scholarly journals Professional Preparation Regarding The Recognition And Treatment Of Exertional Heat Stroke: The Student Perspective

2011 ◽  
Vol 6 (4) ◽  
pp. 182-193 ◽  
Author(s):  
Stephanie M. Mazerolle ◽  
Kelly D. Pagnotta ◽  
Douglas J Casa ◽  
Lawrence Armstrong ◽  
Carl Maresh
Keyword(s):  
Athletic Training ◽  
Cold Water ◽  
Water Immersion ◽  
Effective Means ◽  
Heat Stroke ◽  
Athletic Training Education ◽  
Higher Order ◽  
Direct Result ◽  
Current Evidence ◽  
Exertional Heat Stroke

Context: Current evidence suggests rectal temperature(Tre) and cold-water immersion (CWI) are the most effective means to diagnose and treat exertional heat stroke (EHS), respectively. Educators, clinicians, and students should be apprised of this evidence to guide their practice. Objective: Investigate what athletic training students (ATS) are learning regarding EHS, both in the classroom and clinical settings that may one day influence their practices as athletic trainers (AT). Design: Qualitative design using in-person focus groups. Setting: National meeting in San Antonio, Texas, 2009. Patients or Other Participants: Thirteen rising senior ATS in a Commission on Accreditation of Athletic Training Education (CAATE)-accredited athletic training education program. Data Collection and Analysis: Interviews were transcribed verbatim and analyzed using open coding techniques. Peer debriefing and multiple-analyst triangulation were used to ensure trustworthiness of the data. Results: Two higher order themes emerged from the data analysis: Lack of Experience and Educators' Influence. Lack of Experience summarizes the ATS lack of exposure, both in the classroom and in the clinical setting regarding the skills associated with EHS. It was apparent that the participant's lack of understanding of EHS was a direct result of a lack of time spent with the topic. The higher order theme of Educators' Influence highlights the role that educators play in influencing and shaping ATS retention of materials, competence, and future practice beliefs regarding EHS. Conclusion: A cyclic reaction occurs with regards to EBP that directly influences ATS. Until the cycle is broken, ATs will continue to struggle implementing best practices identified from research into clinical practice.

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.

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.

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 Effective Teaching Methods for the Assessment and Treatment of Exertional Heat Illness in Athletic Training Education

2019 ◽  
Vol 14 (2) ◽  
pp. 128-134
Author(s):  
Beth L. Kinslow ◽  
Holly Schmies ◽  
Kirk J. Armstrong ◽  
Malissa Martin
Keyword(s):  
Confidence Interval ◽  
Athletic Training ◽  
Heat Stroke ◽  
Athletic Training Education ◽  
Educational Material ◽  
Clinical Scenario ◽  
Athletic Training Students ◽  
Exertional Heat Stroke ◽  
Time Points ◽  
Assessment And Treatment

Context Athletic training education should focus on evidence-based teaching through providing authentic learning opportunities. Objective To examine the effectiveness of 2 different instructional methods' impact on pre–athletic training students' assessment and treatment of a patient with exertional heat stroke (EHS). Design A pretest, posttest randomized control trial study design was used. Setting Five undergraduate athletic training programs. Patients or Other Participants Thirty-six pre–athletic training students volunteered to participate. Thirty-two participants completed the research interventions (19 = hybrid simulation [HS], 13 = case-based learning [CLB]). Intervention(s) All participants received educational material and classroom presentation regarding EHS. Participants completed the preintervention Knowledge, Preferences, and Practices of Certified Athletic Trainers Regarding Recognition and Treatment of Exertional Heat Stroke (KPP-EHS) survey. Approximately 2 to 3 weeks after receiving the educational material, the participants completed HS or CBL intervention protocol and completed the postintervention KPP-EHS survey. The HS intervention consisted of a clinical scenario using a standardized patient and rectal thermometer task trainer. The CBL intervention involved completing a case-study worksheet regarding a clinical scenario. At the 6-week follow-up time point participants completed the KPP-EHS survey. Main Outcome Measure(s) Composite and subscale scores from the KPP-EHS survey. Results A factorial repeated measure 2 × 3 (Group × Time) analysis of variance revealed a statistically significant main effect for time of the total composite score of both groups (F = 28.005, P = .000, partial η2 = 0.659). Bonferroni post hoc testing revealed a statistically significant difference between time points 1 and 2 (mean difference = −25.176, P = .000, 95% confidence interval −34.036, −16.317) and time points 1 and 3 (mean difference = −32.842, P = .000, 95% confidence interval −44.917, −20.767). Conclusions Athletic training educators should consider the use of HS and CBL in conjunction with didactic course work to prepare students to appropriately manage EHS.

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.

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.

scholarly journals High Schools Struggle to Adopt Evidence Based Practices for the Management of Exertional Heat Stroke

2021 ◽  
Author(s):  
SE Scarneo-Miller ◽  
RM Lopez ◽  
KC Miller ◽  
WM Adams ◽  
ZY Kerr ◽  
...  
Keyword(s):  
Health Behavior ◽  
Rectal Temperature ◽  
Process Model ◽  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Adoption Process ◽  
Online Questionnaire ◽  
Exertional Heat Stroke ◽  
Facilitators And Barriers

Abstract Context: Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. Objective: We investigated the adoption of policies and procedures for the recognition and treatment of EHS and the factors influencing the adoption of a comprehensive policy. Design: Cross Sectional. Setting: Online questionnaire. Patients or Other Participants: Athletic trainers (ATs) practicing in the high school (HS) setting. Main Outcome Measure(s): Using the NATA Position Statement: Exertional Heat Illness, an online questionnaire was developed and distributed to ATs to ascertain their schools' current written policies for the use of rectal temperature and cold-water immersion (CWI). The Precaution Adoption Process Model (PAPM), allowed for responses to be presented across the various health behavior stages (“Unaware if have the policy”, “Unaware for the need for the policy”, “Unengaged”, “Undecided”, “Decided Not to Act”, “Decided to Act”, “Acting”, and “Maintaining”). Additional questions included perceptions of facilitators and barriers. Data are presented as proportions. Results: A total of 531 ATs completed this questionnaire. Overall, 16.9% (n=62) report adoption of all components for proper recognition and treatment of EHS. The policy component with the highest adoption was “cool first transport second” with 74.1% (n=110) of ATs reporting “Acting” or “Maintaining.” The most variability in the PAPM responses was for a rectal temperature policy, with 28.7% (n=103) of ATs reporting “Decided not to Act” and 20.1% (n=72) reporting “Maintaining.” The most commonly reported facilitator and barrier for rectal temperature included state mandate from state HS athletics association (n=274,51.5%) and resistance or apprehension from parents or legal guardians (n=311,58.5%), respectively. Conclusions: ATs in the HS setting appear to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing to appear as the biggest undertaking. Tailored strategies based on health behavior, facilitators and barriers may aid in changing this paradigm.

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.

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