Last year, heat-related deaths among middle school, high school and college football players were at their highest level since 1936, according to new statistics.

There were a total of 20 football-related deaths in 2006; two "pick-up" game players, three college players and 13 middle and high school players. Just one of the 20 deaths was not heat-related, involving a 17-year-old high school player who suffered a spinal cord injury when tackled in practice.

Heat-related deaths have been compiled since 1931 as part of the Annual Survey of Football Injuries. Fred Mueller, a professor of sports administration at University of North Carolina at Chapel Hill, has been in charge of compiling the list since 1980.

The last time the country saw more than five heat-related deaths among children and teens was 1972, when there were seven. In five of the past 16 years there were none. There have been 31 total since 1995 and all could have been avoided, Mueller said.

“Coaches, athletes and parents should be aware that all fall sports could lead to heat-related deaths if precautions aren’t taken,” Mueller said. “Every year we have to get the word out.”

Mueller said there must be a change in the mentality that still exists in some football circles, where kids feel pressured from coaches or parents not to complain about feeling ill during practices or games.

Mueller makes the following suggestions:

— Require each athlete to have a physical and know if an athlete has a history of heat-related illness; these kids are more susceptible to heat stroke. Overweight players are also at higher risk.

— Acclimatize players to the heat slowly; North Carolina mandates that the first three days of practice be done without uniforms.

— Alter practice schedules to avoid long workouts in high-humidity.

— Provide cold water before, during and after practice in unlimited quantities.

— Provide shaded rest areas with circulating air; remove helmets and loosen or remove jerseys.

— Know the symptoms of heat illness: nausea, incoherence, fatigue, weakness, vomiting, muscle cramps, weak rapid pulse, and visual disturbance. Contrary to popular belief, heat stroke victims may sweat profusely.

— Have an emergency plan in place; parents should inquire about emergency plans for their kids’ teams.