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Anderson SA, Eichner ER, Bennett S, Boden BP, Colgate B, Courson R, Davis JK, Elkins GA, Judge LW, Krueger M, Kucera KL, Niehoff K, Rooks Y, Tucker JB, Roberts WO. Preventing Exertional Heat Stroke in Football: Time for a Paradigm Shift. Sports Health 2024:19417381241260045. [PMID: 38874455 DOI: 10.1177/19417381241260045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
CONTEXT Among American sports, football has the highest incidence of exertional heat stroke (EHS), despite decades of prevention strategies. Based on recent reports, 100% of high school and college EHS football fatalities occur during conditioning sessions. Linemen are the at-risk population, constituting 97% of football EHS deaths. Linemen heat up faster and cool down slower than other players. EVIDENCE ACQUISITION Case series were identified from organized, supervised football at the youth, high school, and collegiate levels and compiled in the National Registry of Catastrophic Sports Injuries. Sources for event occurrence were media reports and newspaper clippings, autopsy reports, certificates of death, school-sponsored investigations, and published medical literature. Articles were identified through PubMed with search terms "football," "exertional heat stroke," and "prevention." STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS Football EHS is tied to (1) high-intensity drills and conditioning that is not specific to individual player positions, (2) physical exertion as punishment; (3) failure to modify physical activity for high heat and humidity, (4) failure to recognize early signs and symptoms of EHS, and (5) death when cooling is delayed. CONCLUSION To prevent football EHS, (1) all training and conditioning should be position specific; (2) physical activity should be modified per the heat load; (3) understand that some players have a "do-or-die" mentality that supersedes their personal safety; (4) never use physical exertion as punishment; (5) eliminate conditioning tests, serial sprints, and any reckless drills that are inappropriate for linemen; and (6) consider air-conditioned venues for linemen during hot practices. To prevent EHS, train linemen based on game demands. STRENGTH-OF-RECOMMENDATION TAXONOMY n/a.
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Affiliation(s)
| | - E Randy Eichner
- Oklahoma University Health Science Center, Oklahoma City, Oklahoma
| | - Scott Bennett
- Collegiate Strength and Conditioning Coaches Association, Roanoke, Virginia
| | - Barry P Boden
- The Orthopaedic Center, a Division of CAO, Uniformed Services University, Rockville, Maryland
| | - Bob Colgate
- National Federation of State High School Associations [NFHS], Indianapolis, Indiana
| | - Ron Courson
- University of Georgia Athletic Association, Athens, Georgia
| | - Jon K Davis
- Gatorade Sports Science Institute, Frisco, Texas
| | | | | | - Mike Krueger
- Colorado High School Activities Association, Aurora, Colorado
| | - Kristen L Kucera
- Department of Exercise and Sport Science, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, and National Center for Catastrophic Sport Injury Research [NCCSIR], Chapel Hill, North Carolina
| | | | - Yvette Rooks
- University of Maryland-College Park, College Park, Maryland
| | - James B Tucker
- Syracuse University, Syracuse, New York, Department of Family Medicine, SUNY Upstate Medical University, Syracuse, New York, and St. Joseph's Hospital Health Center, Syracuse, New York
| | - William O Roberts
- American College of Sports Medicine, Indianapolis, Indiana, and Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
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Miller KC, Amaria NY. Body Bag Cooling with Two Different Water Temperatures for the Treatment of Hyperthermia. Aerosp Med Hum Perform 2024; 95:194-199. [PMID: 38486327 DOI: 10.3357/amhp.6364.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
INTRODUCTION: Exertional heatstroke (EHS) is a life-threatening condition that requires quick recognition and cooling for survival. Experts recommend using cooling modalities that reduce rectal temperature (TREC) faster than 0.16°C/min though rates above 0.08°C/min are considered "acceptable." Hyperthermic individuals treated in body bags filled with ice water (∼3°C) have excellent cooling rates (0.28 ± 0.09°C/min). However, clinicians may not have access to large amounts of ice or ice water when treating EHS victims. The purpose of this study was to determine if using a body bag filled with water near the upper limits of expert recommendations for EHS treatment would produce acceptable (>0.08°C/min) or "ideal (>0.16°C/min)" TREC cooling rates or different nadir values.METHODS: A total of 12 individuals (9 men, 3 women; age: 21 ± 2 yr; mass: 74.6 ± 10.2 kg; height: 179.5 ± 9.6 cm) exercised in the heat until TREC was 39.5°C. They lay supine while 211.4 ± 19.5 L of 10°C (Ten) or 15°C (Fifteen) water was poured into a body bag. Subjects cooled until TREC was 38°C. They exited the body bag and rested in the heat for 10 min.RESULTS: Subjects exercised in similar conditions and for similar durations (Ten = 46.3 ± 8.6 min, Fifteen = 46.2 ± 7.8 min). TREC cooling rates were faster in Ten than Fifteen (Ten = 0.18 ± 0.07°C/min, Fifteen = 0.14 ± 0.09°C/min). TREC nadir was slightly higher in Fifteen (37.3 ± 0.2°C) than Ten (37.1 ± 0.3°C).DISCUSSION: Body bag cooling rates met expert definitions of acceptable (Fifteen) and ideal (Ten) for EHS treatment. This information is valuable for clinicians who do not have access to or the resources for ice water cooling to treat EHS.Miller KC, Amaria NY. Body bag cooling with two different water temperatures for the treatment of hyperthermia. Aerosp Med Hum Perform. 2024; 95(4):194-199.
