High School Sports

Ice tubs save athletes’ lives after heatstroke, so why don’t all schools have them?

A simple tub of ice water could have saved the life of 14-year-old William Shogran when his body temperature soared to 107 degrees during a high school football practice on a hot, humid Florida morning five years ago.

Even a cheap, plastic kiddie pool filled with ice water likely would have saved him.

Extensive medical research shows there is a 100 percent survival rate if a person with heat stroke is immersed in ice-cold water within 10 minutes. The body can be brought to a safe temperature in 15 minutes.

But on that day, there was no tub. Nor was there an athletic trainer on site.

Sebastian High coaches transported heavy blocking sleds and other equipment to the off-site training session, but left the ice tub back at school.

That decision torments Shogran’s parents, Courtney and William, every single day.

“Had that ice bath been there, we could potentially still have our son,” Courtney Shogran said. “It was so preventable. They called me at 9:30 to say he didn’t feel well. At 10:30, they called me panicking. When they took him to the hospital, his body temperature was still 107. If there was an ice tub, they could have dropped him in it at 9:30 when they called me, and he’d still be here.”

Since 1995, a total of 64 football players have died of exertional heat stroke, according to the National Center for Catastrophic Sport Injuries. Forty-seven of those were high school players, 13 were college, two pro and two youth. Ninety percent of the deaths occurred during practice.

Florida leads the nation with four high school athlete heat stroke deaths over the past nine years.

The Shograns sued the Indian River County School District and settled for $300,000; but money was not their motivation. They wanted answers, wanted to understand how something so avoidable could cost their son his life; and now, they are on a mission to make sure it doesn’t happen to another family.

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Zach Martin-Polsenberg

Their son’s death motivated the Shograns to petition the Florida High School Athletic Association and state legislators to make cold-water immersion tubs mandatory at all high school games and practices.

They were joined in their crusade by the parents of Zach Martin-Polsenberg, a 16-year-old Fort Myers-area football player who died in July 2017 following heat stroke at a practice where no cooling tub was available.

Despite their efforts, the FHSAA has yet to mandate ice tubs.

In January 2018, after gathering research from national experts on heat illness, the 15-person FHSAA Sports Medicine Advisory Committee recommended that all member schools be required by the association to have cold water immersion tubs.

But the FHSAA went against the advice of its own medical committee. It decided to require coaches and athletes to watch an educational video on heat acclimatization, and it strengthened its heat illness rules, but stopped short of requiring ice tubs. They said they would only “strongly recommend’’ the tubs unless legislators mandated them.

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Whole body immersion in ice water is one of the best ways to treat exertional heat stroke. Photo courtesy of Dr. Douglas J. Casa

More than 200 Florida high schools — including some in Miami-Dade and Broward County — are still not equipped with cooling tubs, according to Bob Sefcik, executive director of Jacksonville Sports Medicine Program and a member and former chairman of the FHSAA Sports Medicine Advisory Committee.

“How many more kids have to die to get this done?” asked Dr. Douglas Casa, one of the nation’s leading experts on heat stroke and director of the Korey Stringer Institute in Connecticut, named after the Minnesota Vikings player who died of heat stroke in 2001. “You know eventually they’re going to do it. Five years from now, two years from now. How many more kids have to die first?

“We’re talking about very low-cost items, a $100 Rubbermaid tub, and you’re in Florida. You’re not in Alaska or Montana. We’re talking about heat stroke and you have the most oppressive heat and humidity in the country there. Florida should lead on lightning policy and heat stroke policy because those are the two horrible things in Florida.

“I’m a University of Florida grad. I know how hot it is. It’s appalling that it’s taking this long for schools to get tubs.”

The Miami Herald reached out to 123 South Florida high schools — 79 in Miami-Dade County, 44 in Broward — and asked if the athletic department had an ice tub. Of the 30 Miami-Dade schools that responded, 23 had at least one tub. Gulliver, Doral Academy, Miami Christian, Westminster Christian and St. Brendan reported two or more tubs.

Seven responded that they did not have a cold-water tub — Champagnat, Divine Savior (“getting one”), Everglades Prep, Hialeah-Miami Lakes, Miami Beach, Riviera Prep, and Carrollton, which uses a whirlpool to cool down athletes.

