When George LaComb moved two years ago to a new high school in Orlando, Florida, he quickly noticed safety precautions that the football team at his previous, less affluent school never had.

There was a designated recovery room, staffed by a full-time athletic trainer, giant ice baths to cool overheated athletes and indoor facilities to practice if outside got too hot. At his old school in another part of Orlando, the football team relied on one makeshift ice bath and a cafeteria table to rest on when injured.

“There’s a vast difference between schools that have money and schools that don’t,” said LaComb, a senior at Lake Buena Vista High School and Florida state representative on the National Student Council, a membership group for student leaders. “Making sure each school has the resources to keep students safe shouldn’t be dependent on income.”

As climate change pushes temperatures to new highs, schools across the country are contending with threats to student health and safety on athletic fields, playgrounds and beyond. More than 9,000 high school athletes receive treatment for heat illnesses each year, according to past estimates from the U.S. Centers for Disease Control and Prevention. In 2021, the most recent year for which data is available, nine high schoolers died from exertional heat stroke — a record. At least 65 teenagers have died from heat-related causes since 2000, according to an analysis by the Louisville Courier Journal.

For now, the United States has no national standard for heat safety in schools. That may change once federal regulators develop a workplace rule that would extend to schools. In the meantime, states have moved ahead with their own rules — ordering schools to adjust practice schedules, buy professional-grade equipment or hire licensed trainers who can spot and treat heat-related illnesses. How easily districts can comply, though — and whether they can afford to go beyond the bare minimum and make the sorts of investments LaComb’s new high school has — depends on the size of their budgets.

“The lack of funding and capacity in many places around the country will almost certainly lead to a continuation of the Swiss cheese heat health protections at the state and local level,” said John Balbus, former deputy assistant secretary for climate change and health equity at the U.S. Department of Health and Human Services.

The United States doesn’t track heat-related injuries or deaths in public schools. But recent research confirms exertional heat stroke as a leading — and preventable — cause of death in high school sports, with incidents increasing over the past four decades. A life-threatening emergency, heatstroke occurs when the body overheats and can’t cool itself down, often due to intense physical activity or exposure to high temperature.

In July of last year, a Mississippi high school sent 11 marching band members to the hospital after they collapsed during practice. A Memphis teenager died that same month from heatstroke after football practice, and a 15-year-old in North Texas died in August following conditioning drills.

Children face unique biological vulnerabilities to extreme heat. Their bodies take longer to acclimate to high temperatures and produce sweat. They’re more prone to dehydration, and young children don’t always know when they need to cool down.

“Children spend more time active outdoors, which results in increased exposure to high ambient heat,” said Autumn Burton, senior associate of climate, health and environment at the Federation of American Scientists, a think tank. “Children usually depend on others to provide them with water and protect them from unsafe outdoor environments.”

What’s new, she explained, is the intensity, length and scope of heat waves.

“Communities that didn’t experience extreme heat in decades and years past are now facing it, and they don’t have the infrastructure and planning and protocols in place to deal with it,” Burton said.

The Korey Stringer Institute — named after the NFL player who died from exertional heat stroke during training camp in 2001 — advocates for athletic safety and evaluates states on policies to protect young athletes. It reviews heat safety rules, licensing of athletic trainers and coaching education. Since 2017, states have adopted nearly 200 heat illness prevention policies, said Rebecca Stearns, chief operating officer for KSI.

States like Florida and Georgia, where tragic heat-related deaths in recent years have spurred policy changes, rank near the top of KSI’s list due to comprehensive legislation and regulations. Both states — as well as Louisiana, New Hampshire, New Jersey and North Carolina — received full marks for requiring a period for athletes to acclimate at the start of formal practices. They also mandate other changes based on readings from wet-bulb globe thermometers, which experts consider the gold standard for measuring heat stress because they account for air temperature, humidity, cloud cover, wind speed and sun angle. All six states also require schools to keep cold water immersion tubs on site at all warm weather practices and adopt the “cool first, transport second” standard to lower a person’s body temperature before taking them to a hospital.

With no formal heat protections in place, Colorado and Maine rank near the bottom of KSI’s evaluation — where California used to be before passing new mandates in 2024.