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Kerr ZY, Diana JC, Adams WM, Register-Mihalik JK, Nedimyer AK. The initial visibility of updated recommendations on preseason heat safety in high school athletics among United States athletic trainers. PLoS One 2024; 19:e0300669. [PMID: 38517911 PMCID: PMC10959349 DOI: 10.1371/journal.pone.0300669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/01/2024] [Indexed: 03/24/2024] Open
Abstract
Updated recommendations on preseason heat safety in high school (HS) athletics ("2021 Consensus Statements") were published in April 2021. This cross-sectional survey study explored the initial roll-out of the 2021 Consensus Statements, including their visibility among United States HS athletic trainers (ATs) and perceived levels of confidence in implementing them. Recruitment occurred first, from a random selection of ATs from the Board of Certification, Inc., and second, an open invitation via social media. An online cross-sectional questionnaire had participating ATs note whether they had seen the 2021 Consensus Statements. If yes, ATs reported their perceived level of confidence in implementing them (5-point-ordinal scale from "not at all confident" to "very confident); if no, ATs disclosed (open-ended) why they had not yet seen them. Descriptive statistics were calculated for quantitative variables; template analysis identified codes related to visibility of and confidence in implementing 2021 Consensus Statements. Nearly half (45.7%) of 116 responding HS ATs reported having seen at least one 2021 Consensus Statements; 23.3% had reviewed all three. Common reasons among the 63 that had not seen them included: not aware they were published (n = 22), have yet to read them (n = 19), and believed they could not access the journal (n = 10). Of the 53 ATs having seen at least one of the 2021 Consensus Statements, 67.9% (n = 36) were very/fairly confident in implementing them at their HS. Reasons for confidence included their schools ensuring up-to-date EHI prevention and management practices (n = 18) and athletics constituent support (n = 8). This exploratory study observed proportions of surveyed HS ATs that had not seen the 2021 Consensus Statements and were not confident in implementing them. Findings highlight the need to continue improving messaging about access to best-practice recommendations. Further, continued efforts inclusive of active and passive dissemination strategies across all athletics constituents are needed to aid proper implementation.
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Affiliation(s)
- Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jake C. Diana
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - William M. Adams
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, CO, United States of America
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO, United States of America
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States of America
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Aliza K. Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Scarneo-Miller SE, Adams WM, Coleman KA, Lopez RM. Exertional Heat Illness: Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators. Sports Health 2024; 16:58-69. [PMID: 36872595 PMCID: PMC10732114 DOI: 10.1177/19417381231155107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Little is known about the adoption by athletic administrators (AAs) of exertional heat illness (EHI) policies, and the corresponding facilitators and barriers of such policies within high school athletics. This study describes the adoption of comprehensive EHI policies by high school AAs and explores factors influencing EHI policy adoption. HYPOTHESIS We hypothesized that <50% of AAs would report adoption of an EHI policy, and that the most common facilitator would be access to an athletic trainer (AT), whereas the most common barrier would be financial limitations. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 4. METHODS A total of 466 AAs (82.4% male; age, 48 ± 9 years) completed a validated online survey to assess EHI prevention and treatment policy adoption (11 components), as well as facilitators and barriers to policy implementation. Access to athletic training services was ascertained by matching the participants' zip codes with the Athletic Training Locations and Services Project. Policy adoption, facilitators, and barriers data are presented as summary statistics (proportions, interquartile range (IQR)). A Welch t test evaluated the association between access to athletic training services and EHI policy adoption. RESULTS Of the AAs surveyed, 77.9% (n = 363) reported adopting a written EHI policy. The median of EHI policy components adopted was 5 (IQR = 1,7), with only 5.6% (n = 26) of AAs reporting adoption of all policy components. AAs who had access to an AT (P = 0.04) were more likely to adopt a greater number of EHI-related policies, compared with those without access to an AT. An AT employed at the school was the most frequently reported facilitator (36.9%). CONCLUSION Most AAs reported having written EHI policy components, and access to an AT resulted in a more comprehensive policy. CLINICAL RELEVANCE Employment of an AT within high school athletics may serve as a vital component in facilitating the adoption of comprehensive EHI policies.
