scholarly journals Exertional Heat-Stroke Preparedness in High School Football by Region and State Mandate Presence

2019 ◽  
Vol 54 (9) ◽  
pp. 921-928 ◽  
Author(s):  
Zachary Y. Kerr ◽  
Samantha E. Scarneo-Miller ◽  
Susan W. Yeargin ◽  
Andrew J. Grundstein ◽  
Douglas J. Casa ◽  
...  
Keyword(s):  
High School ◽  
Heat Stroke ◽  
State Mandates ◽  
High School Football ◽  
Heat Acclimatization ◽  
Exertional Heat Stroke ◽  
Wet Bulb Globe Temperature ◽  
State Mandate ◽  
Globe Temperature ◽  
Football Programs

Context Exertional heat stroke (EHS) is a leading cause of sudden death in high school football players. Preparedness strategies can mitigate EHS incidence and severity. Objective To examine EHS preparedness among high school football programs and its association with regional and state preseason heat-acclimatization mandates. Design Cross-sectional study. Setting Preseason high school football programs, 2017. Patients or Other Participants A total of 910 athletic trainers (ATs) working with high school football (12.7% completion rate). Main Outcome Measure(s) We acquired data on high school football programs' EHS preparedness strategies in the 2017 preseason via an online questionnaire, looking at (1) whether schools' state high school athletic associations mandated preseason heat-acclimatization guidelines and (2) heat safety region based on warm-season wet-bulb globe temperature, ranging from the milder region 1 to the hotter region 3. Six EHS-preparedness strategies were assessed: EHS recognition and treatment education; policy for initiating emergency medical services response; emergency response plan enactment; immersion tub filled with ice water before practice; wet-bulb globe temperature monitoring; and hydration access. Multivariable binomial regression models estimated the prevalence of reporting all 6 strategies. Results Overall, 27.5% of ATs described their schools as using all 6 EHS-preparedness strategies. The highest prevalence was in region 3 schools with state mandates (52.9%). The multivariable model demonstrated an interaction in which the combination of higher heat safety region and presence of a state mandate was associated with a higher prevalence of reporting all 6 strategies (P = .05). Controlling for AT and high school characteristics, the use of all 6 strategies was higher in region 3 schools with state mandates compared with region 1 schools without state mandates (52.9% versus 17.8%; prevalence ratio = 2.68; 95% confidence interval = 1.81, 3.95). Conclusions Our findings suggest a greater use of EHS-preparedness strategies in environmentally warmer regions with state-level mandates for preseason heat acclimatization. Future researchers should identify factors influencing EHS preparedness, particularly in regions 1 and 2 and in states without mandates.

Exertional Heat Stroke Management Strategies in United States High School Football

2013 ◽  
Vol 42 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Zachary Y. Kerr ◽  
Stephen W. Marshall ◽  
R. Dawn Comstock ◽  
Douglas J. Casa
Keyword(s):  
United States ◽  
High School ◽  
Heat Stroke ◽  
Management Strategies ◽  
Stroke Management ◽  
High School Football ◽  
Exertional Heat Stroke

scholarly journals A Functional Return-to-Play Progression After Exertional Heat Stroke in a High School Football Player

2018 ◽  
Vol 53 (3) ◽  
pp. 230-239 ◽  
Author(s):  
Rebecca M. Lopez ◽  
Patrick Tanner ◽  
Sarah Irani ◽  
P. Patrick Mularoni
Keyword(s):  
High School ◽  
Perceived Exertion ◽  
Heat Stroke ◽  
School Setting ◽  
Rating Of Perceived Exertion ◽  
Return To Play ◽  
Close Monitoring ◽  
High School Football ◽  
Exertional Heat Stroke ◽  
Central Nervous System Dysfunction

Objective: To present a functional return-to-play (RTP) progression after exertional heat stroke (EHS) in a 17-year-old high school football defensive end (height = 185 cm, mass = 145.5 kg).Background: The patient had no pertinent medical history but moved to a warm climate several days before the EHS occurred. After completing an off-season conditioning test (14- × 110-yd [12.6- × 99.0-m] sprints) on a warm afternoon (temperature = approximately 34°C [93°F], relative humidity = 53%), the patient collapsed. An athletic trainer (AT) was called to the field, where he found the patient conscious but exhibiting central nervous system dysfunction. Emergency medical services were summoned and immediately transported the patient to the hospital.Differential Diagnosis: Exertional heat stroke, heat exhaustion, exertional sickling, rhabdomyolysis, and cardiac arrhythmia.Treatment: The patient was immediately transported to a hospital, where his oral temperature was 39.6°C (103.3°F). He was transferred to a children's hospital and treated for rhabdomyolysis, transaminitis, and renal failure. He was hospitalized for 11 days. After a physician's clearance once the laboratory results normalized, an RTP progression was completed. The protocol began with light activity and progressed over 3 weeks to full football practice. During activity, an AT monitored the patient's gastrointestinal temperature, heart rate, rating of perceived exertion, fluid consumption, and sweat losses.Uniqueness: Documentation of RTP guidelines for young athletes is lacking. We used a protocol intended for the football setting to ensure the athlete was heat tolerant, had adequate physical fitness, and could safely RTP. Despite his EHS, he recovered fully, with no lasting effects, and successfully returned to compete in the final 5 games of the season.Conclusions: Using a gradual RTP progression and close monitoring, a high school defensive end successfully returned to football practice and games after EHS. This case demonstrates the feasibility of implementing a safe RTP protocol after EHS and may serve as a guide to ATs working in the high school setting. This case also highlights the need for more research in this area.

