NFHS Health & Safety Management Suggestions

Heat Issues

First, with regard to heat, exertional heat stroke is preventable, and the NFHS and its member associations, as well as other groups such as the National Athletic Trainers Association (NATA), Centers for Disease Control and Prevention (CDC) and the Korey Stringer Institute, offer a variety of resources for schools to confront the dangers of heat illness. Through the NFHS Learning Center at, the NFHS offers a free course titled Heat Illness Prevention as well as its core course First Aid, Health and Safety, which was developed with its partner, the American Red Cross.

In addition, the NFHS Sports Medicine Advisory Committee provides state associations and its member schools additional heat-related guidelines on the sports medicine page of its website as well as the NFHS Heat Acclimatization and Heat Illness Prevention Position Statement and the NFHS Position Statement and Recommendations for Maintaining Hydration to Optimize Performance and Minimize the Risk for Exertional Heat Illness.

Other organizations offer guidelines for schools to deal with heat-related issues. The NATA Preseason Heat-Acclimatization Guidelines for Secondary School Athletics is available here. The CDC Heat and Athletes is available at, and the Korey Stringer Institutes offers its 5 Pillars of Exertional Heat Stroke Prevention. 

Finally, the cover story of the May 2017 issue of High School Today – “Dangers of Heat Illness Reduced by Following Proper Guidelines” by David Csillan – offers some tremendous resources.

Heart Issues

In 2015, the NFHS provided the “Anyone Can Save a Life” emergency action plan toolkit originally developed by the Minnesota State High School League to member state associations for distribution to the nation’s schools. Activation of schools’ Emergency Action Plans, including the use of Automated External Defibrillators (AEDs), is in order as the new school year begins. More information on the “Anyone Can Save a Life” program is available at

The NFHS also offers its free course on Sudden Cardiac Arrest which was developed with its partner, Simon’s Fund.

Head Issues

The concern related to concussions is in all sports. The sport of football continues to make headlines, but with the protocols for concussion management and implementation of state laws the past 12 years, the NFHS and its member state associations believe the sport of football at the high school level is as safe as it has been since the first rules were written in 1932.

The NFHS and its member state associations utilize the services of two national injury reporting and research organizations in an effort to reduce the risk of injury for high school student- athletes. The National Center for Catastrophic Sport Injury Research (NCCSIR) seeks to enhance the understanding of sports-related catastrophic injuries, illnesses and fatalities through active surveillance and research, with a focus on head/neck injuries, commotio cordis injuries, fatal/near-fatal cardiac conditions and fatal/near-fatal heat-related conditions. NCCSIR is committed to providing timely and useful information to the NFHS, its member state associations and high schools.

The development of an online portal in 2015 enables state high school associations and their member schools to report the basic details surrounding catastrophic sports events ( Ongoing, active surveillance to monitor the incidence of catastrophic injuries, illnesses and fatalities is critical to identify areas for prevention and further study. Continued and improved efforts for detailed information and record-gathering is also critical to prevention.

The National High School Sports-Related Injury Surveillance System (High School RIO)  is a sports-injury surveillance system that has captured data from a large national sample of high schools annually since 2005-06. Since that time, High School RIO has captured information on nearly 80,000 injuries sustained during more than 40 million athlete exposures. The NFHS Sports Medicine Advisory Committee and individual NFHS rules committees use data from High School RIO to better understand which athletes are at risk of injury during different types of sports activities. As a result, evidence-based decisions can be made to keep high school athletes as safe as possible. High School RIO data is used to monitor injury rates over time, to identify new concerns and to evaluate the effectiveness of rules changes.

Data from High School RIO during the 2015-16 season indicated that attempts by the NFHS and its member state associations to reduce the risk of head trauma and concussions in football have proven effective. Surveys from 2015-16 indicated that the rate of concussions during practice dropped below 5.0 per 1,000 athletic exposures to 4.77 for the first time since 2010-11. Also, a 2015 study by the University of Wisconsin, Madison, revealed that the rate of concussions was reduced by more than 50 percent from the previous two seasons. These studies came on the heels of the 2014 NFHS Concussion Summit Task Force, which recommended that state associations adopt plans for limiting contact during football practices.

With state laws and rules administration in place to govern removing individuals from games who have concussion-like symptoms, to the reduction of contact in practice, to the continued education efforts, the focus on risk minimization has never been higher. However, as the new season looms, it is important to make sure that no concussion goes unreported.

More than 3 million individuals have taken the NFHS’ free course “Concussion in Sport,” and this is a great time to offer this wonderful resource again to schools across the country. This course is available at  In addition, a related course specifically for high school students – Concussion for Students is available.

In addition, since 2010, the Suggested Guidelines for Management of Concussion in Sports statement has been published in all NFHS rules books. 

Also, the CDC, which teamed with the NFHS in the Concussion in Sport online course, offers the “HEADS UP to School Sports” .

The NFHS Sports Medicine Advisory Committee, which is composed of six medical experts, three certified athletic trainers, four administrators from state high school associations, as well as one high school coach and one official, has been invaluable in providing important information for NFHS rules committees and state association sports medicine committees in writing rules that minimize risk of injury for high school student-athletes.

We hope this provides you the appropriate information to share with your member schools as the new school year approaches with our ongoing goal of reducing the risk of injury for the almost eight million participants in high school sports.