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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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Hosokawa Y, Akama T. Navigating implementation barriers: a holistic approach to improving exertional heat stroke management. BMJ Open Sport Exerc Med 2024; 10:e001861. [PMID: 38420116 PMCID: PMC10900327 DOI: 10.1136/bmjsem-2023-001861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives To assess the shift in medical volunteers' perception and practice surrounding exertional heat stroke (EHS) prehospital management after the Tokyo 2020 Olympic Games. Methods An online survey was sent to medical volunteers assigned to work at high EHS risk events during the Tokyo 2020 Olympic Games. Surveys were sent at the time of initial training, immediately after the Games, and one year after the Games. The survey investigated medical volunteers' perceptions and practices regarding the assessment of rectal temperature and the use of whole-body cold water immersion (CWI) as prehospital management of EHS. In addition, an open-ended question was prepared to examine barriers and facilitators of their chosen perception and/or behaviour. Results The lack of knowledge about rectal temperature assessment improved over time, but the actual implementation did not. Meanwhile, increased utilisation of CWI was observed 1 year after the Games. The lack of equipment, apprehension towards rectal temperature assessment, the perception of difficulty getting patient consent, concerns for hypothermic overshoot and the number of required medical providers were raised as barriers to implementation. Conclusion Some improvements were observed in perception and practice; however, further organisational and financial support is warranted for a broader skill transfer and implementation.
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Affiliation(s)
- Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Takao Akama
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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Flouris AD, Notley SR, Stearns RL, Casa DJ, Kenny GP. Recommended water immersion duration for the field treatment of exertional heat stroke when rectal temperature is unavailable. Eur J Appl Physiol 2024; 124:479-490. [PMID: 37552243 DOI: 10.1007/s00421-023-05290-5] [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] [Received: 05/01/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION The recommended treatment for exertional heat stroke is immediate, whole-body immersion in < 10 °C water until rectal temperature (Tre) reaches ≤ 38.6 °C. However, real-time Tre assessment is not always feasible or available in field settings or emergency situations. We defined and validated immersion durations for water temperatures of 2-26 °C for treating exertional heat stroke. METHODS We compiled data for 54 men and 18 women from 7 previous laboratory studies and derived immersion durations for reaching 38.6 °C Tre. The resulting immersion durations were validated against the durations of cold-water immersion used to treat 162 (98 men; 64 women) exertional heat stroke cases at the Falmouth Road Race between 1984 and 2011. RESULTS Age, height, weight, body surface area, body fat, fat mass, lean body mass, and peak oxygen uptake were weakly associated with the cooling time to a safe Tre of 38.6 °C during immersions to 2-26 °C water (R2 range: 0.00-0.16). Using a specificity criterion of 0.9, receiver operating characteristics curve analysis showed that exertional heat stroke patients must be immersed for 11-12 min when water temperature is ≤ 9 °C, and for 18-19 min when water temperature is 10-26 °C (Cohen's Kappa: 0.32-0.75, p < 0.001; diagnostic odds ratio: 8.63-103.27). CONCLUSION The reported immersion durations are effective for > 90% of exertional heat stroke patients with pre-immersion Tre of 39.5-42.8 °C. When available, real-time Tre monitoring is the standard of care to accurately diagnose and treat exertional heat stroke, avoiding adverse health outcomes associated with under- or over-cooling, and for implementing cool-first transport second exertional heat stroke policies.
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Affiliation(s)
- Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Defence Science and Technology Group, Melbourne, VIC, Australia
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Montpetit Hall, 125 University Private, Room 367, Ottawa, ON, K1N 6N5, Canada.
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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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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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