Exertional heat stroke management strategies in the United States high school football
Kerr ZY, Marshall SW, Comstock RD, Casa DJ. Am J Sport Med. 2014; 42:70.
Take Home Message: Many athletes especially football players suffer exertional heat stroke each year To reduce the prevalence of exertional heat stroke, clinicians should be well educated on, and implement active exertional heat stroke management strategies such as moving the athletes into air conditioning, cold water immersion, and monitoring body temperature.
Exertional heat stroke (EHS) is a severe condition, which if left untreated affects the central nervous system and can lead to death. Although EHS is preventable, many athletes – especially football players – are still affected each year. Because of this, many clinicians have implemented heat illness management strategies to prevent EHS. If we understood how common EHS is among football programs and how clinicians implement EHS management strategies then we could improve our management protocols. Therefore, Kerr and colleagues completed a cross-sectional survey study to examine the how athletic trainers (ATs) manage and treat EHS events in high school football. Researchers designed an anonymous, online survey and distributed it to 6,343 ATs. All ATs were identified by a National Athletic Trainers’ Association membership list and were responsible for high school sports in the 2011-2012 school year. The ATs reported their clinician experience, characteristics of the high school, number and frequency of preseason practices, as well as number and frequency of strategies used to prevent exertional heat illness and manage EHS during the 2011 football preseason. Of the 6,343 ATs contacted for participation, 1,142 (18%) agreed to participate and fully completed the survey. One third of respondents worked in a state that required implementation of heat acclimatization guidelines. The ATs treated 561 EHS events. ATs who reported treating at least 1 EHS event used an average of 6.6 management strategies, while ATs who did not treat an EHS event reported that they would have used an average of 7.9 management strategies. The most common EHS management strategies were removing the athlete’s equipment (98.2%) and moving the athlete to a shaded area (91.6%). The least common EHS management strategies were using a rectal thermometer to record body temperature (0.9%), called for EMS (29%), and cold water immersion (52%). Further, ATs reported more EHS management strategies if they worked in states that required implementation of heat acclimatization guidelines. ATs in these states also used more active management strategies than those ATs in states without mandates – such as, moving the athletes into air conditioning, cold water immersion, and monitoring body temperature.
Overall, this study provides clinicians with some interesting data regarding the prevalence and management of EHS. Perhaps the most interesting result is that ATs in states that required implementation of heat acclimatization guidelines reported the using more EHS management strategies than those in states with no such mandate. This may suggest an education bias as ATs in states with a mandate may be more aware of EHS treatment strategies to effectively implement the mandate. Furthermore, ATs in states with mandates also utilized more active EHS management strategies than ATs in states without mandates. This may indicate that clinicians in states with mandates may be more informed and better prepared to handle EHS events due to the mandated heat acclimatization guidelines. Despite the amount of education ATs received, EHS events still occurred, which suggests that EHS management is still not optimized and should be furthered studied. Currently to ensure an athlete’s safety, a clinician should be diligent in seeking continuing education opportunities on EHS and should familiarize themselves with heat acclimation guidelines regardless of if their state requires such a program.
Questions for Discussion: Do you currently implement a heat acclimation program for your athletes? If so, what does it entail? If not, would you feel confident in your EHS management strategies if faced with an EHS event?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best Practices Recommendations