Heat-related illnesses, such as heat stroke and heat exhaustion can be serious and potentially life-threatening conditions. U.S. Soccer’s RECOGNIZE TO RECOVER program prepared this guide for coaches, referees and players when training or playing in warmer climates, outlining recommendations for hydration breaks and participant safety during extreme temperature conditions. The information provided herein is not a substitute for medical or professional care, and you should not use the information in place of a visit, consultation or the advice of your physician or other healthcare provider. For specific questions and concerns, please consult your healthcare provider or physician.

HEAT-RELATED ILLNESS

Heat-related illnesses, such as heat exhaustion and exertional heat stroke (EHS), can be serious and potentially life-threatening conditions which can be brought on or intensified by physical activity. Recognizing the signs and symptoms as early as possible allows for treatment and rapid recovery with hydration and cooling down the individual.

•   Early signs and symptoms of heat illness include weakness or fatigue, headache, nausea and dizziness
•   Altered mental status, such as confusion, irritability, aggressive behavior, dizziness
•   Slurred speech
•   Hallucinations
•   Loss of balance, falling down
•   Throbbing headache
•   Body temperature above 104 degrees Fahrenheit
•   Complaining of chills, while skin may be warm to the touch

Preventing heat related illness is the best medicine. It may become important to adjust training, match play and hydration breaks when playing in warmer climates and during extreme temperature conditions.

•   Develop and implement a heat policy (heat acclimatization guidelines, activity modification guidelines based on environmental conditions and management of heat-related illness) as part of your emergency action plan (EAP)
•   Frequently monitor environmental conditions using Wet Bulb Globe Temperature (WBGT) device or Heat Index and make practice modifications (e.g., increase in the number and duration of hydration breaks, shortening practice, postponing practice/competition until cooler parts of the day)
•   Follow heat acclimatization guidelines (below) during preseason practices and conditioning
•   Ensure appropriate hydration policies are in place with athletes having unlimited access to water during practice and competition, especially in warm climates.
•   Educate staff on the signs and symptoms of heat related illness and early management
•   Consider having a health care provider such as an athletic trainer onsite for all practices and competitions

To assist coaches and athletes in this, RECOGNIZE to RECOVER created an easy reference poster. The guidelines are intended to help evaluate situations to prevent heat-related illness before it begins. The three-step Heat Guidelines include methods for evaluating danger levels and appropriate responses to those various levels

EXCESSIVE HEAT IMPACT ON PLAY

Depending on your Region Category, it is recommended that training or match play be canceled or delayed until cooler when WBGT exceeds these levels:

•   Region  Category 1 >86.2°F;
•   Region Category 2 >89.9°F
•   Region Category 3 >92.0°F

Once an alert level is determined, follow these “Work to Rest” ratios to modify training to help ensure safe play:

•   Alert Level Black – No outdoor training, delay training until cooler or cancel.
•   Alert Level Red – Maximum of one hour of training with four separate 4 minute breaks within the hour. No additional conditioning allowed.
•   Alert Level Orange – Maximum two hours of training time with four separate 4 minute breaks each hour, or a 10 minute break after 30 minutes of continuous training
•   Alert Level Yellow – Use discretion, provide three separate 4 minute breaks each hour, or a 12 minute break every 40 minutes of continuous training
•   Alert Level Green – Normal Activities, provide three separate 3 minute breaks each hour of training, or a 10 minute break every 40 minutes.

HEAT POLICY

A heat policy is intended to serve as a guide for regulating match play, practice sessions, hydration breaks and participant safety during extreme temperature conditions. Such a heat policy can be shared with participants, making sure everyone is aware of the safety precautions in place. The steps listed below should be considered when developing a heat policy:

•   Heat policy should be part of an overall EAP
•  Prevention
•  Follow heat acclimatization guidelines (see box)
•  Activity modification guidelines based on environmental conditions
•   Frequently monitor environmental conditions
•  WBGT device or Heat Index
•   Increase the number and duration of hydration breaks
•   Shorten practice/reduce intensity of exercises
•   Postponing practice/competition until cooler parts of the day
•   Management and treatment of heat-related illness
•   Remove from training and source of heat

