Suspected RED-S or Low Energy Availability

Fatigue, recurrent injury or illness, food restriction, mood change, or declining training tolerance begins to cluster in any runner.

Recognize

What to notice before you act

1/5

The situation

Fatigue, recurrent injury or illness, food restriction, mood change, or declining training tolerance begins to cluster in any runner.

Observable signs and patterns

Several changes occur together rather than one isolated bad day.
Performance declines despite continued effort.
Injury, illness, recovery, sleep, mood, or food behaviors change.
The athlete expresses pressure to become lighter or eat less.

May be routine

A short performance dip with a clear, resolving cause.
Normal day-to-day appetite and training variation without a pattern.

Needs attention

Multiple signs persist or worsen.
There is recurrent bone pain, fainting, intentional restriction, purging, menstrual disruption with other underfueling signs, or marked male reproductive/endocrine symptoms disclosed to a clinician.

Coach boundary: Coach scope is observe, protect, communicate, and refer. Do not diagnose, order testing, prescribe treatment, promise confidentiality, store detailed health histories, or override the school emergency action plan or a qualified clinician's participation instructions. The IOC RED-S clinical assessment tool is for trained clinicians, not coach scoring or athlete self-diagnosis.

Respond

What to say and do today

2/5

Opening script

“I have noticed a pattern: your recovery and performance look different, and there have also been changes in injury, illness, or eating. I am not diagnosing the cause. I want to protect your health and involve the adults and clinicians who can evaluate it properly.”

Neutral questions to ask

1How long have you felt different from normal?
2Is fatigue present outside practice?
3Have injury, illness, sleep, mood, appetite, or eating patterns changed?
4Do you feel pressure to change your body or restrict food?
5Have you felt dizzy, faint, unusually short of breath, or had chest pain?
6Which parent, guardian, athletic trainer, or physician should we contact today?

Actions for today

Describe only the observable cluster and the athlete's report.
Reduce or stop the session when health or safe performance is in question.
Contact the parent or guardian and athletic trainer; a physician-led team determines evaluation and participation.

Do not do this

Do not calculate an athlete's RED-S score or diagnose RED-S.
Do not weigh the athlete, request food logs, or prescribe calories.
Do not frame the concern as discipline, toughness, or a girls-only issue.

Act

Green, yellow, and red decisions

3/5

Green · Single mild sign

One mild, short-lived change
No injury, restriction, or medical red flag

Monitor observable function and schedule a private check-in within 48 hours.

Yellow · Clustered or persistent

Two or more domains change
The pattern recurs, worsens, or includes bone pain or restriction

Involve the parent or guardian and athletic trainer promptly; request physician-led evaluation rather than coach screening.

Red · Immediate safety concern

Collapse, fainting, chest pain, confusion, severe shortness of breath, acute psychiatric danger, purging with acute illness, or inability to participate safely

Stop participation, stay with the athlete, activate the school's emergency action plan, and contact the parent or guardian through the approved process.

What happens to training

green: Use only ordinary coaching adjustments while monitoring the short-lived issue.
yellow: Do not increase load; follow written athletic-trainer or physician restrictions while evaluation is pending.
red: Stop participation and do not return the athlete that day without the authorized medical pathway.

Implement

Make the response repeatable

4/5

Implementation objective

Create an early, private observe-and-refer pathway for every sex without coach diagnosis.

Weekly routine

1.Train staff on observable signs.
2.Name the referral chain before the season.
3.Prohibit public weigh-ins and body commentary.
4.Review only participation information staff need to implement.

Resources needed

School emergency action plan
Private referral contact list
Parent communication template
Secure school documentation channel

Owner: Athletic director and athletic trainer own policy; coaches report observable concerns.
Cadence: Review staff roles preseason and after any referral event.
Cost and purchasing: No athlete screening purchase is required; budget for staff training and access to qualified clinical referral partners.

Who should be involved

Parent or guardian

A cluster is observed or health evaluation is needed.

Athletic trainer and physician

They lead medical assessment, risk classification, and participation decisions.

Sports RDN and mental-health professional

The clinician-led plan identifies nutrition or behavioral care needs.

Follow up and refer

Close the loop without becoming the clinician

5/5

Follow-up timing

Recheck within 24 to 48 hours and after every participation-plan update.

Questions to recheck

Was the parent or guardian reached?
Did the athletic trainer or physician evaluate the concern?
Are written restrictions clear?
Is the athlete protected from public discussion or body pressure?

How to know the response is working

The clinical team owns evaluation and care.
Staff follow one consistent participation plan.
Observable function improves without concealment or pressure.

Copy-ready parent message

We have observed a cluster of changes in recovery, performance, injury or illness, and eating-related behavior. We are not diagnosing RED-S. We recommend prompt evaluation through the athletic trainer and physician-led team and will follow written participation guidance.

