Fatal exertional heat
stroke and American football players: The need for regional heat-safety
AJ, Hosokawa Y, and Casa DJ. J Athl
g. 2018. 53(1) 43-50.
Take Home
: 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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