Acclimatization

Acclimatization is the body’s natural adaptation to exercising in the heat. This process typically takes 10-14 days. Effective acclimatization should require a gradual graded progression of exercise in the heat. This typically applies at the start of preseason (summer months) where athletes are beginning fitness training and progressive training exposure in heat is recommended

GUIDE FOR ACCLIMATIZATION (10-14 DAYS)

Avoid the hottest part of the day for training sessions (11am-4pm)

Days 1-5

•   One formal practice a day
•   Maximum three hours of training time (this includes warm up, stretches and cool down)

Days 6-14

•   Double practice days can begin day 6 and not exceed five hours in total practice time between the two practices.
•   Minimum of three-hour rest period between each training session during double practice days. The three-hour rest period should be in a cool environment to allow the body to fully recover.
•   Each double practice day should be followed by a single practice day with practice time not to exceed three hours.
•   Athletes should receive one day rest following six days of continuous practice.

RECOVERY

•   Remove from training and away from the source of heat
•   Cool in a shaded area using ice towels
•   Fan or spray with water to bring down body temperature
•   Provide access to fluids/electrolytes and encourage rehydration

SPECIFIC HEAT-RELATED ILLNESS

The first steps to recovery in all these cases are replacing fluids and cooling the body by resting in a cool, shaded place. Fanning or spraying with water will also help bring down the body temperature.

Heat Cramps

Heat cramps usually affect those who sweat a lot during strenuous activity. This sweating depletes the body’s salt level, as well as hydration. Low salt levels lead to painful muscle cramps. Heat cramps may also be a symptom of heat exhaustion.

Heat Stroke

Heat stroke is the most serious heat-related disorder. It occurs when the body becomes unable to control its temperature. When this happens, the body’s temperature rises rapidly, the sweating mechanism fails and the body is unable to cool down. The surge in body temperature can happen very quickly, within 10 to 15 minutes, rising to 106° Fahrenheit or higher. Heat stroke can cause death or permanent disability if emergency treatment is not given.

Someone suffering heat stroke will be dizzy and confused. They may slur their speech, have hallucinations or complain of a throbbing headache. While their skin may be warm to the touch, they may actually complain of chills. If you suspect heat stroke, get the on-site medical provider or call 9-1-1.

MANAGEMENT

HEat Illness (Heat Exhaustion, Heat Cramps)

•      Remove from training and source of heat
•      Cool in a shaded area using ice towels
•      Provide access to fluids/electrolytes and encourage rehydration

Exertional Heat Stroke

•      Is a medical emergency
•      Immediately call EMS (911) and prepare hospital for heat related emergency
•      Athlete may have confusion or altered mental status and a rectal temperature >104°F
•      Remove excess clothing/equipment and immediately begin cooling the athlete by placing them in an ice-water-tub
•      If no tub is present, rotate cold wet ice towels (every 2-3 minutes over the entire surface of the body or as much as possible)

 If teams are aware of a potential air quality issue in their home market in advance of hosting a match, they must notify the league as soon as they become aware of the issue.  Teams are to use www.AIRNOW.gov to determine AQI in the local market. AQI is to be read 1 hour prior to teams starting warmups.

Based on the reading the following must be implemented: 

AQI 100-150:

• Add one hydration break per half to be taken at the 30’ and 75’ or at a natural break close to the times.

• Players with underlying health conditions should use caution and will communicate with local CMO and each team to monitor players with complicating health issues. To make decisions in the players best interests and risk category

• EMS to have oxygen available as needed on game day-consider oxygen availability at each bench

AQI >150:

• Four hydration breaks will be taken at the 15’, 30’, 60’, and 75’ or at a natural break close to the times.

