all or this was kind of a terminal thing, and you dropped off after a period of time. But I think there's that to be played, too. But we hope that we inject in the sense that -- a sense of professionalism.

SPARKSAnd we hope that as -- for the most part, a faculty member of the school, that there are some levels of maturity that they come into play. And certainly we hope that there's some good supervision from -- over head coaches and athletic directors and even principals and so forth. So, you know, that's not to say that everybody is not perfect.

SPARKSAnd there are some cases where maybe too much exuberance for, you know, a young coach can perhaps, you know, be a detriment to the youngsters, but by the same token -- and I think pretty well, pretty much in large, that the, you know, are coaches and our athletic directors do a good job as far as bringing a level of professionalism to that whole aspect.

NNAMDIWell, we got an email from Jerry in Fredericksburg. It's a little long, so bear with me. Jerry writes, "I'm glad to see school systems are putting in place appropriate rules to protect young people playing all sports in the late summer heat, not just football. Seems to me that pop culture has a particularly poisonous effect on many of the people who coached these kids and are responsible for them. I shudder to think of how many high school coaches might have seen 'Remember the Titans' and thought, that's the coach I want to be.

NNAMDI"Denzel Washington's character may have given some charismatic speeches in that movie, but he also told his players that water makes players weak. How dumb is that? And let's not forget just how much influence coaches have in some of these communities. Kids look up to these adults. Many of the players live in a world where pleasing their coach and performing well on the field is the most important thing in their lives.

NNAMDI"A scary amount of responsibility comes with having that much influence in a young person's life." That said, Jon Almquist, what are the rules in Fairfax County about having an athletic trainer on hand during practices and during games?

ALMQUISTIn football, an athletic trainer has to be on site at all times, all levels, freshmen, JV and varsity. And the -- all the other sports, the athletic trainer is going to be campus nearby, and they are full -- then we have a full-time athletic trainer, as well as one associate athletic trainer who also is a teacher or another support person within the school. So we basically have two professionals at each school to deal with all the athletes, not just football, all the athletes across the board. And all the games are going to be covered at home as well by a certified athletic trainer.

NNAMDII guess this is for both you and for Ned Sparks. The president of the National Athletic Trainers Association was quoted as saying, many high schools do not have an athletic trainer or anyone trained in first aid present for workouts. He compared it to dropping your child off at a swimming pool with no lifeguard. Appropriate comparison, Ned Sparks?

SPARKSI'm not sure I would entirely agree with that. And, like I said earlier, our coaches are all required to have a care and prevention of athletic injuries course prior to stepping on the field. Also, we know that they are required to have training in concussion management and recognition. And now this year, beginning of this year, we're going to have it with heat acclimation.

NNAMDIWell, he said -- he did say not only an athletic trainer, but someone trained in first aid present for workouts. I guess, the -- what you're talking about would fall into the latter category.

SPARKSWell, like I said, the course that they're required to take is care and prevention of athletic injuries, and that's a 15-hour clock hour course. And, you know, that's the rudiments. I mean, you know, why you say you could have one on hand for the varsity football team, but, you know, what about the JV soccer team that might be practicing off campus, or what about the cross-country team that's out, you know, running -- are far away from where the trainer might be and so forth?

SPARKSSo we feel it's important for all of our coaches to have at least a rudimentary sense of what to do and what care to take and what are the procedures, and that's an important element of this whole thing. And that's part of the reason for, you know, our regulation in -- is the fact that we don't have athletic trainers everywhere, and we need some professional people that know what they're doing and care what they're doing and are available to assist and take care of injuries before they become, you know, a matter of life and death.

NNAMDIFollowing up, Jon, how do you teach the coaching staff to recognize heat-related exhaustion or illness?

ALMQUISTWell, we -- also, in our county, we require all coaches to have sports first aid, as well as a full gamut of coaches' education, which includes coaching principles course, sports first aid and orientation. And during this sports first aid, we cover heat-related illnesses, as well as the orientation, we cover that. And then they follow up with the athletic trainers at the individual schools. We'll have meetings with the coaches at the beginning of the season.