Toward the end of that year, the Biden administration advanced federal regulations that would for the first time protect workers from the heat, including teachers and other school staff. Employers would have to develop plans for heat hazards, with higher temperatures triggering more controls, like access to cool drinking water or shaded breaks. The Occupational Safety and Health Administration, under President Donald Trump, is moving forward with finalizing those rules.

Already, OSHA requires employers to report heat-related deaths on the job — a tally schools don’t have to report for students.

“At the high school level or below, there’s no required reporting when a kid dies,” Stearns said. “What we know is probably just the tip of the iceberg.”

And the new standards would only apply to about half the country: Twenty-seven states, and Puerto Rico and the Virgin Islands, extend OSHA protections to cover public workplaces, like schools. The other states do not include government workers.

New Hampshire once ranked at the very bottom of the KSI list. But after years of lobbying by athletic trainers — motivated in part by a desire to cover their own liability — the state in 2021 passed some of the strongest heat safety policies in the country.

Every campus must have emergency response plans, identifying which staff members are trained and responsible for attending to injuries. Schools now must use wet-bulb globe temperature readings to add more break times or to delay or cancel practices and games.

“It’s not a partisan issue,” said state Sen. Ruth Ward, the Republican chair of the education committee who sponsored the 2021 legislation. “This is about keeping our kids safe.”

But the bill exposed the challenge of unfunded mandates. New Hampshire courts have found the state underfunds its public schools by more than $3,000 per pupil. Wet bulb devices can cost up to $500, yet lawmakers allocated just a symbolic $1 account for schools to buy them.

During debates over the bill, some school district officials expressed concern that the statewide standard would create an unfunded mandate, further straining tight budgets. Schools have had to seek outside grants to cover what seems like a small expense.

New Hampshire, like just three other states, also now requires athletic trainers at collision and contact sporting events. But an annual count in 2024 found that close to a third of secondary schools report having no athletic trainers on staff. Part of the problem is pay, said Precious Burke, president-elect of the New Hampshire Athletic Trainers’ Association: Athletic trainers can earn much more at New Hampshire’s private schools and in private practice.

In the face of funding shortfalls, schools — and students — are improvising.

Molly McDougal, assistant athletic director for Kearsarge Regional School District in New Hampshire, laughed while describing a method her cash-strapped district employs, known as TACO, which stands for “tarp-assisted cooling with oscillation.” Her schools can’t afford standing immersion tubs, but coaches can lay overheated athletes in a tarp filled with ice water to rapidly cool them.

“It sounds, for lack of a better word, kind of sketchy,” McDougal said. “But it’s just as effective.”

In neighboring Massachusetts, the Boston school system, which couldn’t afford to hire full-time staff like its neighboring districts, started partnering with a regional hospital to hire a team of athletic trainers. A dermatology group offers grants to help schools create more shade on their campus, and California created a statewide initiative to transform asphalt-covered schoolyards into shaded green spaces.

Isabella Malloy, a senior at Vista PEAK Preparatory, a high school in Aurora, Colorado, said young people also should guard their own health and safety. Temperatures there have already broken heat records this year, reaching 85 degrees.

Malloy, who has played on her school’s flag football, softball and wrestling teams, recalled hyperventilating during one football game on a particularly warm Saturday morning and signaled for her coach to sub her out. He immediately started pouring water over her head.

“You have to know yourself and if something doesn’t feel right,” Malloy said. “Some kids get afraid if they tell coach they’re tired, he’ll make you run more,” she added. “It’s hard to advocate for ourselves when you also don’t want to seem lazy.”

The safety measures come with tradeoffs, too.

Even with the amenities at his new school, LaComb at Lake Buena Vista High School said wet-bulb readings often meant his football team couldn’t train at all. Some athletes desperate for time on the field, he said, would resort to blowing on the wet-bulb thermometer to trick it into a cooler reading or arrange informal practices at nearby parks without the supervision of trained staff.

“It’s so hot, and the heat’s increasing so much over the years,” LaComb said. “We get less and less play time every year.”

He added, “It really impacts the joy that you have in the sport. You’re supposed to think only of the game, but now you’re just thinking about how hot it is — even when you’re sitting on the bench.”

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