Perceptions of Secondary School Athletic Trainers in the Diagnosis of Exertional Heat Stroke

Exertional Heat Illness: Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators

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.

Proper Recognition and Management of Exertional Heat Stroke in a High School Cross-Country Runner: A Validation Clinical Case Report

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.

High Schools' Adoption of Evidence-Based Practices for the Management of Exertional Heat Stroke

CONTEXT

Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices.

OBJECTIVE

To investigate high schools' adoption of policies and procedures for recognizing and treating patients with EHS and the factors influencing the adoption of a comprehensive policy.

DESIGN

Cross-sectional study.

SETTING

Online questionnaire.

PATIENTS OR OTHER PARTICIPANTS

Athletic trainers (ATs) practicing in the high school (HS) setting.

MAIN OUTCOME MEASURE(S)

Using the National Athletic Trainers' Association position statement on exertional heat illness, we developed an online questionnaire and distributed it to ATs to ascertain their schools' current written policies for using rectal temperature and cold-water immersion. The precaution adoption process model allowed for responses to be presented across the various health behavior stages (unaware if have the policy, unaware of the need for the policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining). Additional questions addressed perceptions of facilitators and barriers. Data are presented as proportions.

RESULTS

A total of 531 ATs completed the questionnaire. Overall, 16.9% (n = 62) reported adoption of all components for the proper recognition and treatment of EHS. The component with the highest adoption level was "cool first, transport second"; 74.1% (n = 110) of ATs described acting on or maintaining the policy. The most variability in the precaution adoption process model responses was for a rectal temperature policy; 28.7% (n = 103) of ATs stated they decided not to act and 20.1% (n = 72) stated they maintained the policy. The most frequently cited facilitator of and barrier to obtaining rectal temperature were a mandate from the state HS athletics association (n = 274, 51.5%) and resistance to or apprehension of parents or legal guardians (n = 311, 58.5%), respectively.

CONCLUSIONS

Athletic trainers in the HS setting appeared to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing as the biggest challenge. Tailored strategies based on health behavior, facilitators, and barriers may aid in changing this paradigm.