scholarly journals Evidence-Based Medicine and the Recognition and Treatment of Exertional Heat Stroke, Part II: A Perspective From the Clinical Athletic Trainer

2011 ◽  
Vol 46 (5) ◽  
pp. 533-542 ◽  
Author(s):  
Stephanie M. Mazerolle ◽  
Danielle E. Pinkus ◽  
Douglas J. Casa ◽  
Brendon P. McDermott ◽  
Kelly D. Pagnotta ◽  
...  
Keyword(s):  
High School ◽  
Clinical Setting ◽  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
School Setting ◽  
Cold Water Immersion ◽  
Comfort Level ◽  
Evidence Based ◽  
Exertional Heat Stroke

Context: Exertional heat stroke (EHS) is one of the leading causes of death in athletes. Certified athletic trainers (ATs) demonstrate strong knowledge of recommended practices with EHS but are apprehensive in implementing 2 basic procedures: rectal temperature assessment and cold water immersion. This apprehension might lead to deaths from EHS that could have been prevented. Objective: To investigate why collegiate and high school ATs do not implement best practices for the recognition and treatment of EHS. Design: Qualitative study. Setting: In-person focus groups consisting of 3 to 6 collegiate or high school ATs. Patients or Other Participants: A total of 19 ATs (9 men, 10 women; age = 36 ± 10 years, length of certification = 12 ± 9 years) employed at either the collegiate (n = 10) or high school (n = 9) level participated in the study. Data Collection and Analysis: Interviews were transcribed verbatim, and data were analyzed using deductive data analysis. Peer review and multiple-analyst data triangulation were conducted to establish trustworthiness of the data. Results: Five emergent themes explained the lack of evidence-based practice (EBP) regarding recognition and treatment of EHS. Three themes (lack of knowledge, comfort level, lack of initiative) were common in both the collegiate and high school settings, and 2 separate themes (liability concerns, lack of resources) were present in the high school setting. Conclusions: Our findings are consistent with those in the literature on EBP and EHS. Regardless of clinical setting, ATs have basic information on recognition and treatment of EHS, but 5 themes act as barriers to implementing proper management in the clinical setting. Workshops or hands-on training sessions need to be made available to improve students' comfort levels so ATs will implement EBP into everyday settings.

scholarly journals Proper Recognition and Management of Exertional Heat Stroke in a High School Cross Country Runner: A Validation Clinical Case Report

2021 ◽  
Author(s):  
Bryanna Garrett ◽  
Rebecca Lopez ◽  
Michael Szymanski ◽  
Drew Eidt
Keyword(s):  
High School ◽  
Cold Water ◽  
Action Plan ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Exertional Heat Stroke ◽  
Difficulty Breathing ◽  
History Of ◽  
Cross Country

A 14-year-old female high school cross country runner (height = 154 cm, mass = 48.1 kg) with no history of exertional heat stroke (EHS) collapsed at the end of a race. An athletic trainer (AT) assessed the patient, who presented with difficulty breathing then other signs of EHS (i.e. confusion, agitation). The patient was taken to the medical area, draped with a towel, and a rectal temperature (Tre) of 106.9°F(41.6°C) was obtained. The emergency action plan was activated and emergency medical services (EMS) were called. The patient was submerged in a cold-water immersion tub until EMS arrived (~15 minutes; Tre = 100.1°F; cooling rate: 0.41°F·min−1[0.25°C·min−1]). At the hospital, the patient received intravenous fluids, and urine and blood tests were normal. The patient was not admitted and returned to running without sequelae. Following best practices, AT's in secondary schools can prevent death from EHS by properly recognizing EHS and providing rapid cooling before transport.

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 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 < .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.

