Epidemiology of Exertional Heat Illness Among U.S. High School Athletes

Kerr, Zachary Y.; Casa, Douglas J.; Marshall, Stephen W.; Comstock, R. Dawn

doi:10.1016/j.amepre.2012.09.058

Cited by 139 publications

(125 citation statements)

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“…Eighteen participants completed the study (Tables 1 and 2). Volunteers were excluded from participating if they self-reported (1) having an injury that impaired their ability to exercise; (2) having any neurologic, respiratory, or cardiovascular disease; (3) taking any medications that may have affected fluid balance or temperature regulation (eg, diuretics); (4) having a sedentary lifestyle, which was defined as exercising less than 30 minutes, 3 times per week 21 ; (5) having a history of heat-related illness (eg, heat exhaustion) in the 6 months preceding data collection; (6) being ill at the time of data collection; or (7) having cold allergy. All participants provided written informed consent, and the study was approved by the Central Michigan University Institutional Review Board.…”

Section: Methods* Participantsmentioning

confidence: 99%

“…Most AFPs with exertional heat illness are overweight or obese (eg, linemen, linebackers). 6 Moreover, athletes with EHS often have central nervous system dysfunction that may manifest as aggression, irritability, or unconsciousness. 15 Therefore, initiating CWI may be easier and safer for individuals treating AFPs with EHS if the athletes are immersed while fully equipped.…”

Section: -15mentioning

confidence: 99%

“…In fact, the rate of exertional heat illness in secondary school AFPs is 11 times higher than that in all other sports combined. 6 If EHS develops and body core temperature stays above the critical threshold for cell damage (approximately 40.58C) longer than 30 minutes, the risk of morbidity and mortality increases. 7,8 Therefore, it is paramount to develop efficient protocols for treating AFPs with hyperthermia.…”

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confidence: 99%

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Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Miller

Long

Edwards

2015

Journal of Athletic Training

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Context: The National Athletic Trainers' Association and the American College of Sports Medicine have recommended removing American football uniforms from athletes with exertional heat stroke before cold-water immersion (CWI) based on the assumption that the uniform impedes rectal temperature (T rec ) cooling. Few experimental data exist to verify or disprove this assumption and the recommendations.Objectives: To compare CWI durations, T rec cooling rates, thermal sensation, intensity of environmental symptoms, and onset of shivering when hyperthermic participants wore football uniforms during CWI or removed the uniforms immediately before CWI.Design: Crossover study. Conclusions: Whereas participants cooled faster in NO pads , we still considered the PADS cooling rate to be acceptable (ie, .0.168C/min). Therefore, if clinicians experience difficulty removing PADS or CWI treatment is delayed, they may immerse fully equipped hyperthermic football players in CWI and maintain acceptable T rec cooling rates. Otherwise, PADS should be removed preimmersion to ensure faster body core temperature cooling.Key Words: clothing, equipment, exertional heat stroke, rectal temperature Key PointsBody core temperature decreased faster when participants wore undergarments, shorts, and crew socks than when they wore the full American football uniform (PADS) without shoes during cold-water immersion (CWI). If CWI is delayed or clinicians have difficulty removing PADS, they can immerse hyperthermic football players in PADS and maintain acceptable core temperature cooling rates. The PADS should be removed before CWI if that can be done properly, easily, and within 30 minutes of athlete collapse.A merican football players (AFPs) may be at higher risk of developing exertional heat stroke (EHS) in part because of the equipment-intensive uniform worn during the sport.1 These athletes compete and often practice while wearing a full uniform consisting of shoes; crew socks; undergarments; shorts; game pants; undershirt; shoulder pads; jersey; helmet; and padding over the thighs, knees, hips, and tailbone (PADS).2,3 The increased metabolic demand and physiologic strain of exercising while wearing PADS, combined with a decreased evaporative surface area to dissipate heat, can result in substantial heat storage 2-5 and may contribute to the development of exertional heat illness. In fact, the rate of exertional heat illness in secondary school AFPs is 11 times higher than that in all other sports combined. 6 If EHS develops and body core temperature stays above the critical threshold for cell damage (approximately 40.58C) longer than 30 minutes, the risk of morbidity and mortality increases. 7,8 Therefore, it is paramount to develop efficient protocols for treating AFPs with hyperthermia.The criterion standard treatment for EHS is cold-water immersion (CWI) because of its superior cooling rates (ie, .0.168C/min) 7,9 and high survival rates when implemented shortly after the onset of symptoms.