ALMQUISTAnd they would go over the guidelines and how they're going to communicate, you know, 'cause the athletic trainers are the one with the sling psychrometer that's going to determine what the temperature is, the wet-bulb temperature is for that day. And if there's any restriction on equipment they have to have or if they can even go outside at all, that there has to be a system set up so everybody knows that that, you know, the temperature has reached 82, so, therefore, everybody is going to be off the field. They can only go into air-conditioned areas.

ALMQUISTSo the education program is pretty elaborate with regard to not only the formal education through coaches' education but also through daily education, just communication with the athletic trainers and the coaches at that individual school. So we have, like, 25 sets of that going on as well. And I think that's important. Virginia State has a coaches' education requirement as well across the state. So, you know, I think that's one of the key factors.

NNAMDIGot to take a short break. If you have called, stay on the line. We will get to your call. The number is 800-433-8850. We still have a couple of lines open, but if you can't get through, you can send us email to kojo@wamu.org, or send us a tweet, @kojoshow. We're talking about the heat in high school sports and what to do about it with young athletes. I'm Kojo Nnamdi.

NNAMDIRespecting the heat in high school sports is what we're calling this conversation with Ned Sparks, executive director of the Maryland Public Secondary Schools Athletic Association and Jon Almquist, administrator of Fairfax County Public Schools Athletic Training Program. Jon is also past chair of the National Athletic Trainers Association Secondary Schools Committee.

NNAMDIWe got this email from Beth, who says, "My son is a rising sophomore at Madison High School, part of Fairfax County public schools in Vienna. Cross-country practice started for the season this morning at 7 a.m. at Nottoway Park. The team ran four miles this morning but will gradually increase to 10. We sent him a large bottle of ice water and gave him a light breakfast beforehand. Practice is always over by 10 a.m. before the heat really starts." Basic practice in Fairfax County, right, Jon?

ALMQUISTYeah. That's -- one of the other things we're trying to do is make sure that we try to stay away from the heat of the day. One of the things to understand, though, sometimes when the temperature goes down in the afternoon, late-afternoon hours on a real humid day, the humidity actually rises a little bit. Sometimes the heat stress can actually have a reverse effect. But, generally speaking, we try to get things in early when the -- before the heat of the day.

ALMQUISTAnd that's just coordinating with the teachers and the coaches and the families -- excuse me -- involved as well with making sure the kids are able to get there on time. And then when schools starts, yeah, we're limited 'cause we can't go out early in the morning 'cause our school starts so early in the morning anyway. So we're kind of pushed to the later afternoon hours. But again, oftentimes, we will push practice. You don't have to go outside until later when it does actually -- the temperature does come down a little bit. As long as the stress doesn't rise, the heat stress doesn't rise.

NNAMDIBack to the telephones. Here is Richard in Rockville, Md. Richard, you're on the air. Go ahead, please.

RICHARDYes. I just wanted to make a comment and then ask a question. I played high school and college football back in the 1960s. I guess this was the dark ages of health because you were considered then a sissy if you asked for water. And if you didn't get your drills right, the coaches will keep pushing you and pushing you and pushing you, and water was given as a reward, not as a need.

RICHARDBut my question is this, talking about hydration, cannot one become over-hydrated? If you drink too much water and don't realize it, doesn't that create a danger because it upsets the acid base balance in the body? You know, I'll take my comment -- answer off the air. Thanks.

NNAMDIRichard says the '60s were the dark ages, Jon.

ALMQUISTWell, that is true. And we're hoping we don't have any fields right now, whether it be youth or high school or college, that they're restricting water 'cause that's just not smart. But, yes, there is a condition called hyponatremia that you can actually drink too much water. But realistically, it's very unlikely that's going to happen to any of the high school-type sports where you're fairly short duration. They're -- hyponatremia is a little bit more common in the longer triathlon-type sports or the ultra-marathon type.

ALMQUISTThe other issues you'll see it where a person who may not have a high sweat rate. We'll see young females running down the bike trail. And they're out for their four-hour run, and they have six water bottles tied to their waists. And they don't sweat much to begin with, and they keep on drinking all this water. And that would cause a potential for hyponatremia, and that is a very dangerous condition. It does need to be watched. But it's very unlikely in the high school-type sports.