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 Current Knowledge, Attitudes, and Practices of Certified Athletic Trainers Regarding Recognition and Treatment of Exertional Heat Stroke

2010 ◽  
Vol 45 (2) ◽  
pp. 170-180 ◽  
Author(s):  
Stephanie M. Mazerolle ◽  
Ian C. Scruggs ◽  
Douglas J. Casa ◽  
Laura J. Burton ◽  
Brendon P. McDermott ◽  
...  
Keyword(s):  
Cold Water ◽  
Current Knowledge ◽  
Athletic Trainers ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Exertional Heat Stroke ◽  
Certified Athletic Trainers ◽  
Attitudes And Practices ◽  
Knowledge Attitudes And Practices

Abstract Context: Previous research has indicated that despite awareness of the current literature on the recommended prevention and care of exertional heat stroke (EHS), certified athletic trainers (ATs) acknowledge failure to follow those recommendations. Objective: To investigate the current knowledge, attitudes, and practices of ATs regarding the recognition and treatment of EHS. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: We obtained a random sample of e-mail addresses for 1000 high school and collegiate ATs and contacted these individuals with invitations to participate. A total of 498 usable responses were received, for a 25% response rate. Main Outcome Measure(s): The survey instrument evaluated ATs' knowledge and actual practice regarding EHS and included 29 closed-ended Likert scale questions (1  =  strongly disagree, 7  =  strongly agree), 2 closed-ended questions rated on a Likert scale (1  =  lowest value, 9  =  greatest value), 8 open-ended questions, and 7 demographic questions. We focused on the open-ended and demographic questions. Results: Although most ATs (77.1%) have read the current National Athletic Trainers' Association position statement on heat illness, only 18.6% used rectal thermometers to assess core body temperature to recognize EHS, and 49.7% used cold-water immersion to treat EHS. Athletic trainers perceived rectal thermometers as the most valid temperature assessment device when compared with other assessment devices (P ≤ .05), but they used oral thermometers as the primary assessment tool (49.1%). They identified cold-water immersion as the best cooling method (P ≤ .05), even though they used other means to cool a majority of the time (50.3%). Conclusions: The ATs surveyed have sound knowledge of the correct means of EHS recognition and treatment. However, a significant portion of these ATs reported using temperature assessment devices that are invalid with athletes exercising in the heat. Furthermore, they reported using cooling treatment methods that have inferior cooling rates.

Preventing Death from Exertional Heat Stroke—The Long Road from Evidence to Policy

2017 ◽  
Vol 6 (1) ◽  
pp. 99-109 ◽  
Author(s):  
Douglas J. Casa ◽  
Yuri Hosokawa ◽  
Luke N. Belval ◽  
William M. Adams ◽  
Rebecca L. Stearns
Keyword(s):  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Current Evidence ◽  
Great Success ◽  
Heat Acclimatization ◽  
Exertional Heat Stroke ◽  
Mortality And Morbidity ◽  
Appropriate Treatment

Exertional heat stroke (EHS) is among the leading causes of sudden death during sport and physical activity. However, previous research has shown that EHS is 100% survivable when rapidly recognized and appropriate treatment is provided. Establishing policies to address issues related to the prevention and treatment of EHS, including heat acclimatization, environment-based activity modification, body temperature assessment using rectal thermometry, and immediate, onsite treatment using cold-water immersion attenuates the risk of EHS mortality and morbidity. This article provides an overview of the current evidence regarding EHS prevention and management. The transfer of scientific knowledge to clinical practice has shown great success for saving EHS patients. Further efforts are needed to implement evidence-based policies to not only mitigate EHS fatality but also to reduce the overall incidence of EHS.

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

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.

scholarly journals Cooling Rates of Hyperthermic Humans Wearing American Football Uniforms When Cold-Water Immersion Is Delayed

2018 ◽  
Vol 53 (12) ◽  
pp. 1200-1205 ◽  
Author(s):  
Kevin C. Miller ◽  
Timothy A. Di Mango ◽  
Grace E. Katt
Keyword(s):  
Rectal Temperature ◽  
Cold Water ◽  
Thermal Sensation ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
American Football ◽  
Exertional Heat Stroke ◽  
Cooling Rates ◽  
Treatment Delays

