Four Years After an MCPS High School Football Player’s Death From Heat Stroke, MCPS Athletics Still Has a Flawed Heat Illness Policy

Below is the text of an email sent to MCPS Athletics Director Beattie, Dr. Tillman, the Md Public Health Officer for MoCo, and Ms. Glick, the MoCo official in charge of health issues for MCPS students.

Today's forecasts for MCPS 25 high schools are for heat indices that would dictate that no outdoor activity be permitted.  Actual conditions at the time of practice may vary from forecasts and from school to school depending on unique conditions.  That is why best practices is to measure the heat index at the field any time the temperature is 84 or above.  Especially on a day like today with high humidity in the forecast.  

As shown on this Maryland map, 3 Md local school systems, including Baltimore City, have policies requiring that the heat index be checked at each school.  MCPS Athletics only requires that the regional air quality index be checked.  Today's AQI forecast is Yellow, which will require no heat restrictions according to MCPS Athletics Policy.

August 26, 2013

Director Beattie, Dr. Tillman, and Ms. Glick,

In July 2009, Edwin “Dek” Miller, a student at MCPS’s Northwest High School, died of heat stroke in a no-pads football practice.[1]  Four years later, MCPS still has a flawed policy for managing the risk of heat strokes in football and other athletics programs.

I testified to the Board of Education about this during public comment at its meeting on July 29, 2013.[2]  As of today, August 26, 2013, however, the flawed heat stroke policies remain unchanged at the MCPS Athletics Department website.[3] 

MCPS’s deviation from best practices may be putting some MCPS students who play football and other fall sports at risk today, August 26, 2013, based on today’s forecasted elevated heat index readings.[4]

Heat Stroke

Heat stroke is a serious and potential fatal condition where the body’s core temperature rises above a safe level.  In high school sports, the majority of heat stroke cases happen in football.  How many happen in MCPS we don’t know because MCPS does not keep such statistics.  In MCPS’s informal annual survey of football coaches, they did not report any heat illness cases in 2010 or 2011.[5]

In neighboring Howard County, however, the public school system keeps detailed records of all sports injuries and reported 22 and 14 heat illness cases in football in 2010 and 2011, respectively.[6]  Howard County only has 12 public high schools so for MCPS, with 25 high schools, a fair estimate is double those occurring in Howard County, or 28 to 44 heat illness cases in football per season.

            It’s the Heat Index, not the AQI Index

MCPS’s policy for managing heat stroke remains flawed in at least two ways.[7]

First, coaches are not required to follow best practices when assessing weather conditions for heat illness risk.  Heat illness risk doesn’t just correspond to the outside temperature.   Rather, it depends on both temperature and relative humidity, the combination of which is measured by what is called the heat index.  As you can see at the heat index chart at this footnote, dangerous conditions can exist with the outside temperature as low as 85 degrees if the relative humidity level is high enough.[8] 

And the heat index has to be measured at the field of practice or play because it can be influenced nearby heat islands, like a parking lot or a school roof.

Sometimes the field itself can be heat island if it is an artificial turf field where surface temperatures can soar to as high as 200 degrees.   So you can’t just look at the heat index for a region or a zip code area.  You have to measure it at the field.

An athletic trainer is trained to measure the heat index before every practice or game using a device called a psychrometer.  And the athletic trainer records the reading on a log chart like this one: http://www.scribd.com/doc/159612075/HS-Athletics-Heat-index-Daily-Log-Template

Howard County Public Schools Policy requires the Heat Index to be measured each day.

MCPS Athletics’ heat policy, however, doesn’t educate coaches about the heat index or require that they measure it to make decisions about play or practice. 

Instead, MCPS Athletics policy requires coaches and athletic directors to consult the air quality index readings for the particulates in the region.[9]

It is true that the Air Quality Index for particulates increases as the outside temperatures increase.  But using an index designed to help people with air quality related conditions, like asthma, to make decisions about heat illness is dangerous.

The danger of making heat activity restriction decisions based on the Air Quality Index readings instead of heat index readings was on display during the heat wave that the DC area experienced between July 12 and July 19 this year.  On many of those days, the heat index was well above 105, the level for which best practices say any outside activity is safe.  The Air Quality Index readings for those days, however, did not exceed a level that under MCPS’s policy would have only required coaches to watch carefully.

Attached are heat index estimates for each of MCPS’s 25 high schools for today, August 26, 2013, based on using the schools zip code in the calculator at the Oregon State Activities Association’s website. http://www.osaa.org/heat-index

The August 26, 2013 heat index estimates are also found at this link: http://www.scribd.com/doc/163163734/MCPS-25-High-Schools-Heat-Index-Estimates-and-Recommendations-for-08-26-2013-by-parent

So MCPS needs to change its policy to align with best practices.  And it needs to go out purchase 25 digital psychrometers and keep them properly calibrated.

            Emergency Plan for Heat Illness

When a heat illness emergency happens, seconds count.  The gold standard practice is to have a shaded cooling station, water, and ice and a tub that a student suffering from heat stroke can be immersed up to his or her shoulders.[10]   Cool first, then transfer.

A distant second best is to pack ice under a student’s armpits and groin and transfer to the school shower.  It’s a second best because the delay in getting the student immersed in ice water could reduce the changes of the student surviving a heat emergency.

MCPS Athletics’ heat policy allows a school to chose which of the two responses and at least one high school.[11]   At least one MCPS high school has chosen to go with the second best plan.[12]

Conclusion

To prevent another tragedy like Dek Miller’s death, please bring MCPS’s heat illness policy in line with best practices.

Sincerely,

Tom Hearn