Thirty-eight of Miami-Dade’s 79 schools belong to the Greater Miami Athletic Conference. Of those, 33 have cold immersion tubs and tubs “have been ordered for all five remaining schools,” according to Jackie Calzadilla, Director of Media Relations for Miami-Dade County Public Schools, who answered collectively for the GMAC schools after athletic directors were instructed by the conference to refer the Herald’s ice tub questions to the county.

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“In addition to GMAC schools being equipped with cold immersion tubs, athletic directors, athletic trainers and principals attend mandatory workshops over the summer to educate/re-train them on the importance of hydration, how to recognize the signs of heat illness/how to treat it, among several other pertinent topics,” said Calzadilla.

“Miami-Dade County Public Schools’ Greater Miami Athletic Conference, in cooperation with the Florida High School Athletic Association, takes pride in protecting the interest of high school athletes to promote and foster a culture of competitive, safe amateur sports,” said Calzadilla, who went on to note that all GMAC schools adhere to the FHSAA policies on hydration and rest.

Of the 30 Broward schools that responded to the Herald survey, 28 had ice tubs and five schools reported two — Calvary Christian, Cypress Bay, Flanagan, Nova, and St. Thomas Aquinas, which also has a whirlpool. Monarch High has no tub, but two whirlpools. Calvary Christian also uses a tarp to wrap athletes and cover them with ice water for cool-downs. Fourteen schools did not reply.

Casa and his colleagues at the Korey Stringer Institute have tracked over 2,000 cases of heat stroke in recent years. In 100 percent of the cases, ice tubs saved the lives of heat stroke victims.

Casa has visited Florida three times in the past three years for heat policy meetings with the FHSAA, and through progress was made in some areas, he said Florida’s refusal to mandate ice tubs is putting the state’s young athletes in peril.

“Florida has had more heat stroke deaths in high school sports than any state in America since 2010, so it’s shocking and appalling to me that any school in that state still doesn’t have a tub,” said Casa.

He finds it “inexcusable” that the FHSAA has not joined state associations of 18 other states in requiring these critical life-saving heat illness measures.

“They made a lot of progress in a lot of different areas like emergency action plans, and heat acclimatization, but two key areas — environmental monitoring with wet bulb globe temperature for preventing heat stroke and requiring the immersion tubs, they’re still not willing to do it,” he said.

Sefcik is equally concerned.

“We’re obviously disappointed the FHSAA did not adopt ice tubs as mandatory components of the athletic department,” said Sefcik. “We recognize the fact that without having someone out there policing every action it’s really hard to manage the accountability of that. Unfortunately, some schools are complacent. The mentality seems to be ‘Nobody died from heat stroke yesterday in our school, so nobody’s going to die today. But the reality is we don’t know that.’’’

The Herald asked FHSAA officials why they did not mandate ice tubs. They responded: “The Florida High School Athletic Association Sports Medicine Advisory Committee recommended that the FHSAA require all schools to secure cold water immersion tubs, but staff felt that this should be a state, district or school mandate, to be monitored by that respective governing body.

“Upon the recommendation of staff, the FHSAA Board of Directors amended Policy 41.6.3.1 regarding `cooling zones’ to include a variety of cooling methods for student-athletes.’

The 2019 FHSAA Handbook devotes three pages to “Policy 41: Exertional Heat Illness”. It begins with this introduction:

“Heat illness is a cause for concern for high school student-athletes beginning pre-season practices in the warm, summer months and other times of extreme heat. The most serious heat illness, exertional heat stroke, is one of the leading causes of preventable death in these athletes. Heat production during intense exercise is 15 to 20 times greater than at rest and can raise body core temperature one to two degrees Fahrenheit every five minutes unless heat is dissipated. The following policy provides guidelines and procedures for conducting preseason practices and activities to ensure the well-being of the student-athletes.”

The handbook goes on to detail requirements and recommendations for practice times, rest times, climate monitoring and hydration.

“The area identified for rest should be considered a `cooling zone’ and out of direct sunlight. It is strongly recommended that cooling zone areas include ice sponges/towels, cold immersion tubs, tarps that can be filled with ice and wrapped around individuals and other cooling alternatives to facilitate the cooling processes to insure the well-being of student-athletes.”

