5 ‘H’s’ of Athlete Safety

Athlete safety is a priority for the Mississippi High School Activities Association, and through our Sports Medicine Advisory Committee, we continue to strive to provide best practice information for coaches, administrators, athletes, and parents on how best to keep our youth safe. While there is inherent risk in athletic participation and all athletes need to discuss participation with their physician beforehand, there are steps that schools and communities can take to help reduce the risk related to the most common life threatening conditions affecting athletes.

The 5 “H’s” of Athlete Safety

Heart – sudden cardiac arrest and underlying heart conditions affecting athletes

Heat – preventing and treating heat illness

Head – traumatic head/spinal injuries and concussion management

Hemoglobin – Sickle Cell Trait and risks to athletes

Health History – gathering the right information before participation


Several cardiac issues can affect athletes and put them at risk for a sudden cardiac arrest. A good health history and physical should be obtained before participation in athletic events, which can help identify preexisting conditions (such as heart murmurs) that can increase the risk posed to athletes. However, the presenting symptom for most cardiac conditions affecting athletes is sudden cardiac death. While screening exams such as electrocardiograms (EKGs) and echocardiograms are currently being studied, they are not sufficiently sensitive/accurate enough to recommend widespread use. Therefore, the current best practices for keeping athletes safe against the risk of sudden cardiac death relate to properly identifying patients suffering a sudden cardiac arrest and providing prompt and effective treatment.


  1. For every minute that an athlete is untreated after a sudden cardiac arrest, the chances of survival decrease by 7-10%.
  2. Any athlete that collapses suddenly should raise suspicion for sudden cardiac arrest. Remember that brief seizure like activity can follow a sudden cardiac arrest, and “seizures” should be considered heart related until proven otherwise.
  3. Automated External Defibrillators should be regularly maintained and available within a 1-2 minute brisk walk from the athletic venue.
  4. Coaches and administrators should be trained in basic CPR, familiar with the location of the closest AED, and up to date with the school’s Emergency Action Plan related to their each athletic venue.


Mississippi weather often combines high heat and high humidity into a dangerous combination for athletes whose sports require training and competition outside. It takes the body up to a week to get safely acclimated to temperature extremes, and beginning a season of phase of training without giving the athlete’s body time to adjust can lead to heat illness, when the athlete becomes dehydrated and ill from the heat, or worse heat stroke when high body temperatures start to affect the brain and neurological function. Even conditioned and acclimated athletes will have trouble with the heat when temperature and humidity are high enough, however, as the principle method for the body to lose excess heat is through evaporation. On very hot and humid days, sweat does not evaporate as efficiently, robbing the athlete of their best defense against overheating.


  1. Familiarize yourself and follow the heat acclimatization guidelines recommended by the MHSAA.
  2. Give frequent rest breaks during high heat and high humidity conditions in order to allow athletes to cool and hydrate.
  3. Modify practice and competition schedules based on wet bulb globe temperatures or heat indexes to avoid dangerous climate conditions.
  4. The best way to cool an overheated athlete is submersion up to the chest in an ice bath. If the athlete is suspected of overheating: Remove any unnecessary clothing/equipment, submerge up to chest, and circulate the water around the body for at least 20 minutes.
  5. If the athlete is confused, combative, or shows any changes in their mental status: CALL EMS and begin cooling immediately. Keep the athlete in the cold water immersion for at least 20 minutes before transporting to the hospital, longer if possible.


Traumatic head and spine injuries have long been a concern for athletes/coaches in contact sports. Changes in rules for tackling in the 1970’s alleviated a large portion of the risk, but injuries still occur. Prompt and appropriate medical care in these situations can be life saving and play a large role in any potential recovery.

Recently, concussions (sometimes called closed head injuries or mild traumatic brain injuries to separate them from more rapidly dangerous conditions) are gaining prominence for their potential long-term impacts on athlete’s health. Coaches, administrators, athletes and parents need to be familiar with the signs and symptoms of concussions as well as the hallmarks of treatment and recovery in order to protect the athletes.


  1. Head and spinal injuries need to be a part of each athletic venues Emergency Action Plan, keeping in mind that any athlete suffering a head or spinal injury should be immobilized and not moved until trained personnel are on the scene
  2. Coaches, administrators, athletes and parents need to be familiar with the MHSAA concussion policy.
  3. No athlete with a suspected concussion should be allowed to return to play without being evaluated by a trained health care provider.
  4. No athlete with a diagnosed concussion should be allowed to return to practice or competition without a completing a return to play protocol.
  5. Athletes who have suffered a concussion or other head injury with symptoms lasting more than 2 weeks should consider meeting with their school administrators to discuss a “return to learn” protocol that allows a return to schoolwork strategy that allows a return to schoolwork without a worsening of symptoms.



Evidence is increasingly linking Sickle Cell Trait to sudden death in young athletes. Unlike sickle cell disease, the way that sickle cell trait affects a person is not yet fully understood. However, we do know that under certain circumstances, the athlete with sickle cell trait can rapidly become ill and suddenly collapse. These circumstances are high physical exertion that causes the amount of oxygen in the athletes blood to drop enough to trigger the sickling in blood cells that normally only happens in people with full blown sickle cell disease. These risks are preventable with certain precautions.


  1. Understand that roughly 8% of all African American Athletes carry sickle cell trait.
  2. These athletes will have issues if forced exercise under maximum or close to maximum exertion for long periods of time time to rest and re-oxygenate. Unconditioned or under-conditioned athletes, or athletes starting a season or heavy workout period in the offseason. An example of an “at-risk” activity: 100-yard sprints back to back without rest as a “conditioning test.”
  3. Athletes who are having a “sickling collapse” will deteriorate quickly. They often complain of a cramping pain in their buttocks, back and thighs, but will not be cramping.
  4. Athletes with known sickle cell trait should be given longer rest breaks between maximum exertion exercises to recover and monitored for early signs and symptoms. Recognizing these athletes quickly, removing them from play, and treating them appropriately is essential to keeping them alive.
  5. The recommended treatment of athletes with suspecting sickling collapse is cooling them, hydrating them, and applying supplemental oxygen (if available) while calling for emergency medical services immediately.


Health History

An athlete needs a pre-participation physical that discusses their medical history as well as family medical history BEFORE participating in any sporting activity, and needs to be repeated yearly.

An athlete’s yearly history and physical should specifically address:

  1. Any personal medical history, with an emphasis any history of dealing with heat issues, any history of heart conditions, any concussion history, or any medical problems that have caused the athlete to take medicine or have surgery in the past.
  2. Athletes also need to know whether or not they carry sickle cell trait
  3. Athletes with sickle cell trait need to aware of the risks of sickle cell collapse and the symptoms
  4. Coach’s need to understand the signs and symptoms of sickling collapse and pull athletes from activity if they show these symptoms and call Emergency Medical Services immediately.


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