scholarly journals State Regulations and Region Are Associated With High School Football Preseason Heat Acclimatization Guidelines Compliance

2019 ◽  
Vol 51 (Supplement) ◽  
pp. 712
Author(s):  
Zachary Y. Kerr ◽  
Samatha E. Scarneo ◽  
Andrew J. Grundstein ◽  
Riana R. Pryor ◽  
Yuri Hosokawa ◽  
...  
Keyword(s):  
High School ◽  
High School Football ◽  
Heat Acclimatization ◽  
State Regulations

scholarly journals Thermoregulatory Responses and Hydration Practices in Heat-Acclimatized Adolescents During Preseason High School Football

2010 ◽  
Vol 45 (2) ◽  
pp. 136-146 ◽  
Author(s):  
Susan Walker Yeargin ◽  
Douglas J. Casa ◽  
Daniel A. Judelson ◽  
Brendon P. McDermott ◽  
Matthew S. Ganio ◽  
...  
Keyword(s):  
High School ◽  
Thermal Sensation ◽  
Sweat Rate ◽  
Urine Osmolality ◽  
Tanner Stage ◽  
American Football ◽  
Adolescent Boys ◽  
Wet Bulb Globe Temperature ◽  
Thermoregulatory Responses ◽  
Globe Temperature

Abstract Context: Previous researchers have not investigated the thermoregulatory responses to multiple consecutive days of American football in adolescents. Objective: To examine the thermoregulatory and hydration responses of high school players during formal preseason football practices. Design: Observational study. Setting: Players practiced outdoors in late August once per day on days 1 through 5, twice per day on days 6 and 7, and once per day on days 8 through 10. Maximum wet bulb globe temperature averaged 23 ± 4°C. Patients or Other Participants: Twenty-five heat-acclimatized adolescent boys (age  =  15 ± 1 years, height  =  180 ± 8 cm, mass  =  81.4 ± 15.8 kg, body fat  =  12 ± 5%, Tanner stage  =  4 ± 1). Main Outcome Measure(s): We observed participants within and across preseason practices of football. Measures included gastrointestinal temperature (TGI), urine osmolality, sweat rate, forearm sweat composition, fluid consumption, testosterone to cortisol ratio, perceptual measures of thirst, perceptual measures of thermal sensation, a modified Environmental Symptoms Questionnaire, and knowledge questionnaires assessing the participants' understanding of heat illnesses and hydration. Results were analyzed for differences across time and were compared between younger (14–15 years, n  =  13) and older (16–17 years, n  =  12) participants. Results: Maximum daily TGI values remained less than 40°C and were correlated with maximum wet bulb globe temperature (r  =  0.59, P  =  .009). Average urine osmolality indicated that participants generally experienced minimal to moderate hypohydration before (881 ± 285 mOsmol/kg) and after (856 ± 259 mOsmol/kg) each practice as a result of replacing approximately two-thirds of their sweat losses during exercise but inadequately rehydrating between practices. Age did not affect most variables; however, sweat rate was lower in younger participants (0.6 ± 0.2 L/h) than in older participants (0.8 ± 0.1 L/h) (F1,18  =  8.774, P  =  .008). Conclusions: Previously heat-acclimatized adolescent boys (TGI < 40°C) can safely complete the initial days of preseason football practice in moderate environmental conditions using well-designed practice guidelines. Adolescent boys replaced most sweat lost during practice but remained mildly hypohydrated throughout data collection, indicating inadequate hydration habits when they were not at practice.

scholarly journals Compliance With the National Athletic Trainers' Association Inter-Association Task Force Preseason Heat-Acclimatization Guidelines in High School Football

2019 ◽  
Vol 54 (7) ◽  
pp. 749-757 ◽  
Author(s):  
Zachary Y. Kerr ◽  
Johna K. Register-Mihalik ◽  
Riana R. Pryor ◽  
Yuri Hosokawa ◽  
Samantha E. Scarneo-Miller ◽  
...  
Keyword(s):  
High School ◽  
Task Force ◽  
Athletic Trainers ◽  
Cross Sectional Study ◽  
Heat Acclimatization ◽  
Cross Sectional ◽  
Full Compliance ◽  
Association Task ◽  
National Athletic Trainers Association ◽  
Football Programs