Jimmie Fairfax, the athletic trainer at Gulliver Prep in Miami, said his school has a large tub indoors and two outdoor tubs. They use them for recovery after practices and games, and also for heat illness. They also have an electronic Wet Bulb Globe Thermometer that monitors temperature, humidity and sun exposure. Fairfax said he stands in the middle of the field and tests the climate with that thermometer to determine safe conditions for practices.

Football players and cross-country runners, in particular, are closely monitored. They avoid practices between 11 a.m. and 1 p.m., especially during summer off-season workouts.

“We are lucky enough to have the resources to be fully equipped for heat acclimatization and heat illness,” Fairfax said. “Rapid cooling of athletes is very important, and we have a large amount of ice water available. We have a heat index policy that is even stricter than the FHSAA requirements. We are constantly monitoring the climate, especially for our football players and cross-country teams. It’s Gulliver, so the parents are very involved and everyone’s watching to make sure our students are safe.”

Courtney Shogran continues to lobby legislators on the issue. She urges parents to find out if their schools provide ice tubs at athletic events, and if they don’t, to pressure them to make the investment.

“Ice baths need to mandated. There’s too much scientific evidence that proves it will save a life,” Shogran said. “A click-through video is not enough. Since the FHSAA is refusing to mandate, each individual school is being allowed to make the decision on whether or not your child’s life is worth saving in that instance.”

Exertional heat stroke is one of the few conditions that results in sudden death among athletes. As the body overheats, it goes into shock and can damage internal organs.

“Once heat stroke is identified and the body has succumbed to the heat, getting them in an ice tub is really the only way they are guaranteed survival,” Sefcik said. “If we can get them in a tub within 10 minutes, there’s a 30-minute threshold during which the body can withstand that temperature, after that it becomes devastating and irreversible to the internal organs and unfortunately, we can’t get rescue to somebody and off to a facility that could cool them down within that time. So, on-site cooling is the best practice.”

In deciding against mandating the tubs in 2018, the FHSAA cited enforcement and liability as reasons. They told Sefcik’s committee that it is not possible to police all the games and practices at all schools for ice tubs, and it would more effective to increase education to help avoid heat stroke.

“They say they can’t regulate things, but that’s hogwash,” Casa said. “Every state association is giving us this hogwash. But the reality is, for a football game, you have to have seven officials, field dimensions have to be this size, the football has to be this size. They have tackling rules for spearing and targeting. They have all these rules but no rules for safety?

“Georgia, which is right next to Florida, requires immersion tubs at every practice when the temperature is over a certain threshold. Eighteen states require tubs. Almost all are concentrated in the southeast. Florida should do it, too.”

Courtney Shogran feels the FHSAA is negligent in not making more mandates for student-athletes’ safety.

“The only thing they care about is if a kid is playing out of zone or didn’t get his waiver signed or eligibility requirements,” Shogran said. “I’ll be honest, in my opinion, the FHSAA is a pointless waste of taxpayer money because William passed away and they never investigated his death at all. What is the FHSAA’s purpose? They’re not doing what’s best for our students.

“There are easy solutions, but everybody’s passing the buck and there will continue to be deaths and it’s awful because nobody wants to step up and do the right thing.”

Sefcik urged state legislators to get behind the cause.

“Hey, we have an adult responsibility and if we need to provide leadership through legislation through our schools, then we need to do that,” Sefcik said. “I can’t imagine it’s a partisan issue whatsoever. All schools need tubs and special thermometers, and these are not expensive items. It’s for the safety of our kids.”

Just a few months ago, on a steamy August afternoon, Sefcik was at a jamboree football game in the Jacksonville area when an overheated cheerleader fainted.

“The young lady was unconscious, the mom was frantic, we put the girl in an ice water tub and it wasn’t too long before she gasped and said `Boy is it cold in here!” Sefcik recalled. “We cooled her off, got her to a safe temperature, and the happiest thing is we put her in the car with her mother and sent her home. We didn’t have to bury her.”

Which South Florida High Schools Have Ice Tubs?

