KRC Asks KHSAA To Revise Protocols For Outdoor Sports Activity Posted: August 25, 2008
August 25, 2008
Ms. Brigid Devries, Commissioner
Mr. Julian Tackett, Assistant Commissioner
Ky. High School Athletic Association
Dear Brigid and Julian:
I am writing to urge KHSAA to revise the "KENTUCKY MEDICAL ASSOCIATION / KENTUCKY HIGH SCHOOL ATHLETIC ASSOCIATION PROCEDURE FOR AVOIDING HEAT INJURY / ILLNESS THROUGH ANALYSIS OF HEAT INDEX AND RESTRUCTURING OF ACTIVITIES" in order to include consideration of ambient levels of ozone and fine particulate matter in determining when outdoor sports-related activity should be decreased or stopped entirely. The current guidelines do not appear to incorporate consideration of air quality in establishing the breakpoints at which outdoor physical activity should be restricted or canceled in order to avoid injury and illness, and this lack of consideration of air quality creates a potentially dangerous situation during summer days when the heat index and ozone and fine particle levels are elevated.
Current KHSAA guidelines require consideration only of temperature and humidity, which are factored into the Heat Index Calculation and Chart. In air quality regions such as Metro Louisville, that is not sufficient to protect the health of teen athletes during periods where ozone or fine particulate matter are elevated, since even when the heat index values are not exceeded, the combination of stress related to elevated heat and humidity, and degraded air quality may combine to induce negative health consequences.
The potential health impacts of exposure to ozone air pollution are significant and include reduced pulmonary function, increased respiratory symptoms, airway hyperreactivity and airway inflammation, in addition to premature mortality, increased hospital admissions for cardiopulmonary causes, and exacerbation of bronchitis, asthma, and respiratory symptoms. The groups most at risk of experiencing adverse responses include children and adults who are active outdoors, and outdoor workers. As noted in "Ambient Air Pollution: Health Hazards to Children," published in the Journal Pediatrics in December 9, 2004,
"Ambient ozone is formed by the action of sunlight on nitrogen oxides and reactive hydrocarbons, both of which are emitted by motor vehicles and industrial sources. The levels tend to be highest on warm, sunny, windless days and often peak in midafternoon, when children are most likely to be playing outside. Ozone is a powerful oxidant and respiratory tract irritant in adults and children causing shortness of breath, chest pain when inhaling deeply, wheezing, and cough. Children have decreases in lung function, increased respiratory tract symptoms, and asthma exacerbations on days with higher levels of ambient ozone. Increases in ambient ozone have been associated with respiratory or asthma hospitalizations, emergency department visits for asthma, and school absences for respiratory tract illness."
Similarly, extensive, peer-reviewed medical research correlates exposure to PM2.5 with significant increases in cardiovascular, respiratory and other illnesses. Particulate pollution affects lung function and lung growth, and contributes to excess mortality and hospitalizations for cardiac and respiratory tract disease.
It may be the case that the recent tragedy involving the teen football player at PRP was unrelated to the fact that the day of the illness had been declared by the Metro Louisville Air Pollution Control District to be an "Air Quality Alert" day. According to a published report, the August 20th practice lasted from about 4:30 or 5 to 6 pm, at a time when the heat index was 94, one point below the level of 95 where precautions would be taken under the KHSAA policy. The ozone concentration, measured at the Watson Lane monitor, reached its peak hourly reading at 4 pm and highest value for 8-hour average at 6 pm, with next highest values at 5 and 7 pm. The teen had trouble breathing, which is one of the adverse health effects of ozone, after practice and collapsed. The director of athletics for Jefferson County Public Schools is reported to have said "it's something where you can do everything right and follow protocol, but sometimes young men and women don't respond well to the heat. Unfortunately, we see it more often than we'd like." It is quite possible that one of the reasons that JCPS is seeing this problem, despite adherence to the KHSAA protocol, is the lack of consideration of poor air quality as a compounding factor in the protocol.
Below is the text of the Air Quality Alert that was issued by Metro Government on August 19 for August 20th, which can be found at http://www.louisvilleky.gov/APCD/News/2008/20080819AQA.htm Air Quality Alert for August 20 Tuesday August 19, 2008
"An Air Quality Alert has been declared for Wednesday, August 20, 2008 for the Louisville area. The air is expected to be Unhealthy for Sensitive Groups. Sensitive groups include active children and adults, and people with lung diseases, such as asthma. These groups should reduce prolonged or heavy exertion outdoors.
The air quality index is expected to reach 106. The determining pollutant is ground level ozone.
The Air Quality Index (AQI) is an index for reporting daily air quality. It tells you how polluted your outdoor air is, and what associated health effects might be a concern for you.
Local air quality affects how we live and breathe. Like the weather, it can change from day to day."
It is clear that as a matter of policy, in those cases where an air quality alert has been issued, Kentucky's public schools should be heeding the recommendations of the air pollution control agency and the body of health literature that strenuous outdoor activity should be curtailed or postponed until the air quality improves.
As a matter of precaution, it would appear prudent for high schools in regions where air quality alerts are declared, to require that schools cancel or limit outdoor practices.
In closing, I would ask that you forward this email to the Board of Control and that KHSAA, in conjunction with the Kentucky Academy of Pediatrics and respiratory health professionals and air pollution control officials in Louisville and Frankfort, to incorporate air quality indices for ozone and fine particulate matter into the policies governing outdoor sports-related activity for high school students.
Tom FitzGerald, Director
Kentucky Resources Council, Inc.
cc: John Lyons, Director, Division for Air Quality, EEC
Lauren Anderson, Director, Metro Louisville Air Pollution
Mike Haydon, Office of the Governor