Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes

ObjectivesTo adapt key components of exertional heat stroke (EHS) prehospital management proposed by the Intenational Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 so that it is applicable for the Paralympic athletes.MethodsAn expert working group representing members with research, clinical and lived sports experience from a Para sports perspective reviewed and revised the IOC consensus document of current best practice regarding the prehospital management of EHS.ResultsSimilar to Olympic competitions, Paralympic competitions are also scheduled under high environmental heat stress; thus, policies and procedures for EHS prehospital management should also be established and followed. For Olympic athletes, the basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. Although these principles also apply for Paralympic athletes, slight differences related to athlete physiology (eg, autonomic dysfunction) and mechanisms for hands-on management (eg, transferring the collapsed athlete or techniques for whole-body cooling) may require adaptation for care of the Paralympic athlete.ConclusionsPrehospital management of EHS in the Paralympic setting employs the same procedures as for Olympic athletes with some important alterations.

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Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-103854 ◽

2021 ◽

pp. bjsports-2020-103854

Author(s):

Yuri Hosokawa ◽

Sebastien Racinais ◽

Takao Akama ◽

David Zideman ◽

Richard Budgett ◽

...

Keyword(s):

Rectal Temperature ◽

Working Group ◽

Olympic Games ◽

Heat Stroke ◽

International Olympic Committee ◽

Exertional Heat Stroke ◽

Weather Impact ◽

Prehospital Management ◽

Adverse Weather ◽

Expert Working Group

ObjectivesThis document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management.MethodsMembers of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management.ResultsSports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site.ConclusionsA coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

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Exertional Heat Illness: Emerging Concepts and Advances in Prehospital Care

Prehospital and Disaster Medicine ◽

10.1017/s1049023x15004628 ◽

2015 ◽

Vol 30 (3) ◽

pp. 297-305 ◽

Cited By ~ 13

Author(s):

Riana R. Pryor ◽

Ronald N. Roth ◽

Joe Suyama ◽

David Hostler

Keyword(s):

Heat Stress ◽

Prehospital Care ◽

Water Immersion ◽

Heat Stroke ◽

Case Series ◽

Whole Body ◽

Heat Illness ◽

Publication Type ◽

Exertional Heat Stroke ◽

Exertional Heat Illness

AbstractExertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. Although evidence is available primarily from case series and healthy volunteer studies, the consensus for treating exertional heat illness, coupled with altered mental status, is whole body rapid cooling. Cold or ice water immersion remains the most effective treatment to achieve this goal. External thermometry is unreliable in the context of heat stress and direct internal temperature measurement by rectal or esophageal probes must be used when diagnosing heat illness and during cooling. With rapid recognition and implementation of effective cooling, most patients suffering from exertional heat stroke will recover quickly and can be discharged home with instructions to rest and to avoid heat stress and exercise for a minimum of 48 hours; although, further research pertaining to return to activity is warranted.PryorRR,RothRN,SuyamaJ,HostlerD.Exertional heat illness: emerging concepts and advances in prehospital care.Prehosp Disaster Med.2015;30(3):19.

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Roundtable on Preseason Heat Safety in Secondary School Athletics: Prehospital Care of Patients With Exertional Heat Stroke

Journal of Athletic Training ◽

10.4085/1062-6050-0173.20 ◽

2020 ◽

Author(s):

Kevin C. Miller ◽

Douglas J. Casa ◽

William M. Adams ◽

Yuri Hosokawa ◽

Jason Cates ◽

...

