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.

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

2012 ◽  
Vol 7 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Stephanie Mazerolle ◽  
Kelly Pagnotta ◽  
Lindsey McDowell ◽  
Douglas Casa ◽  
Lawrence Armstrong
Keyword(s):  
Best Practices ◽  
Heat Stroke ◽  
Team Physician ◽  
Exertional Heat Stroke

American College of Sports Medicine Roundtable on Exertional Heat Stroke - Return to Duty/Return to Play

2010 ◽  
Vol 9 (5) ◽  
pp. 314-321 ◽  
Author(s):  
Francis G. O'Connor ◽  
Douglas J. Casa ◽  
Michael F. Bergeron ◽  
Robert Carter ◽  
Patricia Deuster ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Heat Stroke ◽  
Return To Play ◽  
Exertional Heat Stroke ◽  
Return To Duty

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

Exertional Heat Illness: Emerging Concepts and Advances in Prehospital Care

2015 ◽  
Vol 30 (3) ◽  
pp. 297-305 ◽  
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.

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 Emergency Medical Service Directors’ Protocols for Exertional Heat Stroke

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 494
Author(s):  
Michael R. Szymanski ◽  
Samantha E. Scarneo-Miller ◽  
M. Seth Smith ◽  
Michelle L. Bruner ◽  
Douglas J. Casa
Keyword(s):  
Best Practices ◽  
Emergency Medical Service ◽  
Best Practice ◽  
Medical Service ◽  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Athletic Trainer ◽  
Chi Squared

Background and Objectives: Emergency Medical Service (EMS) protocols vary widely and may not implement best practices for exertional heat stroke (EHS). EHS is 100% survivable if best practices are implemented within 30 min. The purpose of this study is to compare EMS protocols to best practices for recognizing and treating EHS. Materials and Methods: Individuals (n = 1350) serving as EMS Medical or Physician Director were invited to complete a survey. The questions related to the EHS protocols for their EMS service. 145 individuals completed the survey (response rate = 10.74%). Chi-Squared Tests of Associations (χ2) with 95% confidence intervals (CI) were calculated. Prevalence ratios (PR) with 95% CI were calculated to determine the prevalence of implementing best practices based on location, working with an athletic trainer, number of EHS cases, and years of directing. All PRs whose 95% CIs excluded 1.00 were considered statistically significant; Chi-Squared values with p values < 0.05 were considered statistically significant. Results: A majority of the respondents reported not using rectal thermometry for the diagnosis of EHS (n = 102, 77.93%) and not using cold water immersion for the treatment of EHS (n = 102, 70.34%). If working with an athletic trainer, EMS is more likely to implement best-practice treatment (i.e., cold-water immersion and cool-first transport-second) (69.6% vs. 36.9%, χ2 = 8.480, p < 0.004, PR = 3.15, 95% CI = 1.38, 7.18). Conclusions: These findings demonstrate a lack of implementation of best-practice standards for EHS by EMS. Working with an athletic trainer appears to increase the likelihood of following best practices. Efforts should be made to improve EMS providers’ implementation of best-practice standards for the diagnosis and management of EHS to optimize patient outcomes.

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

2016 ◽  
Vol 51 (11) ◽  
pp. 946-951 ◽  
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 &lt; .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 &lt; .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 &lt; .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.

Can Temperate-Water Immersion Effectively Reduce Rectal Temperature in Exertional Heat Stroke? A Critically Appraised Topic

2017 ◽  
Vol 26 (5) ◽  
pp. 447-451 ◽  
Author(s):  
Tyler T. Truxton ◽  
Kevin C. Miller
Keyword(s):  
Rectal Temperature ◽  
Water Immersion ◽  
Heat Stroke ◽  
Medical Emergency ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Temperate Water ◽  
Bottom Line ◽  
Exertional Heat Stroke ◽  
Cooling Rates

Clinical Scenario:Exertional heat stroke (EHS) is a medical emergency which, if left untreated, can result in death. The standard of care for EHS patients includes confirmation of hyperthermia via rectal temperature (Trec) and then immediate cold-water immersion (CWI). While CWI is the fastest way to reduce Trec, it may be difficult to lower and maintain water bath temperature in the recommended ranges (1.7°C–15°C [35°F–59°F]) because of limited access to ice and/or the bath being exposed to high ambient temperatures for long periods of time. Determining if Trec cooling rates are acceptable (ie, >0.08°C/min) when significantly hyperthermic humans are immersed in temperate water (ie, ≥20°C [68°F]) has applications for how EHS patients are treated in the field.Clinical Question:Are Trec cooling rates acceptable (≥0.08°C/min) when significantly hyperthermic humans are immersed in temperate water?Summary of Findings:Trec cooling rates of hyperthermic humans immersed in temperate water (≥20°C [68°F]) ranged from 0.06°C/min to 0.19°C/min. The average Trec cooling rate for all examined studies was 0.11±0.06°C/min.Clinical Bottom Line:Temperature water immersion (TWI) provides acceptable (ie, >0.08°C/min) Trec cooling rates for hyperthermic humans post-exercise. However, CWI cooling rates are higher and should be used if feasible (eg, access to ice, shaded treatment areas).Strength of Recommendation:The majority of evidence (eg, Level 2 studies with PEDro scores ≥5) suggests TWI provides acceptable, though not ideal, Trec cooling. If possible, CWI should be used instead of TWI in EHS scenarios.

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.

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