Exertional heat illness (EHI) is a leading cause of preventable death among student athletes. While causes and preventative measures for EHI are known, school districts may not be implementing evidence-based practices. This descriptive, exploratory study explored school policies, resources, and practices of coaches in a mid-Atlantic state in the prevention and identification of EHI; 397 responded. Ninety-three percent knew of EHI, but only 52% scheduled acclimatization. Coaches reporting a heat emergency plan (56%) were significantly more likely to follow other evidence-based recommendations: altering equipment (p < 0.0001, odds ratio [OR] = 2.53), monitoring environment (p < 0.0001, OR = 2.56), providing acclimatization (p < 0.0001, OR = 2.50), having athletic trainers at practices (p < 0.0001, OR = 4.75), and believed that they could handle the emergency until EMS arrival (p < 0.001, OR = 2.48). School districts should comply with evidence-based guidelines. School nurses play a key role in education, developing emergency plans and training coaches in first aid.