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Affiliation(s)
| | - William M. Adams
- Division of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado
| | - Kelly A. Coleman
- Department of Health and Movement Sciences, Southern Connecticut State University, New Haven, Connecticut
| | - Rebecca M. Lopez
- University of South Florida, School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, Tampa, Florida
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Adams WM, Hosokawa Y, Scarneo-Miller SE, Belval LN. Enhancing exertional heat stroke patient care: where are we now and where do we need to go? Br J Sports Med 2023:bjsports-2023-106713. [PMID: 37344155 DOI: 10.1136/bjsports-2023-106713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Affiliation(s)
- William M Adams
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, Colorado, USA
- US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
- School of Sport, Exercise and Health Science, Loughborough University, Leicestershire, UK
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | | | - Luke N Belval
- Naval Submarine Medical Research Laboratory, Groton, Connecticut, USA
- Leidos Inc, Reston, Virginia, USA
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Miller KC, Launstein ED, Glovatsky RM. Rectal Temperature Cooling Using 2 Cold-Water Immersion Preparation Strategies. J Athl Train 2023; 58:355-360. [PMID: 36094578 PMCID: PMC11215638 DOI: 10.4085/1062-6050-0248.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Cold-water immersion (CWI) is essential to treat patients with exertional heatstroke (EHS). Experts recommend that patients with EHS be immersed in water between 1.7°C and 15°C within 30 minutes of collapse. Some clinicians fill cooling tubs several hours before exercise, keep the tub in hot conditions, and then add ice in the event of an EHS emergency. No data exist on whether adding ice to water at the time of treatment is as effective as keeping water in the recommended range. OBJECTIVES To (1) compare the cooling rates of individuals immersed in a water bath kept at 10°C (CON) or 17°C water with 75.7 L (20 gal) of ice added to it immediately upon immersion (ICE) and (2) examine perceptual responses before, during, and after cooling. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twelve individuals (7 men, 5 women; age = 22 ± 2 years, height = 176.0 ± 12.8 cm, mass = 74.5 ± 10.6 kg). INTERVENTIONS Participants exercised in the heat until rectal temperature was 39.5°C. They then immersed themselves in CON (initial water volume = 681 ± 7.6 L, 10.0°C ± 0.03°C) or ICE (initial water volume = 605.7 ± 7.6 L water at 17.0°C ± 0.03°C with 75.7 L ice) until rectal temperature was 38°C. Thermal sensation and environmental symptoms questionnaire (ESQ) responses were recorded before, during, and after exercise and cooling. MAIN OUTCOME MEASURE(S) Rectal temperature cooling rates, thermal sensation, ESQ responses. RESULTS Participants exercised for similar durations (CON = 39.6 ± 18.2 minutes, ICE = 38.8 ± 14.3 minutes, Z11 = 0.94, P = .38) and had similar thermal sensation and ESQ scores immediately postexercise each day (P values > .05). They cooled quickly and at similar rates in both conditions (CON = 0.20°C ± 0.06°C/min, ICE = 0.21°C ± 0.12°C/min, t12 = 0.72, P = .49). Perception data were similar between conditions during and after cooling (P < .05). CONCLUSIONS Clinicians can cool patients with EHS quickly by adding ice to water that has warmed to above expert recommendations. Adding ice to a water bath at the time of EHS emergencies could save time, energy, and resources instead of always maintaining water bath temperatures within expert-recommended ranges.
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Affiliation(s)
- Kevin C. Miller
- Department of Health and Human Performance, Texas State University, San Marcos
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Garrett B, Lopez RM, Szymanski MR, Eidt D. Proper Recognition and Management of Exertional Heat Stroke in a High School Cross-Country Runner: A Validation Clinical Case Report. J Athl Train 2022; 57:586-591. [PMID: 35969664 DOI: 10.4085/1062-6050-0462.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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 assessed the patient, who presented with difficulty breathing and then other signs of EHS (eg, confusion and agitation). The patient was taken to the medical area and 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 was called. The patient was submerged in a cold-water immersion tub until emergency medical services 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. She was not admitted and returned to running without sequelae. Following best practices, secondary school athletic trainers can prevent deaths from EHS by properly recognizing the condition and providing rapid cooling before transport.
