It's been a generation since high school football coaches used to 'toughen up' their players by denying them water.
It's been a decade since the stunning day when NFL player Korey Stringer died of heat-related issue at training camp.
Education on the subject has never been greater.
So why are high school football players still dying from the heat?
Since last Wednesday, a player in Florida, another in South Carolina, two from Georgia and a coach in Texas have died after participating in football activities held during hot weather. Leading doctors, athletic trainers and heads of institutes directly involved in studying heat issues involving high school athletes can only shake their heads in anguish.
And while much of the country is in the midst of a record-breaking heat wave, the experts say that isn't an acceptable reason for these tragedies.
"It is 100 percent preventable - absolutely," Dave Csillan, the head athletic director at Ewing (N.J.) High and the co-chair of the National Athletic Trainer's Association statement paper on the issue. "If you have adequate fluid intake and adequate rest in a cool environment you'll have no problem with heat strokes."
Dr. George Luber, the associate director for climate change at the Centers for Disease Control and Prevention (CDC) in Atlanta, agreed.
"It's an unnecessary tragedy," Luber said. "I'm the father of three kids myself. I feel for the parents. They are putting their children under supervised care but this keeps happening. I think it's a wake-up call to our schools."
But therein lies the problem. Too often schools feel they have gotten the wake-up call and are working to prevent such tragedies. Unfortunately, their education on the subject is not at the level it needs to be.
Becca Stearns, the vice president of operations and directors of education of the Korey Stringer Institute, which opened on the campus of the University of Connecticut in Storrs last spring, said more education is key.
"We speak to high schools and even colleges and review all of their practices - most are not where they need to be," she said. "They say we have water and take plenty of breaks."
That, however, isn't enough.
Here are the issues:
Acclimatization: Athletes need to get used to the weather they are working out in. Working out all July in an air-conditioned gym will not get you ready for a hot day of outdoor practice. Your body, Luber said, needs to adjust.
"The kid who spent the previous month mowing lawns will be better able to handle the first day of practice than the kid who spent time in an air-conditioned gym, even if it was six hours of working out in the gym," Luper said. "The body needs to adjust to the weather conditions."
Gradual increase: You can't expect an athlete to be ready to go full-speed on the first day. Dr. Ellen Yard, an epidemiologist at the CDC, said pacing is important.
"We recommend having only one practice the first week - and have it be light in intensity," she said.
The adjustment isn't just to the weather but to the intensity, especially for the younger players.
"You have 9th graders playing football for the first time," Csillan said. "You can't expect them to arrive at the first day of practice in the same shape and understanding as a senior who has been through three summer camps."
BEAT THE HEAT
Here are some helpful ideas to help keep athletes safe in the sun:
Rest and recovery: All involved said a cool-down period in an air-conditioned environment is key. Csillan recommends a one-to-one hour break during two-a-day practices. In other words, for every hour kids are on the field in the morning, they must take a one hour break (with fluids) to recover.
"The problem is you start to build a deficit," Csillan said. "If you practice three hours then take a two-hour break you haven't fully recovered. And that will accumulate. We see a lot of issues on the second and third day because kids are behind in their recovery."
Recognition: The CDC stresses that all care-givers must be trained in recognizing the signs of heat-related issues.
"We call it the surround approach" Luber said. "Everyone from the coaches to the trainers to the players themselves needs to be looking for the symptoms. You can't rely on the at-risk person to identify the problem. It comes on so quickly and they lose mental acuity and the ability to take care of themselves."
And even if they did recognize the symptoms, high school students are more likely to try to resist them. "A kid who is battling to be the starting linebacker is not going to tell the coach he needs a break," Luber said.
Treatment: How you treat - and how soon you treat - is key, Sterns said.
"The No. 1 thing anyone can do is cold-water immersion," she said. "We've looked at the incidents. Whenever someone has been immersed within 10 minutes of their episode, there's been a 100 percent survival rate.
"All you need to treat heat stroke is a 150-pound tub with ice and water and you have a great chance to save the athlete. It also means we are treating on site, which is unusual in emergencies. With heat stroke, the time of transporting takes away from the chances of survival; we recommended treating on site then transporting."
Luber said he couldn't speak to the specifics of any of the recent heat-related deaths, but he was comfortable in suggesting such incidents usually are not the result of negligence or ignorance - just lack of education and understanding.
"There's an under-appreciation for the legality of heat exposure," he said. "It's the number one weather related cause of death, much higher than tornadoes or lightning, floods, hurricanes or earthquakes. People have an under-appreciation for even short-term exposure.
"It's two hours and we have plenty of water, 'What can happen?'"