For the second year running, no football player in the U.S. died of heat stroke last year, according to an annual survey of injuries among football players.

Despite the good news about heat stroke-related deaths, researchers report that three football players died after being injured on the field.

“It is important to follow the recommendations of the report in order to further reduce the number of deaths to football players,” Dr. Frederick O. Mueller of the University of North Carolina at Chapel Hill told Health News Online.

Mueller encouraged parents to find out how their child’s football program plans to prevent injuries among players.

Mueller, who is the chairman of the American Football Coaches Committee on Football Injuries, co-authored the report with Jerry L. Diehl, the assistant director of the National Federation of State High School Associations.

Last year was the second year in a row that there were no reported cases of heat stroke deaths among football players, but since 1995, 21 young football players have died of heat stroke.

“There is no excuse for any number of heat stroke deaths since they are all preventable with the proper precautions,” the report notes.

Athletes should be allowed to acclimate themselves to hot weather by gradually increasing the intensity of practices during the first week or so of the season or during unusually hot weather, Mueller and Diehl advise.

To prevent dehydration, players should always have cold water available and should be allowed to drink unlimited amounts of water during practice, according to the report.

Although no football player died of heat stroke last year, three players died after being injured in a game. The deaths included two high school athletes and one player in a youth league. Two players died of a direct injury to the brain, while the other died from an injury to an artery in his neck.

To prevent head and neck injuries, players should never be taught to use the helmet first when tackling or blocking, according to the report.

“Contact should always be made with the head up and never with the top of the head/helmet,” the authors note. “Initial contact should never be made with the head/helmet or face mask.”

Besides deaths that were directly related to football, seven players died from what were judged to be indirect causes such as heart-related conditions.

Besides the 10 players who died as a direct or indirect result of playing football, there were three additional deaths among football players, but these were not believed to related to the sport. For instance, two of the players died in their sleep.

Mueller and Diehl make several other recommendations in the report, including that athletes should undergo a medical exam before being allowed to participate.

If possible, a physician should be present at every practice or game, they advise.

In addition, rules should be strictly enforced to prevent risky behavior.

The report is prepared annually for the American Football Coaches Association, the National Collegiate Athletic Association and the National Federation of State High School Associations.