Statement of Purpose Our study aimed to identify factors concerning school-based policy that were associated with the implementation of the National Athletic Trainers’ Association (NATA) Inter-Association Task Force (IATF) preseason heat acclimatization guidelines to prevent exertional heat illness (EHI).

Methods/Approach Semi-structured phone interviews regarding implementing the NATA-IATF guidelines were conducted with a purposive sample of 33 US high school football athletic trainers (ATs; 16 male/17 female; mean age=36.4±12.5 years). Interviews were transcribed verbatim. Four progressive stages in the consensual qualitative research tradition were utilized to create a codebook. Study personnel coded interviews and held consensus meetings to resolve coding discrepancies.

Results Participants highlighted themes related to school-based policy in implementing the NATA-IATF guidelines. First, participants discussed using the NATA-IATF guidelines as primary sources to initiate and inform school-based policy; however, policy was noted needing updates to account for current EHI prevention/management best practices. Second, participants noted state laws and state-specific athletic associations (not school-based policy) were the primary resource for EHI prevention among administrators and coaches; however, these resources did not always align with best practices, creating frustration for ATs. Third, participants emphasized needing policy that included accountability and enforcement, particularly for coaches; most looked to state athletic associations and administrators for such support. Last, school-based policy seemed more beneficial when in schools located in states where NATA-IATF guidelines were mandated and when in warmer areas where there was higher perceived EHI risk.

Conclusions Gaps existing in school-based policy may affect the implementation of the NATA-IATF guidelines. Policy should be continually updated, align with best practices, and consider accountability and enforcement. Future research should also identify factors associated with disparities in implementation.

Significance/Contribution to Injury and Violence Prevention Science School-based policy may be helpful in facilitating the implementation of the NATA-IATF guidelines and thus, increasing their effectiveness in reducing EHI.