scholarly journals An Exertional Heat Stroke Survivor’s Return to Running: An Integrated Approach on Treatment, Recovery, and Return to Activity

2016 ◽  
Vol 25 (3) ◽  
pp. 280-287 ◽  
Author(s):  
William M. Adams ◽  
Yuri Hosokawa ◽  
Robert A. Huggins ◽  
Stephanie M. Mazerolle ◽  
Douglas J. Casa
Keyword(s):  
Best Practices ◽  
Heat Stroke ◽  
Predisposing Factors ◽  
Hydration Status ◽  
Evidence Based ◽  
Exertional Heat Stroke ◽  
Warm Weather ◽  
Road Race ◽  
Return To Activity

Context:Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS.Objective:To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race.Design:Case study.Setting:Warm-weather road race.Participant:53-y-old recreationally active man.Intervention:A runner’s treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance.Main Outcomes:Runner’s perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity.Results:The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner’s EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner’s return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident.Conclusions:This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

scholarly journals Incidence of Recurrent Exertional Heat Stroke in a Warm-Weather Road Race

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 720
Author(s):  
Rebecca L. Stearns ◽  
Yuri Hosokawa ◽  
William M. Adams ◽  
Luke N. Belval ◽  
Robert A. Huggins ◽  
...  
Keyword(s):  
Relative Risk ◽  
Risk Ratio ◽  
Heat Stroke ◽  
Case Series ◽  
Relative Risk Ratio ◽  
Future Research ◽  
Exertional Heat Stroke ◽  
Warm Weather ◽  
Before And After ◽  
Road Race

Background and Objectives: Exertional heat stroke (EHS) survivors may be more susceptible to subsequent EHS; however, the occurrence of survivors with subsequent EHS episodes is limited. Therefore, the purpose of this study was to evaluate the incidence of participants with repeated EHS (EHS-2+) cases in a warm-weather road race across participation years compared to those who experienced 1 EHS (EHS-1). Materials and Methods: A retrospective observational case series design was utilized. Medical record data from 17-years at the Falmouth Road Race between 2003–2019 were examined for EHS cases. Incidence of EHS-2+ cases per race and average EHS cases per EHS-2+ participant were calculated (mean ± SD) and descriptive factors (rectal temperature (TRE), finish time (FT), Wet Bulb Globe Temperature (WBGT), age, race year) for each EHS was collected. Results: A total of 333 EHS patients from 174,853 finishers were identified. Sixteen EHS-2+ participants (11 males, 5 females, age = 39 ± 16 year) accounted for 11% of the total EHS cases (n = 37/333). EHS-2+ participants had an average of 2.3 EHS cases per person (range = 2–4) and had an incidence rate of 2.6 EHS per 10 races. EHS-2+ participants finished 93 races following initial EHS, with 72 of the races (77%) completed without EHS incident. Initial EHS TRE was not statistically different than subsequent EHS initial TRE (+0.3 ± 0.9 °C, p > 0.050). Initial EHS-2+ participant FT was not statistically different than subsequent EHS FT (−4.2 ± 7.0 min, p > 0.050). The years between first and second EHS was 3.6 ± 3.5 year (Mode: 1, Range: 1–12). Relative risk ratios revealed that EHS patients were at a significantly elevated risk for subsequent EHS episodes 2 years following their initial EHS (relative risk ratio = 3.32, p = 0.050); however, the risk from 3–5 years post initial EHS was not statistically elevated, though the relative risk ratio values remained above 1.26. Conclusions: These results demonstrate that 11% of all EHS cases at the Falmouth Road Race are EHS-2+ cases and that future risk for a second EHS episode at this race is most likely to occur within the first 2 years following the initial EHS incident. After this initial 2-year period, risk for another EHS episode is not significantly elevated. Future research should examine factors to explain individuals who are susceptible to multiple EHS cases, incidence at other races and corresponding prevention strategies both before and after initial EHS.