NNAMDIRichard, thank you very much for your call. Ned Sparks, how are coaches in Maryland reacting to the new heat guidelines? They are getting, I guess, pretty short notice to change plans for workouts that start this weekend.

SPARKSYeah, well, I think a lot of them were a little bit in shock. I think there was a, you know, sort of the sticker shock that kind of commends with first -- all this and first realizing what they have to do. But I think they're beginning to absorb it now, and they're beginning to realize that this is not just simply them. It's something that's happening across the country. It's something happening in the college level. It's even, you know, something happening in the professional level.

SPARKSSo as time wears on, as they begin to realize that now our challenges -- or maybe they will arrange our practices a little bit differently than we've done for the last 10, 12, 15, however many years they've been coaching, and maybe do some things that perhaps are a little bit different from what they're traditional role has been, I think that they are beginning to adjust. We hope to be able to change some of our regulations, too, that would help them out a little bit.

SPARKSBut I think, more and large, as time goes on, they'll be closer and they realize that everybody is in the same position, you know, it's not one school system has an advantage over another, they're all following the same rules and same regulations, I think they're coming to the realization that, you know, maybe this is something that's long overdue, something we need to do and maybe we can prevent a tragedy from happening. And if that's the case, we're better off for it.

NNAMDIHere is Ree (sp?) in Washington, D.C. Hi, Ree, your turn. Ree, are you there?

REE(unintelligible)

NNAMDIRee, we can't hear you very well. I'm going to put you on hold. And if you're talking on a speaker phone, try to talk through your handset, and we'll get back to you. In the meantime, let's go to Tom in Bethesda, Md. Tom, your turn.

TOMYes, hi. Thanks for taking my call. This is a very timely conversation in Montgomery County. Three years ago, a Northwest High School student, Edwin "Dek" Miller, died of heatstroke sustained during football practice in July. I spent this past weekend looking at some of the material we're preparing for a parent of high school student. And what the takeaway it is that I had that it's a very preventable disease, but the management of it is very, very complicated.

TOMJon -- I think there's discussion before about weighing students each day, students having to pre-hydrate and -- before they come to practice, as much as two hours before, hydrate afterwards. And it seems like some fairly complicated systems need to be in place. And I'm just wondering whether or not it's feasible to have that in place, to have an athletic trainer on staff. Thank you.

NNAMDIA couple of answers to that. Jon, I'll have you answer that question directly. And then, Ned, I'll -- I want to talk about that case with you later. But go ahead, please.

ALMQUISTYeah. I think to help alleviate the risk or lower the risk, weighing kids in before practice on a daily basis is a smart move. Weighing them in after practices can give you a guide of how much water they actually have to drink. And, remember, hydration is not just something you do during the practice or the game. This is something that's a 24-hour day job. And so that's extremely important to understand. The kids need to understand it as well as the parents because the parents are then eventually going to be able to provide them with some of the liquids that they do need.

ALMQUISTAlso, you know, fruits and vegetables also have a lot of water content, so overall nutrition is marked as well. But to do the right thing, to have somebody on the sidelines to be able to identify when something is going wrong and then doing the right thing, which should be immediate cooling when it's the concern of heat, that's why having the certified athletic trainer in the sideline is an advantage. They are a medical provider, allied health care provider, that, in most states, they are licensed by the state board of medicine.

ALMQUISTAnd they have these emergency action plans that's part of their education, and they're -- they should have that in place and ready to go. And so having all the tools in place, thinking about what you're going to do in the heat of the moment -- no pun intended -- is not good enough. You have to actually act and act quickly. And then that's why it's so important to get them in this immediate, aggressive cooling. If your plan is to take them back up to the school and put them in a cold shower, you probably are going to waste -- if you're close to the school, you're going to waste five or 10 minutes.

ALMQUISTYou need to have something right there on the practice field to be able to get them cooled off immediately and keep them being cooled off. And so just putting, you know, ice bags under their armpits and their groin for the arterial cooling, that's not enough either. A massive cold -- ice towel and continuing to recirculate that ice towel process is another method that may work. But, ultimately, the best is submersion in ice water. And you have to have it available, though. You can't start filling a tub up when you have a kid crashing on you.