Keyword(s):

Secondary School ◽

Best Practice ◽

Cold Water ◽

Early Recognition ◽

Prehospital Care ◽

Water Immersion ◽

Heat Stroke ◽

School Setting ◽

Exertional Heat Stroke ◽

Prehospital Management

Objective First, we will update recommendations for the prehospital management and care of patients with exertional heat stroke (EHS) in the secondary school setting. Second, we provide action items to aid clinicians in developing best-practice documents and policies for EHS. Third, we provide practical strategies clinicians can use to implement best practice for EHS in the secondary school setting. Data Sources An interdisciplinary work group of scientists, physicians, and athletic trainers evaluated the current literature regarding the prehospital care of EHS patients in secondary schools and developed this narrative review. When published research was nonexistent, expert opinion and experience guided the development of recommendations for implementing life-saving strategies. The workgroup evaluated and further refined the action-oriented recommendations using the Delphi method. Conclusions Exertional heat stroke continues to be a leading cause of sudden death in young athletes and the physically active. This may be partly due to the numerous barriers and misconceptions about the best practice for diagnosing and treating patients with EHS. Exertional heat stroke is survivable if it is recognized early and appropriate measures are taken before patients are transported to hospitals for advanced medical care. Specifically, best practice for EHS evaluation and treatment includes early recognition of athletes with potential EHS, a rectal temperature measurement to confirm EHS, and cold-water immersion before transport to a hospital. With planning, communication, and persistence, clinicians can adopt these best-practice recommendations to aid in the recognition and treatment of patients with EHS in the secondary school setting.

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Cooling Effectiveness of a Modified Cold-Water Immersion Method After Exercise-Induced Hyperthermia

Journal of Athletic Training ◽

10.4085/1062-6050-51.12.07 ◽

2016 ◽

Vol 51 (11) ◽

pp. 946-951 ◽

Cited By ~ 22

Author(s):

Katherine E. Luhring ◽

Cory L. Butts ◽

Cody R. Smith ◽

Jeffrey A. Bonacci ◽

Ramon C. Ylanan ◽

...

Keyword(s):

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Effect Size ◽

Cold Water ◽

Water Immersion ◽

Heat Stroke ◽

Cold Water Immersion ◽

Whole Body ◽

Exertional Heat Stroke

Context: Recommended treatment for exertional heat stroke includes whole-body cold-water immersion (CWI). However, remote locations or monetary or spatial restrictions can challenge the feasibility of CWI. Thus, the development of a modified, portable CWI method would allow for optimal treatment of exertional heat stroke in the presence of these challenges. Objective: To determine the cooling rate of modified CWI (tarp-assisted cooling with oscillation [TACO]) after exertional hyperthermia. Design: Randomized, crossover controlled trial. Setting: Environmental chamber (temperature = 33.4°C ± 0.8°C, relative humidity = 55.7% ± 1.9%). Patients or Other Participants: Sixteen volunteers (9 men, 7 women; age = 26 ± 4.7 years, height = 1.76 ± 0.09 m, mass = 72.5 ± 9.0 kg, body fat = 20.7% ± 7.1%) with no history of compromised thermoregulation. Intervention(s): Participants completed volitional exercise (cycling or treadmill) until they demonstrated a rectal temperature (Tre) ≥39.0°C. After exercise, participants transitioned to a semirecumbent position on a tarp until either Tre reached 38.1°C or 15 minutes had elapsed during the control (no immersion [CON]) or TACO (immersion in 151 L of 2.1°C ± 0.8°C water) treatment. Main Outcome Measure(s): The Tre, heart rate, and blood pressure (reported as mean arterial pressure) were assessed precooling and postcooling. Statistical analyses included repeated-measures analysis of variance with appropriate post hoc t tests and Bonferroni correction. Results: Before cooling, the Tre was not different between conditions (CON: 39.27°C ± 0.26°C, TACO: 39.30°C ± 0.39°C; P = .62; effect size = −0.09; 95% confidence interval [CI] = −0.2, 0.1). At postcooling, the Tre was decreased in the TACO (38.10°C ± 0.16°C) compared with the CON condition (38.74°C ± 0.38°C; P < .001; effect size = 2.27; 95% CI = 0.4, 0.9). The rate of cooling was greater during the TACO (0.14 ± 0.06°C/min) than the CON treatment (0.04°C/min ± 0.02°C/min; t15 = −8.84; P < .001; effect size = 2.21; 95% CI = −0.13, −0.08). These differences occurred despite an insignificant increase in fluid consumption during exercise preceding CON (0.26 ± 0.29 L) versus TACO (0.19 ± 0.26 L; t12 = 1.73; P = .11; effect size = 0.48; 95% CI = −0.02, 0.14) treatment. Decreases in heart rate did not differ between the TACO and CON conditions (t15 = −1.81; P = .09; effect size = 0.45; 95% CI = −22, 2). Mean arterial pressure was greater at postcooling with TACO (84.2 ± 6.6 mm Hg) than with CON (67.0 ± 9.0 mm Hg; P < .001; effect size = 2.25; 95% CI = 13, 21). Conclusions: The TACO treatment provided faster cooling than did the CON treatment. When location, monetary, or spatial restrictions are present, TACO represents an effective alternative to traditional CWI in the emergency treatment of patients with exertional hyperthermia.