Recovery and Return to Activity Following Exertional Heat Stroke: Considerations for the Sports Medicine Staff

2007 ◽  
Vol 16 (3) ◽  
pp. 163-181 ◽  
Author(s):  
Brendon P. McDermott ◽  
Douglas J. Casa ◽  
Susan W. Yeargin ◽  
Matthew S. Ganio ◽  
Lawrence E. Armstrong ◽  
...  
Keyword(s):  
Data Extraction ◽  
Heat Stroke ◽  
Data Sources ◽  
Exertional Heat Stroke ◽  
Data Synthesis ◽  
Residual Symptoms ◽  
Study Selection ◽  
Initial Care ◽  
Type Data ◽  
Return To Activity

Objective:To describe the current scientific evidence of recovery and return to activity following exertional heat stroke (EHS).Data Sources:Information was collected using MEDLINE and SPORTDiscus databases in English using combinations of key words, exertional heat stroke, recovery, rehabilitation, residual symptoms, heat tolerance, return to activity, and heat illness.Study Selection:Relevant peer-reviewed, military, and published text materials were reviewed.Data Extraction:Inclusion criteria were based on the article’s coverage of return to activity, residual symptoms, or testing for long-term treatment. Fifty-two out of the original 554 sources met these criteria and were included in data synthesis.Data Synthesis:The recovery time following EHS is dependent on numerous factors, and recovery length is individually based and largely dependent on the initial care provided.Conclusion:Future research should focus on developing a structured return-to-activity strategy following EHS.

Effectiveness of Cold Water Immersion in the Treatment of Exertional Heat Stroke at the Falmouth Road Race

2015 ◽  
Vol 47 (2) ◽  
pp. 240-245 ◽  
Author(s):  
JULIE K. DEMARTINI ◽  
DOUGLAS J. CASA ◽  
REBECCA STEARNS ◽  
LUKE BELVAL ◽  
ARTHUR CRAGO ◽  
...  
Keyword(s):  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Exertional Heat Stroke ◽  
Road Race

scholarly journals Promoting Best Practices Regarding Exertional Heat Stroke: A Perspective from the Team Physician

2012 ◽  
Vol 7 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Stephanie M. Mazerolle ◽  
Kelly D. Pagnotta ◽  
Lindsey McDowell ◽  
Douglas J Casa ◽  
Lawrence Armstrong
Keyword(s):  
Professional Development ◽  
Best Practices ◽  
Sports Medicine ◽  
Water Immersion ◽  
Skill Training ◽  
Heat Stroke ◽  
Real Life ◽  
Assessment Tools ◽  
Team Physician ◽  
Exertional Heat Stroke

Context: Knowing the team physician's perspective regarding the use of evidence-based practice (EBP) for treatment of exertional heat stroke (EHS) may help increase the number of athletic trainers (ATs) implementing best practices and avoiding the use of improper assessment tools and treatment methods. Objective: To ascertain team physicians' perspectives regarding the AT's use of rectal temperature (Tre) and cold-water immersion (CWI) for recognition and treatment of EHS. Design: Exploratory study using semi-structured focus groups and follow-up telephone interviews. Setting: American College of Sports Medicine Annual meeting. Patients or Other Participants: Thirteen family or internal medicine specialists who were currently serving as the team physician for a college/university or secondary school participated. The mean age was 44 ± 4 with 10 ± 8 years of sports medicine specific experience. Of these, 7 participated in a focus group and 5 completed a telephone interview. Data Collection and Analysis: Data analysis included open coding procedures by a 3-member research team. Credibility was established by member checks and multiple analyst triangulations. Results: Two major themes emerged regarding how ATs could be encouraged to use Tre assessment and CWI in clinical practice: 1) pre-certification and 2) post-certification. Pre-certification included two lower level themes: a) real-life experience and b) skill set mandate. The post-certification theme included one lower theme: professional development. Conclusion: Physicians, in recognition of the dichotomy between best and actual practices, believe that ATs must receive both formal skill training in a structured learning environment and field experience using these methods, and remain current through annual professional development seminars and courses.