NNAMDINed Sparks, we remember the case of Edwin Miller. He collapsed during football practice at Northwest High School. He was reportedly rushed to a hospital and later died from heat and dehydration. His parents are suing the Montgomery County school system and three football coaches saying, in part, the school failed to supply water and ice, which is what led to the heat stroke. Can you tell us any more about this case?

SPARKSNo, I can't. I know about it and another case. I do know it wasn't during the official school practice period. I think it was during some summer conditioning period. Matter of fact, my recollection was it happened early in July, and, of course, that's well before the starting date of our teams. So I'm a little unaware of that, of all those particulars. And, quite honestly, since there is litigation that appears to be going on...

NNAMDIYou can't comment on it anyway.

SPARKS...I wouldn't comment at all anyways.

NNAMDIThank you, Tom, for your call. Here is Ree in Washington, D.C. Ree, let's see if we hear you better this time.

REEHi there. This is Ree.

NNAMDIYou're very clear. Go right ahead, please.

REEThanks so much for taking my call, Kojo. I'm questioning whether or not these regulations apply also to girls who are practicing for sports. I have a granddaughter that plays field hockey, and I know that for...

NNAMDIOh, well, Ned Sparks can tell you, there are regulations for field hockey also, aren't there, Ned Sparks?

SPARKSYeah. That's absolutely -- matter of fact...

REEWell, they're not even required to -- the girls are not even required to wear helmets while the guys do, and that's important.

SPARKSWell, our field hockey goalies wear equipment, and we have put in standards for when they can begin to add those pieces of personal equipment. So there's a gradual acclimation for field hockey players as well as there is for volleyball players and cross-country and soccer and everybody else. Although this emphasis certainly seems to be on football, the other sports are certainly taken into account on this.

NNAMDIRee?

REEThat's right. One follow-up, my granddaughter had a concussion that took her out of school for three weeks so...

NNAMDISo you're very glad, I'm assuming, that there are regulations.

REEYeah, and I'd sure like to see that helmet rule go in place, too, as well as the heat.

NNAMDIOK. Thank you very much. We got an email from Kathleen, who said, "Many schools are now using artificial turf, which has been found to heat up to very high temperatures." What are the schools doing about the particular heat hazards of artificial turf, Jon?

ALMQUISTWell, we're monitoring the turf. We're monitoring all the surfaces. And at times, if they -- we find a practice field with natural grass that's going to be cooler than the turf, that's where all the athletes will then shift to. So that's important that, you know, we're just monitoring the individual surface areas of their practices, not just one -- we don't take the temperature off of the website or off of the schools thermometer.

ALMQUISTWe're taking it on the field, so that's important to understand. And sometimes the older turfs are a little bit warmer usually, and it really depends on what the cross-flow is. There's a lot of factors that come into play with regard to heat on turf versus grass.

NNAMDIAnd with -- referring to the earlier call we had about the student who died, Jon, you've said you worry about off-season practices where there may not be an athletic trainer present.

ALMQUISTAbsolutely, and I think one of the things you will find is the more recent deaths in high school sports has been in these off-season practices. We implemented this year the heat guideline, which when there's a heat advisory throughout our county, all off-season practices are cancelled outside. They can still practice inside, but they can't go outside. So we're extending our limitations when the heat is high in that respect because there aren't athletic trainers on site to actually do the wet bulb and/or care for them.

ALMQUISTBut the education to the coaches also, you know, we do provide them first aid, and we also provide them with information that would allude to the common sense factor, that they need to use common sense when we're dealing with these issues.

NNAMDIJon Almquist, he is administrator of Fairfax County Public Schools Athletic Training Program and past chair of the National Athletic Trainers' Association's Secondary Schools Committee. Jon, thank you so much for joining us.

ALMQUISTThank you.

NNAMDINed Sparks is executive director of Maryland Public Secondary Schools Athletic Association. Ned, thank you for joining us.

SPARKSThank you.

NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.