4.2 Lightning, Cold, Altitude & Air Quality
Key Takeaways
- NATA lightning safety slogan: “If you see it, flee it; if you hear it, clear it.” All people must be in a safe location when lightning is within about 5 nautical miles (~6 statute miles); wait 30 minutes after the last lightning or thunder.
- Flash-to-bang (seconds/5 = miles; 30 seconds ≈ 6 miles) and the 30-30 rule are backups when no verified lightning-detection technology is available—not substitutes for a real-time system and a named chain of command.
- Safe locations are substantial buildings with wiring and plumbing or fully enclosed metal vehicles. Dugouts, picnic shelters, press boxes, isolated trees, bleachers, tents, golf carts, and showers are not safe lightning shelters.
- Cold injury prevention uses wind chill and wet-clothing control: frostbite is tissue freezing of exposed skin; hypothermia is a drop in core temperature. Altitude illness (AMS, HAPE, HACE) is recognized by the AT and referred; acetazolamide is physician-prescribed.
- EPA Air Quality Index: 101–150 is unhealthy for sensitive groups (including many athletes with asthma); 151–200 is unhealthy for everyone—modify, shorten, or move activity indoors rather than “push through the smoke.”
Heat is the headline environmental killer in football preseason. Lightning, cold, altitude, and air quality kill or disable athletes in other months and other venues. PA8 task 0105 still applies: monitor, decide, evacuate, modify, and document using a written emergency action plan (EAP) with a named chain of command.
Lightning: Policy Before the First Rumble
The NATA 2013 position statement Lightning Safety for Athletics and Recreation (Walsh et al., Journal of Athletic Training, 48(2):258–270) remains the athletic-training standard. Lightning casualties cluster from May to September and between about 10:00 a.m. and 7:00 p.m.—the hours of practices and games. The operational slogan used in NATA-derived education is: “If you see it, flee it; if you hear it, clear it.” Every cloud-to-ground flash is dangerous. Lightning can strike many miles from the rain core (commonly cited up to about 10 miles).
Detection, Distance, and the 30-30 Backup
Preferred practice is a verified commercial real-time lightning-detection service plus a designated weather watcher who also uses National Weather Service forecasts. NATA recommends that all individuals be completely inside an identified safe location when the storm’s lightning is within 5 nautical miles (nmi)—roughly 6 statute miles or 9.26 km (recommendation 15). Activities stay suspended until 30 minutes after the last lightning flash within 5 nmi and the last thunder. That 30-minute clock restarts with each new flash or thunder (recommendation 17).
When technology is down, flash-to-bang is the field backup: count seconds from the flash to the thunder and divide by 5 to estimate miles (sound travels about 1 mile in 5 seconds). A count of 30 seconds ≈ 6 miles. The 30-30 rule means: seek safety when flash-to-bang approaches 30 seconds, and wait 30 minutes after the last thunder or flash before resuming. Teach 30-30 as a minimum backup, not as permission to skip a detection service. Allow evacuation time so the last person is inside before the 5 nmi / 6-mile edge arrives.
Example alert language from NATA Table 4: “heads up” near 15 miles, begin safety procedures near 10 miles, “you are now in danger” near 6 miles (about 5 nmi), and “all clear” when lightning has not been detected at 15 miles for 30 minutes. Local policy should name who can postpone a game—typically the AT or athletic director in the chain of command, not a coach protecting a playoff seed.
Safe Versus Unsafe Locations
Safe locations:
- A substantial building with plumbing and wiring (school, field house, locker room building)—stay off corded phones and away from showers, plumbing, and electrical equipment during the storm.
- A fully enclosed metal vehicle with the windows up (bus, car). Convertibles, golf carts, gators, and ATVs are not this.
Not safe (exam favorites):
- Dugouts, picnic / park shelters, storage sheds, tents, press boxes that are open or lightly built, bleachers, tall isolated trees, open fields, pools, and showers (plumbing can conduct).
Exam trap: sending teams to a dugout because it “has a roof” or “is grounded.” A dugout is a lightning magnet: metal benches, open sides, and often the tallest nearby structure on a flat field. The same is true of a baseball “cage” or a sideline canopy.
If someone is struck: the scene is safe to enter after the flash (the victim does not remain charged). Manage airway, breathing, and circulation; lightning injury is a trauma and cardiac problem. Move the victim to a safer location if the storm continues.
Cold Injury Prevention: Wind Chill and Wet Clothing
The American College of Sports Medicine (ACSM) expert consensus on cold-weather exercise (Castellani et al., 2021) and the older ACSM position stand on preventing cold injuries (2006) frame risk as temperature + wind + wetness + duration + isolation, not the stadium thermometer alone. The wind-chill temperature (WCT) index estimates how wind accelerates facial cooling and frostbite risk. National Weather Service charts are the usual field reference: frostbite becomes possible on exposed skin as WCT falls (for example, risk in about 30 minutes near −18°F WCT, faster at lower values—use the current NWS chart rather than memorizing every cell).
