Exertional Heat Illness: Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators
Scarneo-Miller SE, Adams WM, Coleman KA, Lopez RM. Sports Health. 2023 Mar 5:19417381231155107. doi: 10.1177/19417381231155107. Epub ahead of print. PMID: 36872595.
https://journals.sagepub.com/doi/10.1177/19417381231155107
Take-Home Message
Most high school athletic administrators reported adopting a written exertional heat illness policy, but they often missed key components. The presence of an athletic trainer helped facilitate having a written policy that included more components.
Background
Athletic administrators play an important role in policy adoption. Policies like those handling emergency exertional heat illnesses are vital since improper management could lead to poor outcomes. Unfortunately, we know little about the facilitators and barriers to adopting exertional heat illness policies.
Study Goal
The authors surveyed high school athletic administrators in the United States to describe the adoption of exertional heat illness policies and explore factors that influence the adoption of these policies.
Methods
During the 2018-2019 academic school year, the study team emailed almost 7,000 athletic administrators to invite them to complete a questionnaire that asked about 1) demographics, 2) exertional health illness policies, 3) oversight and modification of written policy, and 4) facilitators and barriers to policy development. The investigators used the precaution adoption process model to assess an athletic administrator’s readiness to adopt policies. The adoption model is based on 8 stages, from being unaware to maintaining a written policy for over 6 months.
Results
Among the 466 athletic administrators (~48 years of age, 82% male, 77% worked in the field for over 15 years), 78% reported adopting a written policy on exertional heat illness prevention and treatment. Only 6% adopted all 11 essential elements of an exertional heat illness policy. Almost half of the administrators reported adopting less than 5 essential elements.
Older athletic administrators, those who previously treated an exertional heat illness, or those with an athletic trainer on staff were more likely to have a written policy. Furthermore, state mandates and having a medical professional were the most commonly reported facilitators for adopting a policy on exertional health illness prevention and using a rectal thermometer. Similarly, the most commonly reported barrier to a comprehensive exertional heat illness policy was lack of a full-time athletic trainer (11). Administrators also acknowledged budget restrictions that limited the use of a cold water immersion tub (23%), and key barriers to using a rectal thermometer were discomfort using the thermometer (32%), resistance from parents/guardians (30%), resistance from coaches (30%), and liability concerns (27%).
Viewpoints
Nearly 80% of the sampled athletic administrators reported adopting a written exertional heat illness policy. However, very few incorporated or were aware of all the necessary components to adhere to best clinical practices. The authors found that access to athletic training services was associated with better adoption of exertional health policies. This finding aligns with the fact that it would be an athletic trainer carrying out such policies. It’s worth recognizing that only 7% of contacted administrators completed the survey. Hence, these results may not accurately reflect what is going on in high schools around the country. One possibility is that people more interested in policies or exertional heat illness completed the survey. Hence, these results may show us the best-case scenario for having written policies (78%) that include all the components (6%) – which is a worrying sign.
Clinical Implications
Encouraging state mandates and schools to hire athletic trainers can help ensure written policies are in place to address exertional heat illness. Clinicians may also want to consider strategies to educate coaches and parents/guardians about the rationale for these policies, like rectal thermometers and cold water immersion tubs.
Questions for Discussion
Do you have difficulty adding rectal temperature into your exertional heat illness protocol? Do you communicate with your athletic administrator regarding the adoption, implementation, and annual review/practice of your emergency policies?
