DAYTONA BEACH, Fla. – As the Mainland High School varsity football team practiced this week, athletic trainer Kallie Walker stood on the sidelines, prepared to assist if one of the student-athletes showed symptoms of heat-related illness.
Of particular concern is exertional heat stroke, a life-threatening condition that can occur when the internal body temperature exceeds 104 degrees Fahrenheit.
"Your body basically turns into its own oven," Walker said. "You can't cool off. You can't get all the sweat off. It's not evaporating off your skin, which is our cooling method for our bodies, and it increases your body temperature."
A 14-year-old incoming freshman at a Hillsborough County high school collapsed and died in June during pre-season football practice, possibly from a heat-related condition.
In 2017, a 16-year-old high school football player from Fort Myers died from internal injuries caused by heat stroke.
To prevent similar deaths from occurring in Volusia County, AdventHealth recently donated more than $8,000 in equipment and medical supplies to all 10 public high schools as part of a partnership between the hospital system and the school district.
The life-saving gear includes a plastic tub large enough to submerge a student in ice water and insulated coolers to store ice cubes during practice and games.
"Rapidly cooling (the body) is the best way and the most survivable way of managing exertional heat stroke," said AdventHealth sports medicine outreach coordinator Erik Nason. "The cells in the body can last about 30 minutes at a temperature of 104 degrees or higher. After that, they start breaking down. And when they break down, you lose central nervous system functions, kidney function and you lose liver function. Those cells do not regenerate."
Last month, a 17-year-old senior at Spruce Creek High School showed symptoms of heat-related illness after collapsing at a football game at Flagler-Palm Coast High School.
The team's physician, an orthopedic surgeon with AdventHealth, made the decision to submerge the student in ice water prior to transporting him to a hospital, according to an AdventHealth spokesperson.
A large tub was located in the school's training room.
"The best part of the story is that he went to the hospital, was released and had dinner with his family that night," Nason said. "That situation could have turned south extremely fast."
AdventHealth has since provided Volusia County high schools with inflatable tubs that can be easily transported to game locations that might not have such equipment.
"Our goal collectively, quite simply, is to ensure we are keeping student-athletes safe," said Kelly Amy, the school district's manager of strategic partnerships.
Besides treating heat-related illnesses, all Volusia County high schools have begun following a protocol aimed at minimizing harm to student-athletes.
A device that measures heat stress using Wet Bulb Globe Temperature, or WBGT, has been issued to all county schools by AdventHealth.
Besides detecting air temperature, the specialty thermometer also measures wind speed, relative humidity and direct sunlight.
"You know what it's like when you're in the shade or you're out in the sun, and whether there is a breeze or no breeze," Nason said. "Even though the temperature is the same outside, you can feel the difference on your body."
Based on the WBGT reading, coaches and athletic trainers have been given guidance on how to modify physical activities.
When weather conditions pose a moderate risk of heat-related illness, at least three separate rest breaks lasting at least four minutes should be provided every hour, according to protocol issued by AdventHealth.
As the environmental danger increases, practices could be limited to just one or two hours with more frequent and longer breaks.
For football players, the WGBT measurement also dictates whether they should wear full, partial or no padding and protective equipment during practice.
During extremely risky weather conditions, the protocol recommends no outdoor workouts until a cooler WBGT reading is reached.
"Instantly (the device) would tell a coach the temperature is too dangerous," Nason said.
All Volusia County high schools are voluntarily following the WBGT protocol recommended by AdventHealth as the school board contemplates a more formal arrangement, according to Amy.
During a school board workshop last month, some board members suggested WBGT thermometers should also be provided to the marching band and other school groups that participate in outdoor activities.
"We've got a lot of events coming up where we're going to put our bands out, walking on the pavement in parades," said school board member Jamie Haynes.
Most school board members expressed support for the heat illness protocol even though the Florida High School Athletic Association does not mandate it statewide, potentially putting Volusia County sports teams at a competitive disadvantage.
"Would we be as supportive at a state conference match in which the FHSAA does not stop the match because of (the weather) but one of our coaches says, 'Well, my team can't participate' and now we forfeit?" asked interim Superintendent Tim Egnor, who also appeared to back the new measures to protect student-athletes.