Heat injuries forcing new technologies

Before Jay Buckalew got into the business of inventing an in-helmet temperature sensor that might help high school athletic trainers detect whether football players are overheating, he overheated himself.

In 2004, Buckalew was working on a telecommunications project on the rooftop of a 20-story building in Puerto Rico.

"I nearly had heat stroke. I had a hard hat on with little or no ventilation, and I became dehydrated. I started wondering what could be done," said Buckalew, the founder of Hothead Technologies.

Buckalew started putting thermometers in helmets worn in high heat by soldiers, firefighters, construction workers, athletes and more. Early prototypes were roughly the size of a candy bar, but have now been whittled down to little bigger than a postage stamp, weighing about half an ounce.

The helmet-borne sensors are just one example of the growing role of technology in the fight against heat-related illnesses and injuries. Technology has also spawned air-conditioned shoulder pads, temperature-taking pills and more.

Here's a closer look:
• The Heat Observation Technology (H.O.T.), which sports equipment manufacturer Schutt is helping Hothead Technologies market, is a small chip that can be installed in a helmet. It sends a signal to a handheld unit an athletic trainer can use to monitor players' temperatures.

• The Temperature Management System allows players on the sidelines to plug a hose up to their shoulder pads. Air that has been dried and cooled is then pushed through the player's pads to circulate over the back of the neck, the shoulders, chest and back.

• First made by NASA, a pill with a tiny onboard computer chip can be ingested and enables an athlete's inner core temperature to be monitored.

These product makers do not claim they can completely prevent heat-related illness, but rather reduce their likelihood.

Heatstroke is the third leading cause of death among athletes in the United States. Thirty-nine football players -- 29 in high school -- have died from heat stroke since 1995, according to data compiled by the National Center for Catastrophic Injury Research at the University of North Carolina.

Ultimately, heat management requires honesty, diligence and common sense from athletes, coaches and athletic trainers.

"It goes back to the basics; hydrate and use knowledge about the athlete," said Randy Oravetz, director of sports medicine at Florida State University. "Is he a heavyset kid? Acclimatize everyone. Kids need to eat enough, drink enough, sleep enough, and he has to tell you if he's been sick.

"Use fans, shade, mist blowers. I've heard of teams that use refrigerated trailers to walk players through."

And if an athlete overheats, a big tub full of ice water can be more important than any new technology.

"That's the best way to cool a body down, full-body immersion," Oravetz said. "We'll just drop a guy in there, shoes and everything."

The core question

The first incarnation of the Hothead device weighed a couple of pounds.

After combining forces with an Austrian company (Identec Solutions) and engineers from GE Medical, Hothead grew and the sensor shrank.

"When we originally started looking at this, radio frequency identification was not available. We had a very large and clunky device," Buckalew said.

When RFID came along, Hothead was able to store significant information on a very small chip.

The result, a tiny pad that Buckalew said players cannot feel in their own helmets, is the latest technology on the market to fight heat-related illness in football.

"It goes in the upper quadrant of the helmet, between the crown and the side pad," said Dave Rossi, vice president of marketing for Schutt. "It has a thermal sensor that rests on front boss, between your temple and forehead. Players cannot even tell they're in the helmet. It is completely non-intrusive."

Schutt is helping Hothead make H.O.T. available in athletics for the first time this summer, while Hothead focuses on applications for the military and firefighters.

"If any [players] go over a pre-set threshold, like 102.5 degrees, it will turn that player's number from green to red and flashing," Rossi said, explaining how the system works. "That signals that a trainer should … cool him down.

At the college level, Texas, Ole Miss, South Florida and TCU have purchased the H.O.T. system.

Douglas Casa, director of athletic training education at the University of Connecticut, is among the skeptics.

As co-chair of the National Athletic Trainers' Association task force, Casa in June recommended high school football coaches phase in early season two-a-day practices to allow student-athletes to adjust to the heat.

"You're just measuring skin temperature, or it could be a kid's hair temperature," said Casa, who was briefed on the system at a NATA convention in San Antonio where Hothead officials were present.

"We've been doing studies with heat for 20 years, and we can't find where skin temperature correlates with core temperature. It worries me because most people who don't study this every day are going to trust that it works just because it's on the market."

A person's core temperature as an indication of the status of inner deep tissues, like internal organs, and can be difficult to measure accurately.

Casa calls for independent thermo-physiology testing of the H.O.T. system.

Buckalew said H.O.T. does not claim to measure core temperature.

"We can't prevent heat stroke; what we can do is say there is something going on with this player," he said. "Maybe he had four or five Red Bulls and it's causing him to dehydrate. Coaches and trainers don't know this. We're hoping this system can act as a precursor."

Taking to the field

When Bill Bates played for the Dallas Cowboys from 1983-1997, he got hot … frequently.

"IVs at halftime were normal for me, and after games," he said. "I was telling my wife on the way home from games to pull over so I could throw up because I was still overheated."

After coaching with the NFL's Cowboys and Jaguars, Bates in 2005 agreed to start coaching the freshman team at Nease (Ponte Vedra Beach, Fla.) High, where current Florida quarterback Tim Tebow was a senior about to lead his team to a state title.

The search for football equipment led Bates to Temperature Management System CEO and founder Fred Williams. There, Bates tried on some fancy shoulder pads.

Williams worked with researchers from the University of Florida who hatched the idea to develop air-conditioned shoulder pads.

The Gators tested the pads in '05, and now use the system regularly on the sidelines in high heat.

South Carolina, NC State, UCLA, Georgia Southern and the NFL's Jaguars and Dolphins are among those who own the TMS. At the high school level, Nease, Ponte Vedra (Fla.) and The Bolles School (Jacksonville, Fla.) own the system. So does Midlothian (Texas).

Williams' company works with Douglas to manufacture TMS shoulder pads. The system can also be installed in other pads.

The NFL a few years ago helped fund a study of TMS by University of Florida officials, although the NFL does not endorse or discourage the product's use.

"It checks [or helps stabilize] the body's core temperature more than anything," Williams said. "It also reduces heartbeats per minute, and may reduce the need for IVs."

Internal solutions?

Some NFL teams have used the HQ core temperature pill, and research reveals fascinating possibilities, like NASA's ingestible thermometer pill.

The tiny computer/pill usually passes through the body in between 24 and 36 hours and may register a temperature close to that of a true core reading.

However, the monitoring system held by athletic trainers generally needs to be closer to the athlete than that used in the H.O.T. system.

The best measure of core temperature, however, is taken rectally. And even if perfect core temperatures were available for all athletes, the deviation between each player's physiology makes monitoring them an inexact science.

"Some guy has a core temp of 104, 105 and he's fine, and another guy is at 102 and he's cramping," said FSU's Oravetz.

Athletic trainers will need to take into account the fact all players react differently and players will have to be honest about what's happening with their bodies.

The NATA's Casa said contrary to popular belief, once a person begins to suffer heat-related illness, that person is not irreversibly damaged.

"The organs don't begin cooking as some say," he said. "When somebody gets to that 106, 107 [-degree core temperature] and there is central nervous system dysfunction … it's still survivable if rapidly cooled, for instance in a cool water bath.

"Where people die is when treatment is delayed. Organs can be damaged. It's how much time you're above that 105.5 threshold. We advise over and over to cool first and then transport [to a medical facility]."

The time spent calling an ambulance, waiting for it to arrive, then traveling to a hospital to be treated can be critical, even fatal, for a heat-distressed person, Casa said.

Matt Winkeljohn left the Atlanta Journal-Constitution after spending 21 years there. He can be reached at mattwinkeljohn@yahoo.com.