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Affiliation(s)
- Bryanna Garrett
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
| | | | - Drew Eidt
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
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Shao F, Shi X, Huo SH, Liu QY, Shi JX, Kang J, Gong P, Yan ST, Wang GX, Qin LJ, Wang F, Feng K, Chen FY, Yin YJ, Ma T, Li Y, Wu Y, Cui H, Yu CX, Yang S, Gan W, Wang S, Du LYZ, Zhao MC, Tang ZR, Zhao S. Development and evaluation of a predictive nomogram for survival in heat stroke patients: a retrospective cohort study. World J Emerg Med 2022; 13:355-360. [PMID: 36119776 PMCID: PMC9420659 DOI: 10.5847/wjem.j.1920-8642.2022.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/26/2022] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND This study aimed to establish an effective nomogram to predict the survival of heat stroke (HS) based on risk factors. METHODS This was a retrospective, observational multicenter cohort study. We analyzed patients diagnosed with HS, who were treated between May 1 and September 30, 2018 at 15 tertiary hospitals from 11 cities in Northern China. RESULTS Among the 175 patients, 32 patients (18.29%) died before hospital discharge. After the univariate analysis, mechanical ventilation, initial mean arterial pressure <70 mmHg, maximum heart rate, lab results on day 1 (white blood cell count, alanine aminotransferase, creatinine), and Glasgow admission prediction score were included in multivariate analysis. Multivariate Cox regression showed that invasive ventilation, initial mean arterial pressure <70 mmHg (1 mmHg=0.133 kPa), and Glasgow admission prediction score were independent risk factors for HS. The nomogram was established for predicting 7-d and 14-d survival in the training cohort. The nomogram exhibited a concordance index (C-index) of 0.880 (95% confidence interval [95% CI] 0.831-0.930) by bootstrapping validation (B=1,000). Furthermore, the nomogram performed better when predicting 14-d survival, compared to 7-d survival. The prognostic index cut-off value was set at 2.085, according to the operating characteristic curve for overall survival prediction. The model showed good calibration ability in the internal and external validation datasets. CONCLUSION A novel nomogram, integrated with prognostic factors, was proposed; it was highly predictive of the survival in HS patients.
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Affiliation(s)
- Fei Shao
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
- Department of Emergency Medicine, Hebei Yanda Hospital, Langfang 065201, China
| | - Xian Shi
- Department of Emergency Medicine, Beijing Huairou Hospital, Beijing 101400, China
| | - Shu-hua Huo
- Department of Emergency Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Qing-yu Liu
- Department of Emergency Medicine, Hebei Yanda Hospital, Langfang 065201, China
| | - Ji-xue Shi
- Department of Emergency Medicine, the Second Affiliated Hospital of Shandong First Medical University, Tai’an 271000, China
| | - Jian Kang
- Department of Emergency Medicine, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Ping Gong
- Department of Emergency Medicine, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Sheng-tao Yan
- Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Guo-xing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Beijing 100050, China
| | - Li-jie Qin
- Department of Emergency Medicine, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Fei Wang
- Department of Emergency Medicine, Beijing Tsinghua Changung Hospital, Beijing 102218, China
| | - Ke Feng
- Department of Emergency Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Feng-ying Chen
- Department of Emergency Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yong-jie Yin
- Department of Emergency Medicine, the Second Hospital of Jilin University, Changchun 130021, China
| | - Tao Ma
- Department of Emergency Medicine, the First Hospital of China Medical University, Shenyang 110001, China
| | - Yan Li
- Department of Emergency Medicine, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Yang Wu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hao Cui
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Chang-xiao Yu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Song Yang
- Department of Emergency Medicine, Beijing Huairou Hospital, Beijing 101400, China
| | - Wei Gan
- Department of Big Data Research, Goodwill Hessian Health Technology Co., Ltd., Beijing 100085, China
| | - Sai Wang
- Department of Big Data Research, Goodwill Hessian Health Technology Co., Ltd., Beijing 100085, China
| | - Liu-ye-zi Du
- Department of Big Data Research, Goodwill Hessian Health Technology Co., Ltd., Beijing 100085, China
| | - Ming-chen Zhao
- School of Public Health, Peking University, Beijing 100083, China
| | - Zi-ren Tang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
- Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing 100020, China
| | - Shen Zhao
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Adams WM, Hosokawa Y, Casa DJ, Périard JD, Racinais S, Wingo JE, Yeargin SW, Scarneo-Miller SE, Kerr ZY, Belval LN, Alosa D, Csillan D, LaBella C, Walker L. Roundtable on Preseason Heat Safety in Secondary School Athletics: Heat Acclimatization. J Athl Train 2021; 56:352-361. [PMID: 33878177 DOI: 10.4085/1062-6050-596-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide best-practice recommendations for developing and implementing heat-acclimatization strategies in secondary school athletics. DATA SOURCES An extensive literature review on topics related to heat acclimatization and heat acclimation was conducted by a group of content experts. Using the Delphi method, action-oriented recommendations were developed. CONCLUSIONS A period of heat acclimatization consisting of ≥14 consecutive days should be implemented at the start of fall preseason training or practices for all secondary school athletes to mitigate the risk of exertional heat illness. The heat-acclimatization guidelines should outline specific actions for secondary school athletics personnel to use, including the duration of training, the number of training sessions permitted per day, and adequate rest periods in a cool environment. Further, these guidelines should include sport-specific and athlete-specific recommendations, such as phasing in protective equipment and reintroducing heat acclimatization after periods of inactivity. Heat-acclimatization guidelines should be clearly detailed in the secondary school's policy and procedures manual and disseminated to all stakeholders. Heat-acclimatization guidelines, when used in conjunction with current best practices surrounding the prevention, management, and care of secondary school student-athletes with exertional heat stroke, will optimize their health and safety.
