Greensburg Central High School football coach Muzzy Colosimo will never forget the day he saw a student suffer from heatstroke.

Although it was more than 20 years ago when he was an assistant coach at Hempfield Area High School, Colosimo remembers clearly how panic surged through the coaching staff when the running back showed signs of heat injury.

"The kid was one of those people who wouldn't slow down if you paid him -- everything he did was full-go," Colosimo said. "We could see he was going to pass out ... for as long as I live I'll never forget the way he looked."

After a 45-minute cold shower failed to improve his condition, the young man was rushed to a hospital where he eventually recovered. Colosimo knows that other students are not always so lucky, however, since heatstroke can be fatal if not treated properly.

In an attempt to decrease the number of heat-related injuries in secondary school athletes, the National Athletic Trainers Association released a set of guidelines in June that high school coaches and trainers in all sports should follow during preseason practices.

The "heat acclimatization" recommendations gradually condition athletes to handle more strenuous practice levels, and they dictate how the first 14 days of preseason training should be conducted.

They stipulate that individual practices should not exceed three hours (including warm-up and cool-down time) and that no more than one practice session per day should be held for the first five days. Additionally, students should not wear full protective gear until the sixth day of practice.

Chris Saluga, Chartiers Valley High School football coach, limits his practices to three hours and modifies his players' gear in hot weather.

"[Heat injury] is something we take very seriously," he said, noting that a few students usually show signs of it each season.

When football training camps start Aug. 17 in accordance with PIAA regulation, Saluga will make sure that players clear the field by 10:30 a.m. before being exposed to midday sun and heat.

Although football players are often especially susceptible because of their late summer practices and cumbersome equipment, heat illness can threaten any type of athlete who stretches his or her physical limits. Endurance athletes such as runners, wrestlers, soccer players and even swimmers have been known to suffer from it, said Dr. Tanya Hagen, assistant professor of orthopedics at the University of Pittsburgh and sports medicine specialist at UPMC.

She believes that high school athletes are at greater risk than collegiate or professional ones, whose heavier practice schedules can better equip their bodies to handle heat.

"We see problems in young athletes who are de-conditioned and try to push themselves to get a position or impress the coach," she said.

The predecessor to heatstroke is heat exhaustion, where victims show signs of dizziness, nausea and muscle weakness. Once a body crosses the heatstroke threshold, 104 degrees Fahrenheit, the chance of mortality is roughly 10 percent, said Dr. Hagen, who works to prevent heat injury at Steelers' practices.

Humidity and direct sun radiation affect the risk along with temperature, so thermometer readings don't reveal the whole picture.

"It's like a wind-chill factor," Dr. Hagen said. "A 10-degree day can feel much colder with the wind, and it's the same at the other end of the spectrum."

She and other professional team trainers measure the "heat stress index," or combination of the three factors, with tools that are generally too expensive for high school and college teams to access.

However, Extech Systems, a subsidiary of Flir Systems, Inc. attempts to remedy the problem with a cheaper product targeted towards secondary school coaches.

The Extech HeatWatch, a sophisticated stopwatch that complies with NATA regulations, costs $39.99 and measures temperature and humidity along with performing normal stopwatch functions.

Dr. Hagen said that alcohol and drug use increases the risk of heat illness, including the use of medications such as diuretics, antihistamines and antidepressants. Individuals who carry the gene for sickle cell anemia -- even if they don't have the condition -- are also more susceptible, she said, since their blood cells are less able to transport oxygen. She encourages high school and college coaches to screen for the trait, a common practice for professional teams.

For now, Saluga and Colosimo keep trainers nearby at each practice to monitor students, evaluate the safety of the conditions, and decide whether individual players are able to perform.

As an added precaution, Colosimo refuses to keep players past the scheduled end of practice, when exhaustion most often takes its toll.

"It's just a game," he said. "When you get to be my age, you realize that there are a lot more important things than football."

NATA guidelines can be found at www.nata.org.