In Atlanta, a 15-year-old died after football practice this month. Heat was blamed as one of the causes.

In Alabama, a high school team is holding football practices at midnight to escape daytime temperatures in the mid-90s.

Nationally, heat and humidity on the sports field have been cause for concern among athletes, coaches and parents. It is no different in Hawai'i, where the average temperature for August is in the high 80s.

"Sometimes this place is like an imu," Waipahu High School football coach Sean Saturnio said of the team's practice field. "If there's no wind, this place can get real muggy. The humidity is what really zaps the kids."

Hawai'i's high school football players — many of whom practice for hours wearing full protective padding — are at greater risk to develop heat illnesses. Many athletes at one point have experienced early symptoms of heat illness with dizziness or cramps.

"I try to bring a water bottle to school every day and refill it every day," Waipahu senior quarterback Gilchrist Fernandez said. "I notice when I don't drink water sometimes, I cramp up easily after lifting weights, running and throwing."

In Hawai'i's athletic season last fall, 1.6 percent of the high school injuries were hydration- or heat-related, according to the state Department of Education. The numbers have remained constant the past few years, according to Ross Oshiro, the DOE's athletic healthcare trainer coordinator.

"The athletes must understand that their most important equipment is their body," Oshiro said. "The coaches must reinforce to their athletes the need to drink water before and after practice."

To beat the heat, athletes can start by drinking ample amounts of water and eating a balanced diet, according to coaches and athletic trainers, who are preparing for preseason games this week.

All public high schools in the DOE system have athletic trainers and follow recommendations from the National Athletic Trainers' Association, American Medical Association and other medical organizations.

One of the easiest ways to check for proper hydration in athletes is to have them monitor the color of their urine, Oshiro said.

"If the athletes' urine is lemonade color, then they may be properly hydrated," he said. "If their urine is dark like apple juice, then they need to drink more fluids."

Saturnio, the Waipahu coach, said coaches have embraced proper hydration. That wasn't the case in the past, when coaches would limit or withhold water at practice.

"I think back in the days with the Junction Boys, and a lot of coaches who were players back in the '60s, '70s and '80s ... you would get a quick 10-second sip off the water hose, and you're back out there," Saturnio said. "Research shows that's the worst thing you can do to the human body, especially when you're putting it through such exertion.

"Being able to be a camel and to not drink water has nothing to do with how tough and how intense you can play the game of football."

At Waipahu, players can drink water anytime during breaks in the action, Saturnio said. Players also weigh themselves before and after practice as an added precaution.

"Our trainer monitors their weight loss, and if any red flags come out, we may possibly sit someone out for the next practice, if possible," Saturnio said.

In one of the most well-documented heat-related cases five years ago, Minnesota Vikings offensive tackle Korey Stringer died from complications of heat stroke during training camp in Mankato, Minn. It was the NFL's first heat-stroke fatality in its 86-year history.

SIGNS OF TROUBLE

In football, large athletes are more susceptible to heat illness, according to University of Hawai'i football trainer Brian Wong.

"Those who are more prone will be our linemen, those who have more body fat than the skill guys, such as the receivers," Wong said. "The other guys who are more prone are guys who sweat a lot."

Wong said the UH football team has had at least one case of heat exhaustion, but never heat stroke.

In most cases, an overheated player is taken to UH's health center or training room and examined by an on-call doctor, Wong said. In the training room, the player can receive intravenous fluids.

"We're lucky in that sense; we can IV guys, whereas the high schools they don't have that capability," Wong said. "They have to call 911 and send the guy to the ER."

Two seasons ago, Wai'anae was nearly forced to cancel practice because the temperature and humidity were borderline unbearable, Wai'anae coach Danny Matsumoto said.

"That happened once," Matsumoto said. "We compromised by giving them more water breaks; we practiced."

Like many high school programs, Wai'anae practices the majority of the time wearing full football equipment, going Mondays, Tuesdays and Wednesdays in full pads. The day before a game, players will wear just helmets.

The heat takes a toll.

"Sometimes you get dizzy," said Wai'anae junior tight end Kawika Kalani, who is competing for a starting spot; he drinks about 12 cups of water each day. "You're hot, and you just want to stop practice already. But you can't. You've got to keep practicing."

Wai'anae athletic trainer Alexander Gasmen said he monitors the weather report and uses a hand-held humidity reader to calculate the heat index, a measurement that combines temperature and humidity. Athletic trainers use the heat index to determine how demanding practices should be.

According to recommendations from the National Athletic Trainers' Association, practices should be modified (shorts only or light pads) when the temperatures and relative humidity fall between 70 degrees Fahrenheit with relative humidity above 78 percent, and temperature of 102 degrees with relative humidity above 20 percent.

Practices should be canceled when temperatures and relative humidity fall between 86 degrees with relative humidity above 95 percent, and temperatures above 102 degrees and relative humidity above 35 percent.

"On the Leeward Coast, the sun is always out," said Gasmen, who has never canceled a practice at Wai'anae. "The coaches know they have to take a lot of water breaks."

INCREASE IN HEADACHES

Younger athletes, such as youth football players, can be at greater risk for dehydration, according Dr. Gregory K. Yim, a Hawai'i pediatrician and pediatric neurologist.

Many youth football teams don't have athletic trainers, and athletes become vulnerable when they limit water or food intake to make eligibility weight standards.

"Most parents feel strongly that their kids don't drink enough," said Yim. "It's more of a concern in the summertime because they're losing so much fluids."

Yim said he sees an increase in the frequency of headaches in patients, a sign of dehydration.

"When we talk to a lot of the parents, they say their kids get headaches in the afternoon, or when they are exposed to the heat," Yim said.

Heat-related cases are likely greater in frequency, but many cases are treated on the field and go unreported, Yim said.

"I think the main principle is: Kids are not little adults," Yim said.

"Kids really need their fluids because their water content is higher than adults. When we think of their diet, we need to think of their fluids as well as their food."

Beating the heat with good nutrition is also important and doesn't have to be expensive.

"We try to tell them you don't really need to buy a $75 bottle of protein shake," Kamehameha-O'ahu athletic trainer Cindy Clivio said. "If they just eat a tuna fish sandwich or a piece of chicken the size of their hand, that's enough protein to help repair and regenerate the muscles."

Clivio said one of the best preventive measures is educating athletes about heat illness.

"We try to tell them the warning symptoms — headaches, fatigue, irritability, confusion — so they might see it coming," Clivio said. "We also try to ask them to watch out for their teammates. A lot of times one player may notice something wrong with a player before anyone else does.

"We encourage them if they see anything suspicious to let the coaches and athletic trainers know as soon as possible."

Reach Brandon Masuoka at bmasuoka@honoluluadvertiser.com.