Context In 2009, the National Athletic Trainers' Association Inter-Association Task Force (NATA-IATF) released preseason heat-acclimatization guidelines for gradually acclimatizing high school (HS) athletes to the environment during the first 2 weeks of the preseason and reducing the risk of exertional heat illness. However, researchers who studied the 2011 preseason found a low level of overall compliance. Objective To assess compliance with the NATA-IATF guidelines during the 2017 preseason and compare the findings with 2011 preseason data and between states mandating and not mandating the guidelines. Design Cross-sectional study. Setting Preseason HS football, 2017. Patients or Other Participants A total of 1023 athletic trainers working with HS football (14.2% response rate). Main Outcome Measure(s) Using a survey, we acquired information from athletic trainers on their HS football programs, including location and compliance with 17 NATA-IATF guidelines during the 2017 football preseason. The outcome measures were full compliance with all 17 NATA-IATF guidelines and compliance with ≥10 NATA-IATF guidelines. Prevalence ratios (PRs) with 95% confidence intervals (CIs) compared findings between (1) the 2017 and 2011 preseasons and (2) states whose HS athletic associations imposed a full or partial or no mandate to follow the NATA-IATF guidelines. Results Overall, 3.9% reported full compliance with NATA-IATF guidelines; 73.9% complied with ≥10 guidelines. The proportion reporting full compliance was higher in 2017 than in 2011 but not statistically different (3.9% versus 2.5%; PR = 1.54; 95% CI = 0.96, 2.46). However, the proportion reporting compliance with ≥10 guidelines was higher in 2017 (73.9% versus 57.9%; PR = 1.28; 95% CI = 1.20, 1.36). The proportion of respondents reporting their HSs were fully compliant was highest among the with-mandate group (9.4%), followed by the partial-mandate group (4.6%) and the without-mandate group (0.6%). Group differences retained significance when we examined compliance with ≥10 guidelines. Conclusions Although full compliance with NATA-IATF guidelines remained low, many HS football programs complied with ≥10 guidelines.

scholarly journals An Evaluation of Portable Wet Bulb Globe Temperature Monitor Accuracy

2017 ◽  
Vol 52 (12) ◽  
pp. 1161-1167 ◽  
Author(s):  
Earl Cooper ◽  
Andrew Grundstein ◽  
Adam Rosen ◽  
Jessica Miles ◽  
Jupil Ko ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heat Stress ◽  
Sports Medicine ◽  
Pearson Correlation ◽  
Heat Stroke ◽  
Heat Index ◽  
Mean Bias Error ◽  
Bias Error ◽  
Wet Bulb Globe Temperature ◽  
Globe Temperature

Context:  Wet bulb globe temperature (WBGT) is the gold standard for assessing environmental heat stress during physical activity. Many manufacturers of commercially available instruments fail to report WBGT accuracy. Objective:  To determine the accuracy of several commercially available WBGT monitors compared with a standardized reference device. Design:  Observational study. Setting:  Field test. Patients or Other Participants:  Six commercially available WBGT devices. Main Outcome Measure(s):  Data were recorded for 3 sessions (1 in the morning and 2 in the afternoon) at 2-minute intervals for at least 2 hours. Mean absolute error (MAE), root mean square error (RMSE), mean bias error (MBE), and the Pearson correlation coefficient (r) were calculated to determine instrument performance compared with the reference unit. Results:  The QUESTemp° 34 (MAE = 0.24°C, RMSE = 0.44°C, MBE = –0.64%) and Extech HT30 Heat Stress Wet Bulb Globe Temperature Meter (Extech; MAE = 0.61°C, RMSE = 0.79°C, MBE = 0.44%) demonstrated the least error in relation to the reference standard, whereas the General WBGT8778 Heat Index Checker (General; MAE = 1.18°C, RMSE = 1.34°C, MBE = 4.25%) performed the poorest. The QUESTemp° 34 and Kestrel 4400 Heat Stress Tracker units provided conservative measurements that slightly overestimated the WBGT provided by the reference unit. Finally, instruments using the psychrometric wet bulb temperature (General, REED Heat Index WBGT Meter, and WBGT-103 Heat Stroke Checker) tended to underestimate the WBGT, and the resulting values more frequently fell into WBGT-based activity categories with fewer restrictions as defined by the American College of Sports Medicine. Conclusions:  The QUESTemp° 34, followed by the Extech, had the smallest error compared with the reference unit. Moreover, the QUESTemp° 34, Extech, and Kestrel units appeared to offer conservative yet accurate assessments of the WBGT, potentially minimizing the risk of allowing physical activity to continue in stressful heat environments. Instruments using the psychrometric wet bulb temperature tended to underestimate WBGT under low wind-speed conditions. Accurate WBGT interpretations are important to enable clinicians to guide activities in hot and humid weather conditions.

Exertional Heat Stroke and Emergency Issues in High School Sport

2010 ◽  
Vol 24 (7) ◽  
pp. 1707-1709 ◽  
Author(s):  
Kelly D Pagnotta ◽  
Stephanie M Mazerolle ◽  
Douglas J Casa
Keyword(s):  
High School ◽  
Heat Stroke ◽  
Exertional Heat Stroke ◽  
School Sport ◽  
High School Sport

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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