scholarly journals Environmental Conditions and the Occurrence of Exertional Heat Illnesses and Exertional Heat Stroke at the Falmouth Road Race

2014 ◽  
Vol 49 (4) ◽  
pp. 478-485 ◽  
Author(s):  
Julie K. DeMartini ◽  
Douglas J. Casa ◽  
Luke N. Belval ◽  
Arthur Crago ◽  
Rob J. Davis ◽  
...  
Keyword(s):  
Relative Humidity ◽  
Environmental Conditions ◽  
Heat Stroke ◽  
Epidemiologic Study ◽  
Treatment Strategies ◽  
Heat Index ◽  
Exertional Heat Stroke ◽  
Road Race ◽  
Relationship Of ◽  
Environmental Temperatures

Context: The Falmouth Road Race is unique because of the environmental conditions and relatively short distance, which allow runners to maintain a high intensity for the duration of the event. Therefore, the occurrence of exertional heat illnesses (EHIs), especially exertional heat stroke (EHS), is 10 times higher than in other races. Objective: To summarize the occurrence and relationship of EHI and environmental conditions at the Falmouth Road Race. Design: Descriptive epidemiologic study. Setting: An 11.3-km (7-mile) road race in Falmouth, Massachusetts. Patients or Other Participants: Runners who sustained an EHI while participating in the Falmouth Road Race. Main Outcome Measure(s): We obtained 18 years of medical records and environmental conditions from the Falmouth Road Race and documented the incidence of EHI, specifically EHS, as related to ambient temperature (Tamb), relative humidity, and heat index (HI). Results: Average Tamb, relative humidity, and HI were 23.3 ± 2.5°C, 70 ± 16%, and 24 ± 3.5°C, respectively. Of the 393 total EHI cases observed, EHS accounted for 274 (70%). An average of 15.2 ± 13.0 EHS cases occurred each year; the incidence was 2.13 ± 1.62 cases per 1000 runners. Regression analysis revealed a relationship between the occurrence of both EHI and EHS and Tamb (R2 = 0.71, P = .001, and R2 = 0.65, P = .001, respectively) and HI (R2 = 0.76, P < .001, and R2 = 0.74, P < .001, respectively). Occurrences of EHS (24.2 ± 15.5 cases versus 9.3 ± 4.3 cases) and EHI (32.3 ± 16.3 versus 13.0 ± 4.9 cases) were higher when Tamb and HI were high compared with when Tamb and HI were low. Conclusions: Because of the environmental conditions and race duration, the Falmouth Road Race provides a unique setting for a high incidence of EHS. A clear relationship exists between environmental stress, especially as measured by Tamb and HI, and the occurrence of EHS or other EHI. Proper prevention and treatment strategies should be used during periods of high environmental temperatures as the likelihood of runners experiencing EHS is exacerbated in these harsh conditions.

scholarly journals Evidence-Based Practice and the Recognition and Treatment of Exertional Heat Stroke, Part I: A Perspective From the Athletic Training Educator

2011 ◽  
Vol 46 (5) ◽  
pp. 523-532 ◽  
Author(s):  
Stephanie M. Mazerolle ◽  
Roberto C. Ruiz ◽  
Douglas J. Casa ◽  
Kelly D. Pagnotta ◽  
Danielle E. Pinkus ◽  
...  
Keyword(s):  
Public Opinion ◽  
Athletic Training ◽  
Evidence Based Practice ◽  
Cold Water ◽  
Athletic Trainers ◽  
Water Immersion ◽  
Heat Stroke ◽  
Evidence Based ◽  
Educational Training ◽  
Exertional Heat Stroke