Context Treatment delays can be contributing factors in the deaths of American football athletes from exertional heat stroke. Ideally, clinicians begin cold-water immersion (CWI) to reduce rectal temperature (Trec) to <38.9°C within 30 minutes of collapse. If delays occur, experts recommend Trec cooling rates that exceed 0.15°C/min. Whether treatment delays affect CWI cooling rates or perceptual variables when football uniforms are worn is unknown. Objective To answer 3 questions: (1) Does wearing a football uniform and delaying CWI by 5 minutes or 30 minutes affect Trec cooling rates? (2) Do Trec cooling rates exceed 0.15°C/min when treatment delays have occurred and individuals wear football uniforms during CWI? (3) How do treatment delays affect thermal sensation and Environmental Symptoms Questionnaire responses? Design Crossover study. Setting Laboratory. Patients or Other Participants Ten physically active men (age = 22 ± 2 y, height = 183.0 ± 6.9 cm, mass = 78.9 ± 6.0 kg). Intervention(s) On 2 days, participants wore American football uniforms and exercised in the heat until Trec was 39.75°C. Then they sat in the heat, with equipment on, for either 5 or 30 minutes before undergoing CWI (10.6°C ± 0.1°C) until Trec reached 37.75°C. Main Outcome Measure(s) Rectal temperature and CWI duration were used to calculate cooling rates. Thermal sensation was measured pre-exercise, postexercise, postdelay, and post-CWI. Responses to the Environmental Symptoms Questionnaire were obtained pre-exercise, postdelay, and post-CWI. Results The Trec cooling rates exceeded recommendations and were unaffected by treatment delays (5-minute delay = 0.20°C/min ± 0.07°C/min, 30-minute delay = 0.19°C/min ± 0.05°C/min; P = .4). Thermal sensation differed between conditions only postdelay (5-minute delay = 6.5 ± 0.6, 30-minute delay = 5.5 ± 0.7; P < .05). Environmental Symptoms Questionnaire responses differed between conditions only postdelay (5-minute delay = 27 ± 15, 30-minute delay = 16 ± 12; P < .05). Conclusions Treatment delays and football equipment did not impair CWI's effectiveness. Because participants felt cooler and better after the 30-minute delay despite still having elevated Trec, clinicians should use objective measurements (eg, Trec) to guide their decision making for patients with possible exertional heat stroke.

scholarly journals Assessing the Validity of Aural Thermometry for Measuring Internal Temperature in Patients With Exertional Heat Stroke

2021 ◽  
Vol 56 (2) ◽  
pp. 197-202
Author(s):  
Margaret C. Morrissey ◽  
Samantha E. Scarneo-Miller ◽  
Gabrielle E.W. Giersch ◽  
John F. Jardine ◽  
Douglas J. Casa
Keyword(s):  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Accurate Method ◽  
Cross Sectional Study ◽  
Cold Water Immersion ◽  
Internal Temperature ◽  
Exertional Heat Stroke ◽  
Finish Line ◽  
Cross Sectional

Context The use of aural thermometry as a method for accurately measuring internal temperature has been questioned. No researchers have examined whether aural thermometry can accurately measure internal body temperature in patients with exertional heat stroke (EHS). Objective To examine the effectiveness of aural thermometry as an alternative to the criterion standard of rectal thermometry in patients with and those without EHS. Design Cross-sectional study. Setting An 11.3-km road race. Patients or Other Participants A total of 49 patients with EHS (15 men [age = 38 ± 17 years], 11 women [age = 28 ± 10 years]) and 23 individuals without EHS (10 men [age = 62 ± 17 years], 13 women [age = 45 ± 14 years]) who were triaged to the finish-line medical tent for suspected EHS. Main Outcome Measure(s) Rectal and aural temperatures were obtained on arrival at the medical tent for patients with and those without EHS and at 8.3 ± 5.2 minutes into EHS treatment (cold-water immersion) for patients with EHS. Results The mean difference between temperatures measured using rectal and aural thermometers in patients with EHS at medical tent admission was 2.4°C ± 0.96°C (4.3°F ± 1.7°F; mean rectal temperature = 41.1°C ± 0.8°C [106.1°F ± 1.4°F]; mean aural temperature = 38.8°C ± 1.1°C [101.8°F ± 2.0°F]). Rectal and aural temperatures during cold-water immersion in patients with EHS were 40.4°C ± 1.0°C (104.6°F ± 1.8°F) and 38.0°C ± 1.2°C (100.3°F ± 2.2°F), respectively. Rectal and aural temperatures for patients without EHS at medical tent admission were 38.8°C ± 0.87°C (101.9°F ± 1.6°F) and 37.2°C ± 1.0°C (99.1°F ± 1.8°F), respectively. Conclusions Aural thermometry is not an accurate method of diagnosing EHS and should not be used as an alternative to rectal thermometry. Using aural thermometry to diagnosis EHS can result in catastrophic outcomes, such as long-term sequelae or fatality.

Sign in / Sign up

Export Citation Format

Share Document