With the triple-digit temperatures comes increased risk for heat-related illness and death.

Temperatures this week and next are forecast to be in the triple digits with heat index values reaching as high as 106, according to the National Weather Service. With most San Antonio-area schools still in session and outdoor sports practices and football scrimmages being held, school officials are using caution and warning students participating in outdoor activities to drink extra water

“The biggest concern when playing outside this summer is dehydration, so we want to make sure that they are listening to their bodies and drinking plenty of water,” said Dr. Ramon Cancino, director of the Primary Care Center at UT Health San Antonio.

On Tuesday morning, Cancino and UT Health San Antonio primary care physicians provided physicals for Nimitz Middle School students, determining whether they were eligible to participate in sports and educating them on how to prevent injury and illness as they participate in training camps now and during the summer months.

Anyone planning to participate in physical activities outside should begin hydrating two days before, continue drinking water throughout, and work to rehydrate completely after being active, he said.

To avoid the heat, students participating in conditioning training over the summer will work out inside the school’s gymnasium, said Robert Barrientes, boys athletics coordinator at Nimitz. “It’s going to be record-breaking temperatures, and the heat isn’t something that we want to deal with,” he said.

Texas schools follow University Interscholastic League (UIL) guidelines regarding heat stress and athletic participation. Those guidelines provides recommendations on the best time of day to be active outdoors, guidelines for the frequency of water breaks and their duration depending on how hot it is, and an explanation of how excessive heat can affect students and how to treat heat-related health issues.

For example, when temperatures are between 90-99 degrees, five-minute water breaks are required every 30 minutes.

For middle school students, if the temperature is 100 degrees or more during a scheduled practice, the session must be relocated to an indoor facility. For high schoolers, practice is moved to either the morning or early evening on 100-degree days to eliminate the risk of heat-related illness.

These policies guide all school-sponsored outdoor sports and include dance, cheerleading, JROTC, and marching band.

In addition to hydration, making sure that people are acclimated to the temperature outside before engaging in physical activity is also important, said Paul Rost, Northside Independent School District’s athletic training coordinator.

“What we used to see was that kids in the summer would go home and stay inside watching TV and playing video games, and when they came for practice they weren’t acclimated, they weren’t used to the environment,” Rost said. No one should go outside and engage in sports or physical activity immediately until they acclimate to the environment, he said.

A football team may go through anywhere from 25-30 gallons of water during a game, Rost said, and there are water stations in the stands for the dance team and band members, who on the hottest days of the year are able to perform out of full uniform in an effort to stay cool.

He said that the majority of middle and high school athletes know to report any symptoms of heat exhaustion, including dizziness, excessive sweating and thirst, and headaches to coaches.

The early heat wave prompted a school district in the Dallas-Fort Worth area to shift the starting time for its outdoor graduation ceremony. Carroll Senior High School in Southlake, Texas, announced it would delay the ceremony’s start time until 8:30 p.m. Friday night to allow the sun to set and temperatures to cool down.

Meanwhile, the City of San Antonio Metropolitan Health District and the Office of Emergency Management notifies residents when extreme temperatures are expected and what actions the public needs to take to stay safe when outdoors according to its Heat Plan, which includes levels to describe heat conditions.

Over Memorial Day Weekend, the City issued a Level III heat outlook, warning residents of the risk of sunstroke, heat cramps, and heat exhaustion, with heat stroke likely with prolonged exposure. A Level I heat outlook is issued when the heat index reaches 113 degrees Fahrenheit or higher, and residents are encouraged to remain indoors.

“When we get to a high heat index we want to educate the community about the risks so that [people] can keep an eye out for the elderly, young children, and people with special needs,” said Mario Martinez, assistant director for environmental health at Metro Health. “For those who want to be out and doing activities, early mornings or evenings are preferable.”

The City, in partnership with Catholic Charities, provides box fans free of charge to residents aged 60 and older to help mitigate risk of heat-related illness and death among some of the most vulnerable people in the community through Project Cool. The program has been providing fans to eligible residents since 1997, and can be contacted by dialing 2-1-1.

“These are the hottest summer months, and we all need to engage with our neighbors to see how they are doing,” Martinez said. “If people are presenting symptoms of heat-related illness they need to be addressed before it becomes more serious and results in hospitalization.”

Roseanna Garza reports on health and bioscience for the San Antonio Report.