The Vianney High School varsity football team was 90 minutes into its first practice of the season, when linebacker-receiver Andy Baker, 17, had a question.

"What do I do if I throw up and am cramping?" he asked athletic trainer Kacey Chamness.

"Get a drink of water and sit down in the shade," she told him, heading off to get a towel from a cooler full of ice water for him.

It was 9:30 a.m. Monday, and Chamness had just plopped ice towels on the head and neck of wide receiver/left cornerback Kevin Schumacker, 16, who was sitting on the ground by a fence.

The temperature had already reached a muggy 82 degrees "—" 90 with the heat index "—" and was steadily climbing.

Within minutes nearly a dozen more players were sitting with towels slung over their heads. Everyone was sweat-drenched and flushed. And this was the first practice of the day. There was another one at noon.

Practices for more than 200 area high school sports teams officially begin this week. With the temperature soaring, coaches and trainers must walk a fine line between pushing their athletes hard enough to get them in tiptop shape for games at the end of the month and putting them in danger.

Many schools have policies that determine when they must cut practice sessions short or cancel them.

The nursing coordinator at Francis Howell High School monitored the temperature Monday afternoon. If the heat index is 105 or above "—" which it was — there's no practice. If it's between 93 and 104, coaches are allowed a modified practice.

Wentzville Holt High School policy also prohibits outdoor practices when the heat index hits 105 degrees, but morning practices were already over by the time it hit that mark.

In Illinois, schools begin practice on Wednesday. Edwardsville High School Athletic Director Brad Bevis said coaches and their trainer will emphasize the need for kids to avoid caffeine and drink a lot of water, while pushing practices as early in the morning as possible.

"If we had kids at practice right now, we'd just be walking through assignments and we'd be doing a lot of chalk-talk in the meeting rooms," he said.

Forty-two football players have died from heatstroke since 1995, according to the National Center for Catastrophic Sports Injury at the University of North Carolina. Of those, 31 were high school athletes.

Some states are taking action against coaches who fail to protect players against the problem. Last month, two assistant football coaches at Middletown High School in Connecticut were arrested and charged with reckless endangerment after a player collapsed during training.

However, the rate of heat-related deaths among football players has decreased from eight in 1970 to about five a year, said Frederick O. Mueller, director of the National Center for Catastrophic Injury Research.

"Those were the days (before 1970) when players weren't getting water," Mueller said. "People thought that if you don't give water, it made kids tougher. It made them tougher, but it also killed more of them."

In an ideal world, high school football players would have the same amenities at practices that NFL players do, said Dr. Matthew Matava, medical director of the Rams and co-chief of sports medicine at Washington University.

He rattled off a list of those amenities, which include a ready supply of sports drinks with electrolytes, tents with misting fans, an ice pool and several doctors and athletic trainers on hand, closely monitoring every player at every moment.

After practice, trainers check players' urine to make sure it's not too concentrated or diluted and give dehydrated players intravenous fluids.

They've been doing the latter several times a day recently, said Matava. They also weigh each player before and after every practice.

"If a player is more than 3 percent off (in weight), he's not allowed to go back to practice until he's replenished it," Matava said. "But that depends on the diligence of the coaches and athletic trainers to weigh 50 or 60 kids before and after every practice."

It's just not feasible at the high school level, Matava said. But he does recommend that high school players weigh themselves before and after practice each day and drink 1 pint of fluid for every pound lost or until their urine is clear.

They should also steer clear of caffeine and alcohol, which are diuretics.

As for food, carbohydrates are every bit as important as protein, because they hold on to water and provide much needed energy.

During practice, Matava recommends drinking 8 ounces of fluid every 15 minutes and removing helmets when not running drills that involve impact.

At the Vianney practice, monitoring and administering to overheated players was left to Chamness, who works for PRO-Rehab, a sports medicine company.

Chamness stopped several times to either cut towels in half so she wouldn't run out, or to check the temperature and heat index on her smart phone.

At 10:30, the end of morning practice, the heat index was 95 degrees.

Chamness shook her head and smiled: "They're going to have to practice inside this afternoon."

Later, she reported that the team went ahead with the noon practice outdoors after all but at a lower intensity and without pads or helmets.