By Michael S. Carroll & Steven H. Wieczorek
A fight is brewing in sunny Florida over mandatory precautions to guard against heat stroke and other forms of heat-related illness in high school sports across the state. In April, the Florida High School Athletic Association (FHSAA) declined to agree with its own medical advisors in support of requiring ice tubs and wet-bulb globe thermometers at practice and competition for the treatment of heat stroke and other forms of heat-related illness (HRI). Earlier this year, the FHSAA 15-member Sports Medicine Advisory Committee supplied the FHSAA with material in support of their position and recommendations, including industry standards for combating HRI. Instead of requiring such safeguards, as was recommended by the Advisory Committee, the Association opted instead to “strongly recommend” the ice baths and thermometers. In explaining their reasoning, the FHSAA cited a concern that mandating the safeguards might expose the agency to greater legal liability and stated that they would only mandate the safeguards if required to do so by the State Legislature.
Founded in 1920, the FHSAA is a Non-Profit 501c (3) Private Corporation that currently has almost 800 member schools. The Florida Legislature gave the FHSAA statutory recognition as the official governing body for interscholastic athletics in Florida in 1997. The purpose of the FHSAA is to promote, direct, supervise, and regulate interscholastic athletic programs in which high school students compete. To accomplish this goal, the Association does the following: (a) establishes and enforces regulations to ensure that all such athletic programs are part of, and contribute towards, the entire educational program; (b) cooperates closely with the Florida Department of Education in the development of athletic programs; (c) promotes the spirit of sportsmanship and fair play in all athletic contests; and (d) enacts policies and guidelines that safeguard the physical, mental, and moral welfare of high school students, and protect them from exploitation.
Heat-Related Illness (HRI) includes a number of conditions of varying severity, from discomfort all the way up to life-threatening. The most severe form of HRI and of utmost importance in discussing the health and safety of athletes is heat stroke. Heat stroke is a condition that occurs when an individual’s body overheats, generally because of prolonged exposure to, or physical exertion in, high temperatures. Heat stroke occurs when the core body temperature rises to 104 F (40 C) or higher. Heat stroke signs and symptoms include high body temperature, altered mental state or behavior, alteration in sweating, nausea and vomiting, reddened skin, rapid breathing, racing heart, and headache. If an individual appears to be exhibiting these signs and symptoms, it is important to take immediate action to cool the overheated person while waiting for emergency treatment. One of the key elements in the treatment of heat stroke is time. The quicker a person suffering from heat stroke is cooled down, the higher the likelihood of survival. According to heat safety experts, there is nearly a 100% survivability rate in cases of heat stroke when the victim is submerged in cold water within 5 to 10 minutes of a medical event. According to the National Center for Catastrophic Sport Injury Research, exertional heat stroke killed an average of three football players a year at all age levels from 1995-2015. In those 61 deaths, 46 occurred at the high school level, 11 in college, two in youth football, and two in professional football. Ninety percent of the deaths occurred during a practice. The state of Florida leads the country in deaths of high school football players due to HRI, hence the concerns raised with the FSHAA Sports Medicine Advisory Committee.
One recent death in the state of Florida highlights the dangers of HRI and high school football players practicing in temperatures that can easily push past 100 degrees with humidity. In June of 2017, 16-year-old Zach Martin-Polsenberg, a 6-foot-5, 320-pound junior offensive lineman collapsed at the conclusion of a summer workout for the Riverdale High School football team. The team had just participated in a three-hour practice consisting of weight lifting and agility drills, which took place both indoors and outside. While the team huddled to finish the practice, Martin-Polsenberg stated that he was not feeling well and proceeded to lie down. At that time, Martin-Polsenberg started to convulse and throw up, and coaches began to attend to him. One team member located the boy’s mother, Laurie Giordano, who was already on the scene in anticipation of the end of practice, to let her know that her son had fallen ill. When Giordano came upon her son, she discovered him in a seated position, but with his eyes closed.
Head Coach James Delgado asked Giordano if she would like to call 911, and she replied that she did. The Fort Myers Shores Fire Department were first on the scene and found Martin-Polsenberg breathing irregularly with a body temperature of 101 degrees. EMS arrived shortly after the fire department, approximately 10 to 15 minutes after the 911 call, and transported Martin-Polsenberg to Golisano Children’s Hospital. The 16-year-old never regained consciousness on the way to the hospital and died eleven days later on July at Jackson Health Center in Miami. Doctors indicated that Martin-Polsenberg’s core temperature had reached 107 degrees for more than an hour prior to his initial collapse. At the practice in which he collapsed, there were no ice tubs or globe thermometers available for the treatment of HRI. Martin-Polsenberg is the second Florida high school football player to die from heat stroke since 2014, when William Shogran Jr., 14, died after collapsing at an August practice with Sebastian River High School. The family of Shogran have filed a lawsuit against the Indian River County School District, stating that coaches ignored health problems the teen having that morning, and the suit is ongoing. Martin-Polsenberg’s family have already notified of their intent to sue the Lee County School District, the School Board, and Riverdale High School for negligence leading up to and immediately after Martin-Polsenberg’s collapse.
Michael S. Carroll is an Associate Professor of Sport Management at Troy University specializing in research related to sport law and risk management in sport and recreation.
Steven H. Wieczorek is a doctoral student at Troy University specializing in athletic administration and the head men’s soccer coach at Spring Hill College.