The Herald e-mailed surveys to 123 high school athletic directors in Miami-Dade and Broward counties asking whether they have an ice tub. Here are the results.

Miami Herald Sports Writer Alanis Thames contributed to this report.

BROWARD COUNTY

American Heritage Plantation: YES; Archbishop McCarthy: YES; Blanche Ely: YES; Boyd Anderson: DNR (did not respond); Calvary Christian: YES; Cardinal Gibbons: YES; Chaminade Madonna: YES; Coconut Creek: DNR; Cooper City: YES; Coral Glades: DNR; Coral Springs: YES; Cypress Bay: YES, 2 tubs; Deerfield Beach: DNR; Dillard: Yes, multiple tubs; Stoneman Douglas: YES; Everglades: YES; Flanagan: YES, 2 tubs; Fort Lauderdale: DNR; Hallandale: YES; Hollywood Hills: YES; McArthur: YES; Miramar: YES; Monarch: NO, but 2 whirlpools; North Broward Prep: YES; Northeast (Oakland Park): DNR; Nova: YES, 2 tubs; NSU University School: YES; Pembroke Pines Charter: DNR; Pine Crest: YES; Plantation: YES; Pompano Beach: DNR; Posnack: DNR; Sagemont: NO; Somerset Academy (Pembroke Pines): YES; Somerset Prep: DNR; South Broward: YES; South Plantation: DNR; St. Thomas Aquinas: YES, 2 tubs, whirlpool; Stranahan: YES; Taravella: YES; West Broward: YES; Western: YES; Westminster Academy: YES.

MIAMI-DADE COUNTY

(Only nine of the 38 public schools in the Greater Miami Athletic Conference schools responded. The rest deferred question to Miami-Dade County Public Schools media relations, which reported that 33 schools have tubs and five are on order for the five schools that did not have them.)

American: DNR (did not respond); Archbishop Carroll: DNR; Belen Jesuit: YES; Brito: DNR; Booker T Washington: DNR; Carol City: YES; Carrollton: NO, but have whirlpool; Central: DNR; Champagnat: NO; Columbus: YES; Coral Gables: YES; Coral Reef: YES; Coral Park: DNR; Cutler Bay: DNR; Dade Christian: DNR; Divine Savior: NO, but getting one; Doral Academy: YES, 2 tubs; Dr. Krop: DNR; Edison: DNR; Everglades Prep: NO; Ferguson: DNR; Florida Christian: YES; Goleman: YES; Gulliver: YES, 3 tubs; Hialeah: DNR; Hialeah Educational: YES; Hialeah Gardens: DNR; Hialeah-Miami Lakes: NO; Highlands Christian: DNR; Hillel: YES; Homestead: DNR; iMater Prep: DNR; LaSalle: DNR; Keys Gate: YES; Killian: DNR; Lourdes Academy: YES; MAST Academy: YES; Mater Academy: YES; Mater Lakes: DNR; Miami High: DNR; Miami Beach: NO; Miami Christian: YES, 2 tubs; Miami Country Day: YES; Miami Jackson: DNR; Miami Springs: YES; Monsignor Pace: DNR; Mourning: DNR; Norland: DNR; Northwestern: DNR; North Miami: DNR; North Miami Beach: YES; Northwest Christian: DNR; Palmer Trinity: YES; Palmetto: DNR; Palm Glades Prep: DNR; Pinecrest Prep: DNR; Southridge: DNR; Sunset: DNR; Ransom Everglades: YES; Reagan: DNR; Redland Christian: DNR; Riviera Prep: NO; Schoolhouse Prep: DNR; SLAM Academy: DNR; Somerset Academy Charter South: DNR; Somerset Silver Palms: YES; South Dade: DNR; South Miami: DNR; Southwest: DNR; St. Brendan: YES, 3 tubs; TERRA: DNR; Varela: DNR; Westland Hialeah: DNR; Westminster Christian: YES, 2 tubs; Westwood Christian: DNR.

Miami Herald sportswriter Michelle Kaufman has covered 14 Olympics, six World Cups, Wimbledon, U.S. Open, NCAA Basketball Tournaments, NBA Playoffs, and has been the University of Miami basketball beat writer for 20 years. She was born in Frederick, Md., and grew up in Miami.
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