07/07/2026 – Exertional Heat Stroke Guidance for High School Football Linemen – NFHS SMAC Task Force

July 7, 2026 2026-2027 News Releases

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This information is being shared with all KHSAA contacts involved in football, based on recently shared guidance from the NFHS.

The NFHS Sports Medicine Advisory Committee (SMAC) convened an expert task force that included physicians, athletic trainers, state association executives, athletic directors, football coaches and strength and conditioning coaches to address a critical and persistent safety issue in high school football: exertional heat stroke (EHS), the leading cause of preventable death in high school players. Nearly all EHS fatalities occur during sustained, high‑intensity conditioning sessions in the first week of practice, and 97% involve linemen—athletes who heat up faster, cool down more slowly, and face unique physiological risks not fully mitigated by existing guidelines on hydration, acclimatization, WBGT monitoring, or uniform modification. These traditional measures remain essential, but they have not adequately accounted for exertional intensity or the disproportionate vulnerability of linemen.

In response, the task force has developed new, position‑specific guidance designed to fundamentally shift how football linemen are trained and conditioned. The recommendations emphasize gradual progression in workload, elimination of inappropriate preseason fitness tests, strict avoidance of exertion‑based punishment drills, and immediate removal and evaluation of any struggling athlete. Coaches are encouraged to design conditioning plans that mirror the demands of line play, incorporate appropriate work‑rest ratios, and reinforce preseason strength and conditioning.

The guidance also calls for (and Kentucky law mandates) regular rehearsal of EHS emergency action plans with rapid‑cooling protocols. By prioritizing control of exercise intensity—particularly during the first week of practice—this statement aims to significantly reduce the risk of exertional heat stroke and protect the athletes most at risk.

There is some tough data around the heat deaths at the high school level during the study period –

• 100% of high school EHS deaths in football occurred during conditioning sessions
• Linemen are the at-risk population (97% of football EHS deaths)
• Paradigm Shift to be Considered:
  • Position specific training
  • Transition period protocols
  • Recognize high risk situations
  • Eliminate punishment drills

Please feel free to share this information with all of your respective coaches,  administrators, parents and others involved in the practice or play in football.

IMPORTANT LINKS

• The notice is at https://khsaa.org/sportsmedicine/ehi/Preventing%20EHS%20in%20High%20School%20Football%20Linemen%20-%20NFHS%20SMAC%20EHS%20Task%20Force%20-%20FINAL%20-%206-13-26.pdf
• The peer reviewed study and data is located at https://khsaa.org/sportsmedicine/ehi/Preventing%20Exertional%20Heat%20Stroke%20in%20Football.pdf
• Further details available, including a complete research abstract and an infographic that may help educate your constituents about the issue – https://pmc.ncbi.nlm.nih.gov/articles/PMC11569638/
• Direct link to the educational infographic – https://pmc.ncbi.nlm.nih.gov/articles/PMC11569638/figure/fig2-19417381241260045/

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