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Consensus Statement- Prehospital Care of Exertional Heat Stroke

Prehospital Emergency Care ◽

10.1080/10903127.2017.1392666 ◽

2018 ◽

Vol 22 (3) ◽

pp. 392-397 ◽

Cited By ~ 37

Author(s):

Luke N. Belval ◽

Douglas J. Casa ◽

William M. Adams ◽

George T. Chiampas ◽

Jolie C. Holschen ◽

...

Keyword(s):

Consensus Statement ◽

Prehospital Care ◽

Heat Stroke ◽

Exertional Heat Stroke

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A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

Case Reports in Emergency Medicine ◽

10.1155/2020/8724285 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Bertram K. Woitok ◽

Shawki Bahmad ◽

Gregor Lindner

Keyword(s):

Supportive Care ◽

Liver Failure ◽

Acute Liver Failure ◽

Multiorgan Failure ◽

Heat Stroke ◽

Exertional Heat Stroke ◽

Hypoxic Hepatitis ◽

Threatening Condition ◽

Life Threatening ◽

Delayed Referral

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10 km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

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Author Correction: Placebo use and unblinding in COVID-19 vaccine trials: recommendations of a WHO Expert Working Group

Nature Medicine ◽

10.1038/s41591-021-01360-3 ◽

2021 ◽

Author(s):

Jerome Amir Singh ◽

◽

Sonali Kochhar ◽

Jonathan Wolff

Keyword(s):

Working Group ◽

Vaccine Trials ◽

Expert Working Group

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Exertional Heat Stroke Knowledge and Management among Emergency Medical Service Providers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18095016 ◽

2021 ◽

Vol 18 (9) ◽

pp. 5016

Author(s):

Rebecca Hirschhorn ◽

Oluwagbemiga DadeMatthews ◽

JoEllen Sefton

Keyword(s):

Service Providers ◽

Heat Stroke ◽

The United States ◽

Knowledge Assessment ◽

Years Of Experience ◽

Exertional Heat Stroke ◽

Emergency Medical ◽

Previously Treated ◽

Stroke Knowledge ◽

Cooling Methods

This study evaluated emergency medical services (EMS) providers’ knowledge of exertional heat stroke (EHS) and assessed current EMS capabilities for recognizing and managing EHS. EMS providers currently practicing in the United States were recruited to complete a 25-item questionnaire. There were 216 questionnaire responses (183 complete) representing 28 states. On average, respondents were 42.0 ± 13.0 years old, male (n = 163, 75.5%), and white (n = 176, 81.5%). Most respondents were Paramedics (n = 110, 50.9%) and had ≥16 years of experience (n = 109/214, 50.9%) working in EMS. Fifty-five percent (n = 99/180) of respondents had previously treated a patient with EHS. The average number of correct answers on the knowledge assessment was 2.6 ± 1.2 out of 7 (~37% correct). Temporal (n = 79), tympanic (n = 76), and oral (n = 68) thermometers were the most prevalent methods of temperature assessment available. Chemical cold packs (n = 164) and air conditioning (n = 134) were the most prevalent cooling methods available. Respondents demonstrated poor knowledge regarding EHS despite years of experience, and over half stating they had previously treated EHS in the field. Few EMS providers reported having access to an appropriate method of assessing or cooling a patient with EHS. Updated, evidence-based training needs to be provided and stakeholders should ensure their EMS providers have access to appropriate equipment.

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