Table 3.

Consensus on Current Expert Recommendations Regarding Environmental Monitoring for Heat Safety During Activity

Recommendation	Strength of Recommendation Taxonomy9
1. Heat stress monitoring should be conducted onsite at a location that representats all playing surfaces (ie, over similar surface and in an open location that is not influenced by surrounding buildings).	B
2. The WBGT measurements should be taken at the activity location with an environmental monitor designed to measure WBGT at a height of 0.9–1.2 m (3–4 ft) from the playing surface. If limited monitoring sites or devices are available, institutional policy should document specific communication procedures for those supervising activity remote from WBGT assessment site(s).	C
3. The WBGT measurement devices should remain exposed to the environment before activity per manufacturer's recommendations or ≥15 min.	B
4. The WBGT measurements should be taken at intervals (frequency of recording) ≤30 min for the duration of the athletic activity.	C
5. The AMGs should outline specific actions (eg, work-to-rest ratio, frequency and timing of hydration breaks, adjustment of total exercise duration, equipment adjustment) and be mandated for all athletic training and competitions.	C
6. The AMG thresholds should be established based on geographic and regional climatologic characteristics.	B
7. State athletic associations should develop and implement environmentally based AMGs that outline specific event modifications and cancellation policies. These guidelines should be developed by, or in coordination with, the state's sports medicine advisory committee or appropriate sports medicine professionals.	C
8. Institutions should develop and implement policies and procedures detailing the procedures for WBGT monitoring and AMGs used for practices, conditioning sessions, and competitions.	C
9. Before a competition, adequate time should be allotted for a medical time out, which includes a discussion of necessary accommodations due to the environmental heat (eg, additional hydration breaks, alteration of competition timing and length) with all decision makers onsite (eg, coaches, athletic director, referees).	C
10. If an exertional heat illness occurs, the athlete's medical record should include details surrounding the injury, such as environmental conditions, time of year, duration and type of activity (eg, conditioning, scrimmage, skill practice), and physical characteristics (eg, fitness, acclimatization state, hydration state) to retrospectively identify risk factors responsible.	B

Abbreviations: AMG, activity-modification guideline; WBGT, wet bulb globe temperature.