title: Implementing exertional heat illness prevention strategies in US high school football.
abstract: OBJECTIVE
  Approximately 6500 high school football athletes are treated annually for exertional heat illness (EHI). In 2009, the National Athletic Trainers Association (NATA)-led Inter-Association Task Force (NATA-IATF) released preseason heat acclimatization guidelines to help athletes become accustomed to environmental factors contributing to EHI. This study examines compliance with NATA-IATF guidelines and related EHI prevention strategies.
  
  
  METHODS
  The study used a cross-sectional survey completed by 1142 certified athletic trainers (AT), which captured compliance with 17 NATA-IATF guidelines and EHI prevention strategies in high school football during the 2011 preseason.
  
  
  RESULTS
  On average, AT reported football programs complying with 10.4 NATA-IATF guidelines (SD = 3.2); 29 AT (2.5%) reported compliance with all 17. Guidelines with the lowest compliance were as follows: "Single-practice days consisted of practice no more than three hours in length" (39.7%); and "During days 3-5 of acclimatization, only helmets and shoulder pads should be worn" (39.0%). An average of 7.6 EHI prevention strategies (SD = 2.5) were used. Common EHI prevention strategies were as follows: having ice bags/cooler available (98.5%) and having a policy with written instructions for initiating emergency medical service response (87.8%). Programs in states with mandated guidelines had higher levels of compliance with guidelines and greater prevalence of EHI prevention strategies.
  
  
  CONCLUSIONS
  A low proportion of surveyed high school football programs fully complied with all 17 NATA-IATF guidelines. However, many EHI prevention strategies were voluntarily implemented. State-level mandated EHI prevention guidelines may increase compliance with recognized best practices recommendations. Ongoing longitudinal monitoring of compliance is also recommended.
authors.affiliation: 1Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; 2Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC; 3Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC; 4Department of Epidemiology, Colorado School of Public Health, Aurora, CO; 5Pediatric Injury Prevention, Education, and Research (PIPER) Program, Colorado School of Public Health, Aurora, CO; and 6Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT.
authors.forename: Zachary Y
authors.initials: ZY
authors.lastname: Kerr
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
authors.forename: R Dawn
authors.initials: RD
authors.lastname: Comstock
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Casa
mesh_terms: D000064:Acclimatization / Q000502:physiology*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005538:Football / Q000502:physiology*; D019983:Guideline Adherence / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D018882:Heat Stress Disorders / Q000517:prevention & control*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion / Q000502:physiology; D012574:Schools; D014481:United States; D055815:Young Adult