• Oxygen behind the benches to be supplied by teams with at least 2 masks available

• Team docs start communicating regarding any at-risk players and how to best continue forward for the health of the players

• Should coordinate with local public health officials and be in line with local and or regional restrictions if in place- this should take into account players and spectators

AQI approaching 180-200:

• Consideration for postponing or canceling with on the ground assessment with the medical team

• Should coordinate with local public health officials and be in line with local and or regional restrictions if in place- this should take into account players and spectators

AQI over 200:

• Cancel or postpone

FACT

One in five adults in the U.S. will develop some form of skin cancer (1). The sun we get as children, teenagers, and young adults impacts individual risk. Prolonged sun exposure sustained while engaged in athletic endeavors is no less damaging than the ultraviolet exposure sustained at the pool, beach or in a tanning bed. Sun prevention makes a difference in reducing risk (2, 3). U.S. Soccer is committed to educating participants, coaches and referees about sunscreen use and sun prevention measures. Join U.S. Soccer in achieving this GOAL!

SUN SAFETY GUIDELINES

• Use a broad spectrum, water resistant (UVA/UVB) sunscreen with an SPF of 30 or higher. Physical sunscreens with Zinc or titanium dioxide are particularly effective (4).

• One ounce of sunscreen (two tablespoons) is typically needed to provide adequate coverage to the face, ears, neck, arms and legs (4).

• All participants should apply sunscreen 15 minutes prior to playing soccer. Coaches and parents need to assist younger players to ensure proper application

• Reapplication is necessary at least every two hours for prolonged outdoor exposure or with heavy perspiration (5)

• Ultraviolet exposure occurs even on overcast days.

• Check local UV index to assess risk. This index is listed on displayed on weather applications such as weather.com or accuweather. The potential for UV damage rises as UV index rises (5).

• Between games and with breaks in training, seek the shade.

• Cover up clothing, clothing with ultraviolet protective factor (UPF) >30, hats and UV-blocking sunglasses provide valuable additional protection

The effects of cold weather can impact health and safety during practices and games. The definition of “cold stress” varies across the United States, depending on how accustomed people are to cold weather. A player from Minnesota will have a much different threshold for cold than a player from Florida.

U.S. Soccer’s RECOGNIZE TO RECOVER program prepared this guide for coaches, referees and players for training or playing in colder climates. Additionally, it serves as a guide for match play and participant safety during extreme temperature conditions. The information provided is not a substitute for medical or professional care, and you should not use the information in place of a visit, consultation or the advice of your physician or other healthcare provider. For specific questions and concerns, please consult your health care provider or physician.

COLD WEATHER SAFETY TIPS

Dress for the Cold
When temperatures drop and wind increases, the body loses heat more rapidly. It is important to dress appropriately when training or playing in cold weather. This also means to not overdress.

Layering clothing in a specific way (see box) is recommended and very effective. The layers can be added or removed based on body temperature and changing environmental conditions, such as temperature and wind. Allow players to wear additional clothing, like gloves, sweatshirts, sweat pants and/or hats or headbands. Also, avoid sweating before going outside because your body will cool too quickly.

Step One - Determine Wind Chill Temperature

The effects of cold weather can impact health and safety during practices and games. The definition of “cold stress” varies across the United States, depending on how accustomed people are to cold weather. A player from Minnesota will have a much different threshold for cold than a player from Florida.

Step Two - Find Your Alert Level

Use this chart to determine the alert level at your location based on the wind chill temperature.

COMMON COLD RELATED ILLNESSES

FROSTBITE

Frostbite is what happens when skin and tissue actually begins freezing. It can cause numbness, tingling or stinging in the affected area. The skin may also lose its natural color, turning pale or bluish. Frostbite can permanently damage body tissue, leading to the loss of an extremity in severe cases.

The most commonly affected areas for frostbite include: nose, ears, cheeks, chin, fingers and toes. Use body heat or warm (but not hot) water to begin warming the affected area.

Recognize

• Swelling/Edema
• Redness or mottled gray skin appearance
• Tingling or burning
• Blisters
• Numbness or loss of sensation

Recover

• Gradually rewarm affected area with warm water

WARNING:

• Do not rub or massage the frostbitten area. This may actually increase the damage.
• Do not use heating pads, heat lamps or the heat of a stove, fireplace, or radiator for warming since affected areas are  numb and can be easily burned

*If any of the symptoms persist for longer than a few hours, seek medical attention from emergency department or physician.