Wet clothing destroys insulation. Sweat, rain, or immersion water conducts heat away and then evaporates, so an athlete in a soaked cotton layer in 40°F wind can lose heat faster than a dry athlete at a lower air temperature. Prevention: moisture-wicking base layer, insulating mid-layer, wind/water shell, cover hands, feet, ears, and nose, extra socks and gloves in the kit, change out of wet uniforms at half-time or between races, and fuel/hydrate—cold athletes still sweat and still dehydrate, and hunger plus fatigue impair decision-making.
Frostbite is freezing of tissue, usually of exposed or poorly perfused skin (fingers, toes, nose, ears, cheeks). Early signs: numbness, pale or waxy skin, firm or wooden feel. Do not rub snow on it, do not use dry radiant heat that can burn numb skin, and do not thaw if there is a realistic chance of refreezing during continued exposure. Move to a warm, dry environment and protect the part.
Hypothermia is a core-temperature problem (generally <35°C / 95°F), not just cold fingers. Early: shivering, clumsiness, apathy, slurred speech, poor judgment. As it deepens, shivering may stop—that is worsening, not recovery. Wet + wind + exhaustion + inadequate calories is the typical athletic pathway (cross-country, soccer in a cold rain, mountaineering). Care: remove wet clothing, insulate, shelter from wind, and activate EMS for moderate/severe cases. Field rewarming details and afterdrop belong with emergency care; here the exam wants prevention and recognition and not confusing frostbite with hypothermia.
Altitude: Recognize AMS, HAPE, and HACE — Then Refer
The Wilderness Medical Society (WMS) 2024 update on acute altitude illness states that travel above about 2,500 m (8,200 ft) by unacclimatized people risks acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE); susceptible people can become ill as low as about 2,000 m (6,500 ft). U.S. venues that matter: Colorado Front Range training camps, mountain trail races, ski/snowboard, and some Western road races.
AMS: headache plus at least one of nausea/vomiting, fatigue, dizziness, or sleep disturbance after ascent. HAPE: disproportionately reduced exercise tolerance, dry then productive cough, dyspnea that progresses to dyspnea at rest, cyanosis, pink frothy sputum—the leading cause of altitude death. HACE: ataxia (cannot tandem walk), confusion, altered mental status—an end-stage of AMS and an emergency.
Prevention is staged ascent and sleeping-altitude discipline (CDC Yellow Book / WMS: avoid jumping a sleeping altitude to ≥2,750 m (9,000 ft) in a single day; once above about 3,000 m (9,800 ft), increase sleeping altitude by no more than about 500 m / 1,650 ft per night and insert rest days). Hydration and avoiding overexertion on day 1 help; they do not replace ascent discipline. Acetazolamide (typical adult prophylaxis 125 mg every 12 hours, starting the day before ascent) speeds acclimatization but is physician-prescribed. ATs do not independently start it. ATs recognize, stop ascent, arrange descent and oxygen when indicated, and refer. Descent is the definitive treatment for HAPE and HACE. Do not send a confused, ataxic skier back out for “one more run.”
Air Quality Index and Asthma
The U.S. Environmental Protection Agency (EPA) Air Quality Index (AQI) is a 0–500 scale for ozone, PM2.5, and other criteria pollutants. Category names and AQI bands have not changed even as PM2.5 concentration breakpoints were tightened in May 2024:
| AQI | Category | Athletic implication |
|---|---|---|
| 0–50 | Good (green) | Normal outdoor activity. |
| 51–100 | Moderate (yellow) | Unusually sensitive people (including some with asthma) should consider limiting prolonged or intense outdoor work. |
| 101–150 | Unhealthy for sensitive groups (orange) | Children, older adults, pregnant people, and those with respiratory or cardiac disease—including many athletes with asthma—should limit prolonged outdoor activity. Have rescue inhalers on the field. |
| 151–200 | Unhealthy (red) | Sensitive groups avoid outdoor activity; everyone else limits prolonged outdoor activity. Strongly consider postponement. |
| 201–300 | Very unhealthy (purple) | Sensitive groups avoid all outdoor activity; everyone else limits outdoor activity. |
| 301–500 | Hazardous (maroon) | Avoid outdoor activity; move indoors with filtered air or cancel. |
Wildfire smoke is now a regular fall-sport problem. Minute ventilation during practice multiplies inhaled dose, so an AQI that feels “just smoky” to a spectator is a bigger load for a soccer midfielder. Exam trap: keeping an asthmatic in a 120 AQI cross-country race because “the state meet is only once a year.” Modify, shorten, move indoors, or postpone. Check the local AQI at event time, not yesterday’s city average.
Thunder is audible during a softball game. The visiting coach wants the teams in the dugouts until the rain passes. Which action matches NATA lightning safety?
A cross-country meet is held in 38°F rain and a 25 mph wind. Several athletes finish shivering and clumsy; one has numb, waxy fingers. Which prevention-and-recognition statement is correct?
A soccer team flies from sea level to a 2,800 m (about 9,200 ft) training camp. One athlete has a headache and nausea; another is unusually short of breath with a cough. The AQI at the field is 155 from wildfire smoke, and two athletes have asthma. What is the AT’s appropriate environmental response?