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Affiliation(s)
- William M Adams
- Hydration, Environment, and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Julien D Périard
- Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia
| | - Sebastien Racinais
- Research and Scientific Support Department, ASPETAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia
| | | | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas
| | - Denise Alosa
- Athletic Medicine, South Burlington School District, Burlington, VT.,College of Nursing and Health Science, University of Vermont, Burlington
| | - David Csillan
- Department of Physical Therapy, Princeton Orthopedic Associates, NJ
| | - Cynthia LaBella
- Department of Pediatrics, Northwestern University Feinberg School of Medicine Institute for Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL
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Adams WM, Hosokawa Y, Casa DJ. Preseason Heat Safety in Secondary School Athletics. J Athl Train 2021; 56:349-351. [PMID: 33878176 DOI: 10.4085/1062-6050-430-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- William M Adams
- Hydration, Environment and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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Miller KC, Adams WM. Common body temperature sites provide invalid measures of body core temperature in hyperthermic humans wearing American football uniforms. Temperature (Austin) 2020; 8:166-175. [PMID: 33997115 PMCID: PMC8098066 DOI: 10.1080/23328940.2020.1829940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022] Open
Abstract
Valid body core temperature measurements are essential for diagnosing and monitoring athletes with exertional heat stroke (EHS). Experts question the validity of body temperature sites that vary by >±0.27°C from the gold standard, rectal temperature (TREC). No research has established the validity of body temperature sites when American football uniforms (PADS) are worn during simulated EHS scenarios. Thirteen men (age, 22 ± 2 y; mass, 77.5 ± 8.8 kg; height, 181.3 ± 5.7 cm) donned PADS and entered an environmental chamber (38.7 ± 0.8°C, 38.9 ± 2.4% relative humidity). We compared TREC to a forehead liquid crystal temperature monitor (TFHD), axillary (TAXL), oral (TORL), and aural temperatures (TEAR) 34 times over four consecutive periods: 10-minutes of rest; exercise until participants TREC was between 39.7°C and 39.8°C; cold-water immersion (CWI, 10.0 ± 0.1°C) until all temperature sites indicated ≤38°C; and a 15-minute post-immersion recovery period. Body temperatures varied between sites during all periods (F36,432 ≥ 2.5, P ≤ 0.001). TAXL and TORL statistically differed from TREC and exceeded the 0.27°C bias threshold at all 34 measurement times (100%). TFHD differed from TREC eight times during rest; eight times during exercise; 0 times during CWI; and twice during recovery (18/34, 53%). TFHD exceeded the bias threshold 28 times (82%). TEAR differed from TREC five times during rest; 0 times during exercise; five times during CWI; and once during recovery (11/34, 32%). TEAR exceeded the 0.27°C bias threshold 15 times during testing (44%). TAXL, TFHD, TEAR, and TORL should not be used to diagnose or monitor American football players with EHS. Abbreviations ANOVA: analysis of variance; CWI: cold water immersion; EHS: exertional heatstroke; PADS: full American football uniform consisting of a helmet; shoulder, knee, thigh, hip and tailbone pads; a jersey top; undergarments; and half-length pants; TAXL: axillary temperature; TEAR: aural temperature; TFHD: liquid crystal temperature monitor; TORL: oral temperature; TREC: rectal temperature.
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Affiliation(s)
- Kevin C. Miller
- School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant, MI, USA
| | - William M. Adams
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
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