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7 Lessons

Football is a global game. As a result, it is played in a wide range of environmental conditions. These factors can both affect a player’s performance and make them more likely to become unwell. This module will focus on four common environmental factors and how they may impact on football. These factors relate to extremes of temperature (both hot and cold), altitude and lightning.

Prevention is a key focus of this module. Careful preparation and an awareness of the various medical conditions which can be induced by extreme environmental conditions should significantly limit the risk of players and team officials becoming unwell. As with all areas of medicine, prevention is truly better than a cure.

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Learning outcomes

By the end of this topic you should:

  • understand the physiological effects of extremes of temperature and altitude on a football player;
  • be able to plan for travel to areas where there may be extremes of temperature or high altitudes;
  • be able to diagnose and treat common medical problems associated with extremes of temperature and high altitudes;
  • understand the situations (relating to extremes of heat and high altitude) where urgent hospital referral is needed;
  • understand the risks associated with playing football during a lightning storm;
  • be able to develop, implement and monitor a predetermined lightning plan.


  • Read the relevant section in the F-MARC Football Emergency Medicine Manual and other required reading.
  • Review the suggested reading.
  • View, or listen to, any relevant multimedia content.
  • Complete the course quiz.


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  2. Smith JE. Cooling methods used in the treatment of exertional heat illness. Br J Sports Med. 2005;39(8):503-7; discussion 507.
  3. Schwellnus MP. Cause of exercise associated muscle cramps (EAMC)–altered neuromuscular control, dehydration or electrolyte depletion? Br J Sports Med. 2009;43(6):401-408.
  4. Miller KC, Stone MS, Huxel KC, Edwards JE. Exercise-associated muscle cramps: Causes, treatment, and prevention. Sports Health. 2010;2(4):279-283.
  5. Cappaert TA, Stone JA, Castellani JW, et al. National athletic trainers’ association position statement: Environmental cold injuries. J Athl Train. 2008;43(6):640-658.
  6. Huissoon A, Krishna MT. Cold-induced urticaria. N Engl J Med. 2008;358(8):e9.
  7. McMahon JA, Howe A. Cold weather issues in sideline and event management. Curr Sports Med Rep. 2012;11(3):135-141.
  8. Bergeron MF, Bahr R, Bartsch P, et al. International olympic committee consensus statement on thermoregulatory and altitude challenges for high-level athletes. Br J Sports Med. 2012;46(11):770-779.
  9. Bartsch P, Saltin B. General introduction to altitude adaptation and mountain sickness. Scand J Med Sci Sports. 2008;18 Suppl 1:1-10.
  10. Levine BD, Stray-Gundersen J FAU – Mehta,,R.D., Mehta RD. Effect of altitude on football performance. Scandinavian journal of medicine & science in sports JID – 9111504. 1124.
  11. Gore CJ, McSharry PE, Hewitt AJ, Saunders PU. Preparation for football competition at moderate to high altitude. Scand J Med Sci Sports. 2008;18 Suppl 1:85-95.
  12. Chalkias A, Georgiou M, Bottiger B, et al. Recommendations for resuscitation after ascent to high altitude and in aircrafts. Int J Cardiol. 2013;167(5):1703-1711.
  13. Walsh KM, Cooper MA, Holle R, et al. National athletic trainers’ association position statement: Lightning safety for athletics and recreation. J Athl Train. 2013;48(2):258-270.
  14. Gratz J, Noble E. Lightning safety and large stadiums. Bull Amer Meteor Soc. 2006;87(9):1187-1194.
  15. 15. Zafren K, Durrer B, Herry JP, Brugger H, ICAR and UIAA MEDCOM. Lightning injuries: Prevention and on-site treatment in mountains and remote areas. official guidelines of the international commission for mountain emergency medicine and the medical commission of the international mountaineering and climbing federation (ICAR and UIAA MEDCOM). Resuscitation. 2005;65(3):369-372.