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From worst to first

Football players begin their seasons practicing under often extreme heat, particularly in the South. Covered by layers of pads, helmets, and jerseys, they run sprints, simulate live game scenarios, and crash into each other on fields that are often hotter than the air itself.

Historically, players might jump straight into two-a-day practices in full pads. There are, after all, only a few weeks to get ready for the season. A couple events helped Cooper begin to understand, however, what might have been behind the seeming epidemic of heat deaths.

In 2003, just a few years after Cooper began researching heat-related illness as a doctoral student, Minnesota Vikings offensive lineman Korey Stringer suffered two heat strokes, succumbing to the second. It was a high-profile death that brought national attention to the issue.

Cooper was approached by the NCAA shortly thereafter to perform a study of 60 colleges and universities from around the country, which he and colleagues divided into six regions. One particular school stood out: Oregon State had practiced for weeks leading up to its first game of the season without a single case of heat exhaustion.

“There were maybe some heat cramps, but nothing else to speak of,” Cooper said. “But their first game of the season was against LSU in Baton Rouge.”

The team traveled south and suffered 13 cases of heat exhaustion during the game. Coupled with the knowledge about Stringer’s death—a player who died in the middle of a heat wave taking place in a typically mild climate (Minnesota)—Cooper began to develop a foundation for the factors at play.

“It was evident the climate took a toll,” he said.

When two Georgia high school football players died of heat stroke in 2008—adding to a total that was already the worst in the nation—then-GHSA executive director Ralph Swearngin reached out for help. Cooper developed a three-year study involving 25 high schools of varying size and location across the state to study practice trends and risk profiles.

They were alarmed by what they found.

“Up until that time, there was really no regulation about how football was practiced,” Cooper said. “Schools would go away to camp and practice six times in a day. They would condition and practice and do walkthroughs and practice again and then lift. There were very few standards.”

The study provided a handful of key insights. First was the importance of heeding the (WBGT), which is used to assess environmental conditions and determine the risk of heat illness.

WBGT combines the influences of humidity, air temperature, sun, and wind. Unlike air temperature, which can be a bit misleading, WBGT provides a more precise measurement of how oppressive the conditions may be to someone exerting physical energy outdoors.

“As the WBGT starts to get over 82 degrees Fahrenheit, we start seeing this increased rate of injuries,” said Andy Grundstein, professor in the and author of the study that identified the number Georgia high school heat deaths in the sport of football. “Hotter WBGT meant higher risk.”

They also identified as key factors the duration of practices, practice intensity, amount of equipment worn, and, importantly, how players were acclimatized prior to putting on their pads and practicing at full strength. Based on these findings, GHSA introduced a new policy in 2012 with new stipulations:

• Practice would open on July 25, and teams were required to spend a week acclimatizing to the weather. They would wear no equipment—just a helmet and t-shirt—and practice for a maximum of two hours each day.
• On Aug. 1, they could transition into full practices but were limited in what they could do. Gone were the days of six practices. The maximum was two, which could not exceed five hours total, with a mandated three-hour break between the two sessions.
• Additionally, Cooper and his team developed a way schools could monitor WBGT using localized sensors. As conditions changed, coaches were forced to adjust practice.

In the 12 years since, there have been two high school player deaths in Georgia—one was a cardiovascular complication, the other the result of negligence for which the family was rewarded a $10 million settlement.

“It’s remarkable the decrease in heat-related problems we’ve seen since this policy came online,” Grundstein said. “We took Georgia from worst to first.”

“Can you think of a better place to be ranked No. 1 than policies for student athlete safety?” Hines added. “I’m not blowing smoke—I think we’re viewed as top of the line for just about every way you’re measured nationally.

“That comes down to Bud Cooper’s work.”

Spreading the message

Cooper and Grundstein’s work, although impactful, didn’t end with the new policies. Cooper continues to contribute to the GHSA sports medicine committee, and both have roles with the University of Connecticut’s (KSI), which pushes for the implementation of heat safety policies around the country.

Cooper’s work with KSI takes him all over the country. With Georgia being an example of the impact such policies can have, Cooper is relied upon to share his experience and expertise with states in early stages of adoption. He estimates he’s traveled to about 10 states, most recently Iowa.

“It’s been rewarding for me because I have their ear,” Cooper said. “When I feel like there is something that needs to be changed, we can make that happen.”

When a handful of schools in metro Atlanta and Fulton County made the decision to change their games from Friday night to Saturday afternoon, Cooper stepped in to add new policies for competition.

“I didn’t make recommendations that games be canceled, just that things be put into place to mitigate risk,” he said. “There would be mandatory timeouts for hydration, and schools would be required to have a cold-water immersion tub onsite.”

They continue to encourage widespread acceptance of cold tubs and urge emergency medical technicians to treat potential heat stroke victims onsite rather than trying to transport them out of the cold water to the hospital.

“There’s not an ambulance in the world that carries any kind of means to cool,” Cooper said. “So, there’s a lot of education that goes on from here. It’s just the battle of pushing back against old prevailing wisdom.”

The climates of tomorrow

When this research began some 20-25 years ago, climate change was not as prominent a piece of the discussion. As locations begin to face heat challenges more acutely, however, Grundstein is focusing more research into how a warming climate affects WBGT.

Grundstein’s lab has produced a paper that examines the readiness of areas around the country. States like Florida, Georgia, and South Carolina are well prepared, and California is beginning to reform, but northern states are left in the cold (or heat, as it were). They have developed region-based guidelines that consider the lower thresholds of acclimatization. Georgia, for example, is generally much hotter than Oregon. So, while both would need to acclimatize their athletes, Oregon must do it at a lower WBGT than Georgia.

“We use their local climate to come up with a lower threshold,” Grundstein said.

The Holy Grail of heat monitoring, Grundstein said, would be to monitor every player individually. A player may wear a biosensor, for example, which can transmit internal temperatures to a trainer who can pull the player back when it gets elevated. Their research indicated that linemen are most at risk of heat illness due to a combination of size and physical exertion.

Beyond athletics, Grundstein collaborated with computer science researchers to measure individual exposure temperatures in various locations and work environments around a given city.

“The weather station may say 85, but locally you can get quite a bit of deviation from that in certain places,” he said. “So if you’re monitoring a postal worker or construction worker—or in this case, a football player—their heat is going to be a lot different than me working in an office.”

They are developing algorithms to see at one point exposure reaches a critical point and recommending breaks and hydration.

“This is applicable in the military, but it will trickle down to recreational athletes and others in the community,” he said.

All the work has proven critical, and Georgia’s success on and off the field has provided an extra layer of credibility that has gotten attention around the nation. As the state has turned around its fortunes in heat safety, it has continued producing some of the nation’s best college prospects (many of whom stayed in-state and won a couple College Football Playoff titles recently).

“You can be among the best competitively and the best for student safety,” Hines said. “They aren’t mutually exclusive. That’s what we’re doing in Georgia.”