Related Posts
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- Following Guidelines to Prevent Exertional Heat Illness? Let’s Reconsider Those Guidelines
Written by Jane McDevitt
Reviewed by Jeffrey Driban
As an ATS I have not seen any of the sites I have been placed with struggle with having rectal temp being in their heat illness protocol. I believe it stems from is the AT in charge comfortable or if they had training in the skill in order to provide it if needed. I also think it depends on the level of athletes you are working at Middle school Vs high school or even High school vs college. There is a lot more kickback from one than there is from the other. I know that the protocol does get discusses with the administration about why it is important and why it should stay and or be implemented into the protocol. If It is in the written protocol then it does get reviewed along with all the other emergency plans that are put into place
My name is Kylie Brincks and I am a second year MATSA student at James Madison University. After having completed an emergency management course in my first year, heat illnesses were a big topic that we discussed, including the management strategies, prevention strategies, and how to inform coaches of these types of illnesses. I found it very interesting after reading this post and the article that there were so many restrictions/resistance from athletic administrators when dealing with exertional heat illnesses. I believe that having an athletic trainer at every clinical site is very important due to the fact that we know how to handle and coach people through situations like this, especially when dealing with individuals that are prone to heat illnesses. When it comes to your questions, as an athletic training student that will soon be done with school, I have no difficulty adding rectal temperature into a exertional heal illness protocol because this is the only temperature that will give you a true reading of ones body temp, and when dealing with heat illnesses you want the most accurate information to determine your next move. Yes, rectal temperature is a big topic for debate due to the process of getting a rectal temp, but I think that as long as the patient/parents of patient know the procedure and know the risk of not having one in an incident and sign a contract giving permission then there should be nothing wrong with it. As for communicating with athletic administers about implementing, adopting, and annual reviewing/practicing of emergency procedures, I believe that this is something that needs to be done because things are constantly changing and everything needs to meet the standards. Having an emergency procedure is a vital component of an athletic program, due to the fact that almost anything can happen, and if coaches, players, staff, and other medical personnel are trained to see the warning signs or how to deal with a situation, it will lead to less chances of something going wrong.
Hi, my name is Jonathan Joia and I am a 2nd year student in James Madison Universities Masters of Athletic Training Program. I believe that it is important to have a clear cut heat illness policy, especially in the high school setting where there might be a lack of resources available. Including all 11 essential components for a heat illness policy is a must and finding only about 6% of athletic administrators that include all components was something that stood out to me greatly. I know that a lot of policies and procedures are fixed and made correctly after an incident occurs, but given the importance of this specific topic what are ways to show the importance and make change to policies before an incident has to happen to do so?
Hello, I am Emily Couvillion, a 2nd year MSAT student at James Madison University. As a current Athletic Training Student learning about best practices & providing the best care possible, I wouldn’t have a hard time adding rectal thermometry into an exertional heat illness protocol. I’m aware that some parents/guardians, students, coaches/staff, etc. may not like the idea of having this on the protocol & it can definitely be a controversial topic. However, if you were to implement or include an education program regarding heat illnesses at the beginning of the year or season for stakeholders I believe they would realize why it is necessary to be included in the exertional heat illness protocol. Without having rectal thermometry on a protocol, the chance of misdiagnosis or preventable harm occurring to the patient increases significantly.
Jordan Reed- I think that having a heat illness policy in place should be a standard among schools/institutions. Being a MSAT student and have clinical rotations I have not run into any issues with the implementation of the heat illness protocols such a rectal thermometry. Also as a future health care provider rectal thermometry needs to not be looked at as an option but as a life saving measure. If all indications are that an athlete/patient are in distress/heat stroke the implementation of rectal thermometry can save a life. It is controversial due to the topic but if your program/institution can send any form of education home with parents/coaches/patients to educate and inform on the necessity of heat illness procedure/protocols then hopefully the understanding behind it will increase. I think every year emergency situation procedures/policies should be reviewed just to make sure they are accurate and up to date. Also, if anything changes regarding emergency situations then education on that change should also be implemented.
My name is Reagan Sellers and I am currently an Athletic Training Student at James Madison University. Within all of my clinical placements, I have seen heat policies and have been briefed on what that policy is and what my role would be during that emergency situation. I think one way to help get these policies adapted would be to run everyone through what their roles would be during a heat illness emergency. In our program, we had to take an emergency management class and heat illness was a topic we spent a lot of time learning about and practicing. We got to practice transportation into a cold tub, different scenarios with different levels of heat illness, and also got to practice rectal thermometry. While there are a lot of varying opinions on this topic, I feel confident in performing rectal thermometry of needed because of how it was taught to me. I now understand the importance of it and the extent of the emergency if it is needed. I believe that if parents, students, and administration were educated on the uses of rectal thermometry and how it can be life saving, the opinions may sway differently. I think the first step would be proper education on the topic.