Sports Medicine Research: In the Lab & In the Field: Following Guidelines to Prevent Exertional Heat Illness? Let’s Reconsider Those Guidelines (Sports Med Res)

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Thursday, March 8, 2018

Following Guidelines to Prevent Exertional Heat Illness? Let’s Reconsider Those Guidelines

Fatal exertional heat stroke and American football players: The need for regional heat-safety guidelines.

Grundstein AJ, Hosokawa Y, and Casa DJ. J Athl Training. 2018. 53(1) 43-50.

Take Home Message: Regional activity modification guidelines may be more effective at preventing fatal exertional heat strokes than current guidelines.

Exertional heat illness is a potentially dangerous development during training in hot conditions, especially in football. While weather-based activity modification guidelines are intended to reduce the risk of exertional heat illness, these guidelines fail to account for regional geographic differences. Therefore, Grundstein and colleagues completed a retrospective study to determine if fatal exertional heat strokes among American football players occurred more frequently on days with abnormally high wet bulb globe temperatures (WBGTs) based on the local climate and to assess how regional activity-modification guidelines would have altered activity. The authors identified 61 American football players with fatal exertional heat stroke two sources: the National Center for Catastrophic Sport Injury Research and the Korey Stringer Institute. Exposure data and locations of each event were determined from available records such as media reports, lawsuit documents, and obituaries. Researchers reconstructed meteorological conditions around the time of the fatal exposure (dry bulb temperature, dew-point temperature, and wet bulb temperature) using data from the nearest weather-observing station. The authors also calculated the regional climate between 1991 to 2010. Previously proposed regional heat-safety guidelines were compared with the 2007 ACSM guidelines, which relies on simple WBGT cut-offs. The authors found that in milder climates, 80% of fatal cases occurred when the WBGTs were above average; however, in hotter climates only half occurred at WBGTs above average. When the authors consider the two types of guidelines they found that the regional-guidelines did not change the activity recommendations much in the hotter climate region. However, 14 out of 15 cases (93%) in milder climates occurred in when regional modifications would have occurred under regional guidelines compared with ACSM guidelines.

Overall, the data presented in the current study suggest that regional activity modification guidelines may be more effective at preventing fatal exertional heat stroke than current blanket guidelines published by ACSM. This authors suggest that regional weather conditions change enough to place some athletes in dangerous environments even when ACSM guidelines suggest that activity in that area is safe. Conceptually, this makes sense since athletes are likely acclimatized to their environment. Hence, when athletes in milder climates experience higher WGBTs than they commonly train in it places them at greater risk for exertional heat stroke even though it may be like a mild summer day in a warmer region. This supports the use of regional heat activity modification guidelines; especially in milder climates. It’s important to note that this study does not prove that the region-based guidelines would have prevented deaths. Despite this limitation, the study makes a compelling argument for adopting regional guidelines. Until these regional activity modification guidelines are adopted as the standard though, clinicians should always carefully monitor weather conditions, and continue to educate themselves and athletes on signs and symptoms of exertional heat illness. Furthermore, clinicians should coordinate with coaches and other members of the sports medicine team to decide if the regional guidelines may be more prudent for their setting.

Questions for Discussion: How do you currently monitor weather conditions to modify activity? Are there any other measurements or considerations which you make and how have they been useful to you?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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