Context: Athletic trainers (ATs) know to diagnose exertional heat stroke (EHS) via rectal thermometry (Tre) and to treat EHS via cold-water immersion (CWI) but do not implement these recommendations in clinical practice. Objective: To gain an understanding of educational techniques used to deliver content regarding EHS. Design: Qualitative study. Setting: In-person focus groups at the National Athletic Trainers' Association (NATA) Annual Meeting in June 2009 and 2 follow-up telephone interviews to confirm emergent themes. Patients or Other Participants: Thirteen AT educators (11 men, 2 women) from programs accredited by the Commission on Accreditation of Athletic Training Education, with an average of 22 ± 9 years of clinical experience and 16 ± 10 years of experience as educators. Five NATA districts were represented. Data Collection and Analysis: Data were analyzed using inductive content analysis. Peer review and data source triangulation also were conducted to establish trustworthiness. Results: Four themes emerged from the analysis: educational techniques, educational competencies, previous educational training, and privacy/public opinion. Educational techniques highlighted the lack of hands-on training for Tre and CWI. Educational competencies referred to the omission of Tre and CWI as psychomotor skills. Previous educational training addressed educators not having the skills or comfort with the skills necessary to properly educate students. Privacy/public opinion comprised external inputs from various groups (parents and coaches), legal considerations, and social bias. Conclusions: Educators supplied students with the appropriate didactic knowledge about EHS, but their lack of training and misgivings about Tre prevented them from allowing students to gain competence with this skill. Until the NATA competencies state the need to teach Tre and CWI and until educators are provided with their own learning opportunities, evidence-based practice regarding EHS will be lacking.

scholarly journals Age- and Sex-Based Differences in Exertional Heat Stroke Incidence in a 7-Mile Road Race

2020 ◽  
Vol 55 (12) ◽  
pp. 1224-1229
Author(s):  
Luke N. Belval ◽  
Gabrielle E.W. Giersch ◽  
William M. Adams ◽  
Yuri Hosokawa ◽  
John F. Jardine ◽  
...  
Keyword(s):  
Heat Stroke ◽  
Age Groups ◽  
Medical Personnel ◽  
Reference Population ◽  
Exertional Heat Stroke ◽  
Stroke Incidence ◽  
Relative Contribution ◽  
Epidemiologic Evidence ◽  
Road Race ◽  
Globe Temperature

Context Sex, age, and wet-bulb globe temperature (WBGT) have been proposed risk factors for exertional heat stroke (EHS) despite conflicting laboratory and epidemiologic evidence. Objective To examine differences in EHS incidence while accounting for sex, age, and environmental conditions. Design Observational study. Setting Falmouth Road Race, a warm-weather 7-mi (11.26-km) running road race. Patients or Other Participants We reviewed records from patients treated for EHS at medical tents. Main Outcome Measure(s) The relative risk (RR) of EHS between sexes and across ages was assessed with males as the reference population. Multivariate linear regression analyses were calculated to determine the relative contribution of sex, age, and WBGT to the incidence of EHS. Results Among 343 EHS cases, the female risk of EHS was lower overall (RR = 0.71; 95% confidence interval [CI] = 0.58, 0.89; P = .002) and for age groups 40 to 49 years (RR = 0.43; 95% CI = 0.24, 0.77; P = .005) and 50 to 59 years (RR = 0.31; 95% CI = 0.13, 0.72; P = .005). The incidence of EHS did not differ between sexes in relation to WBGT (P > .05). When sex, age, and WBGT were considered in combination, only age groups <14 years (β = 2.41, P = .008), 15 to 18 years (β = 3.83, P < .001), and 19 to 39 years (β = 2.24, P = .014) significantly accounted for the variance in the incidence of EHS (R2 = .10, P = .006). Conclusions In this unique investigation of EHS incidence in a road race, we found a 29% decreased EHS risk in females compared with males. However, when sex was considered with age and WBGT, only younger age accounted for an increased incidence of EHS. These results suggest that road race medical organizers should consider participant demographics when organizing the personnel and resources needed to treat patients with EHS. Specifically, organizers of events with greater numbers of young runners (aged 19 to 39 years) and males should prioritize ensuring that medical personnel are adequately prepared to handle patients with EHS.

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