Brief documentation template

Dates and observable changesExact athlete statements relevant to safetyTraining action takenParent and health contacts notifiedOnly the participation instructions staff need

Evidence and scope

Coach scope is observe, protect, communicate, and refer. Do not diagnose, order testing, prescribe treatment, promise confidentiality, store detailed health histories, or override the school emergency action plan or a qualified clinician's participation instructions. The IOC RED-S clinical assessment tool is for trained clinicians, not coach scoring or athlete self-diagnosis.

Open the paired athlete handout

This guide is general education for school sport operations. Follow current school policy, the venue-specific emergency action plan, safeguarding requirements, and written instructions from qualified health professionals.

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All coach protocols

Suspected RED-S or Low Energy Availability

Fatigue, recurrent injury or illness, food restriction, mood change, or declining training tolerance begins to cluster in any runner.

Recognize

What to notice before you act

1/5

The situation

Fatigue, recurrent injury or illness, food restriction, mood change, or declining training tolerance begins to cluster in any runner.

Observable signs and patterns

Several changes occur together rather than one isolated bad day.
Performance declines despite continued effort.
Injury, illness, recovery, sleep, mood, or food behaviors change.
The athlete expresses pressure to become lighter or eat less.

May be routine

A short performance dip with a clear, resolving cause.
Normal day-to-day appetite and training variation without a pattern.

Needs attention

Multiple signs persist or worsen.
There is recurrent bone pain, fainting, intentional restriction, purging, menstrual disruption with other underfueling signs, or marked male reproductive/endocrine symptoms disclosed to a clinician.

Respond

What to say and do today

2/5

Opening script

Neutral questions to ask

1How long have you felt different from normal?
2Is fatigue present outside practice?
3Have injury, illness, sleep, mood, appetite, or eating patterns changed?
4Do you feel pressure to change your body or restrict food?
5Have you felt dizzy, faint, unusually short of breath, or had chest pain?
6Which parent, guardian, athletic trainer, or physician should we contact today?

Actions for today

Describe only the observable cluster and the athlete's report.
Reduce or stop the session when health or safe performance is in question.
Contact the parent or guardian and athletic trainer; a physician-led team determines evaluation and participation.

Do not do this

Do not calculate an athlete's RED-S score or diagnose RED-S.
Do not weigh the athlete, request food logs, or prescribe calories.
Do not frame the concern as discipline, toughness, or a girls-only issue.

Act

Green, yellow, and red decisions

3/5

Green · Single mild sign

One mild, short-lived change
No injury, restriction, or medical red flag

Monitor observable function and schedule a private check-in within 48 hours.

Yellow · Clustered or persistent

Two or more domains change
The pattern recurs, worsens, or includes bone pain or restriction

Involve the parent or guardian and athletic trainer promptly; request physician-led evaluation rather than coach screening.

Red · Immediate safety concern

Collapse, fainting, chest pain, confusion, severe shortness of breath, acute psychiatric danger, purging with acute illness, or inability to participate safely

Stop participation, stay with the athlete, activate the school's emergency action plan, and contact the parent or guardian through the approved process.

What happens to training

green: Use only ordinary coaching adjustments while monitoring the short-lived issue.
yellow: Do not increase load; follow written athletic-trainer or physician restrictions while evaluation is pending.
red: Stop participation and do not return the athlete that day without the authorized medical pathway.

Implement

Make the response repeatable

4/5

Implementation objective

Create an early, private observe-and-refer pathway for every sex without coach diagnosis.

Weekly routine

1.Train staff on observable signs.
2.Name the referral chain before the season.
3.Prohibit public weigh-ins and body commentary.
4.Review only participation information staff need to implement.

Resources needed

School emergency action plan
Private referral contact list
Parent communication template
Secure school documentation channel

Owner: Athletic director and athletic trainer own policy; coaches report observable concerns.
Cadence: Review staff roles preseason and after any referral event.
Cost and purchasing: No athlete screening purchase is required; budget for staff training and access to qualified clinical referral partners.

Who should be involved

Parent or guardian

A cluster is observed or health evaluation is needed.

Athletic trainer and physician

They lead medical assessment, risk classification, and participation decisions.

Sports RDN and mental-health professional

The clinician-led plan identifies nutrition or behavioral care needs.

Follow up and refer

Close the loop without becoming the clinician

5/5

Follow-up timing

Recheck within 24 to 48 hours and after every participation-plan update.

Questions to recheck

Was the parent or guardian reached?
Did the athletic trainer or physician evaluate the concern?
Are written restrictions clear?
Is the athlete protected from public discussion or body pressure?

How to know the response is working

The clinical team owns evaluation and care.
Staff follow one consistent participation plan.
Observable function improves without concealment or pressure.

Copy-ready parent message

Brief documentation template

Dates and observable changesExact athlete statements relevant to safetyTraining action takenParent and health contacts notifiedOnly the participation instructions staff need

Evidence and scope

Open the paired athlete handout