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Section: Methods* Participantsmentioning

confidence: 99%

Section: -15mentioning

confidence: 99%

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confidence: 99%

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Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Miller

Long

Edwards

2015

Journal of Athletic Training

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“…E xertional heat stroke (EHS) is one of the most common causes of sudden death among athletes and military personnel. [1][2][3][4] The risk increases during the summer months, when ambient temperature and relative humidity increase. 3 Adding protective equipment further compromises normal thermoregulation.…”

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confidence: 99%

Cooling Effectiveness of a Modified Cold-Water Immersion Method After Exercise-Induced Hyperthermia

Luhring

Butts

Smith

et al. 2016

Journal of Athletic Training

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Context: Recommended treatment for exertional heat stroke includes whole-body cold-water immersion (CWI). However, remote locations or monetary or spatial restrictions can challenge the feasibility of CWI. Thus, the development of a modified, portable CWI method would allow for optimal treatment of exertional heat stroke in the presence of these challenges.Objective: To determine the cooling rate of modified CWI (tarp-assisted cooling with oscillation [TACO]) after exertional hyperthermia.Design: Randomized, crossover controlled trial. Setting: Environmental chamber (temperature ¼ 33.48C 6 0.88C, relative humidity ¼ 55.7% 6 1.9%).Patients or Other Participants: Sixteen volunteers (9 men, 7 women; age ¼ 26 6 4.7 years, height ¼ 1.76 6 0.09 m, mass ¼ 72.5 6 9.0 kg, body fat ¼ 20.7% 6 7.1%) with no history of compromised thermoregulation.Intervention(s): Participants completed volitional exercise (cycling or treadmill) until they demonstrated a rectal temperature (T re ) !39.08C. After exercise, participants transitioned to a semirecumbent position on a tarp until either T re reached 38.18C or 15 minutes had elapsed during the control (no immersion [CON]) or TACO (immersion in 151 L of 2.18C 6 0.88C water) treatment.Main Outcome Measure(s): The T re , heart rate, and blood pressure (reported as mean arterial pressure) were assessed precooling and postcooling. Statistical analyses included repeated-measures analysis of variance with appropriate post hoc t tests and Bonferroni correction.Results: Before cooling, the T re was not different between conditions (CON: 39.278C 6 0.268C, TACO: 39.308C 6 0.398C; P ¼ .62; effect size ¼À0.09; 95% confidence interval [CI] ¼À0.2, 0.1). At postcooling, the T re was decreased in the TACO (38.108C 6 0.168C) compared with the CON condition (38.748C 6 0.388C; P , .001; effect size ¼ 2.27; 95% CI ¼ 0.4, 0.9). The rate of cooling was greater during the TACO (0.14 6 0.068C/ min) than the CON treatment (0.048C/min 6 0.028C/min; t 15 ¼ À8.84; P , .001; effect size ¼ 2.21; 95% CI ¼ À0.13, À0.08). These differences occurred despite an insignificant increase in fluid consumption during exercise preceding CON (0.26 6 0.29 L) versus TACO (0.19 6 0.26 L; t 12 ¼ 1.73; P ¼ .11; effect size ¼ 0.48; 95% CI ¼ À0.02, 0.14) treatment. Decreases in heart rate did not differ between the TACO and CON conditions (t 15 ¼ À1.81; P ¼ .09; effect size ¼ 0.45; 95% CI ¼ À22, 2). Mean arterial pressure was greater at postcooling with TACO (84.2 6 6.6 mm Hg) than with CON (67.0 6 9.0 mm Hg; P , .001; effect size ¼ 2.25; 95% CI ¼ 13, 21).Conclusions: The TACO treatment provided faster cooling than did the CON treatment. When location, monetary, or spatial restrictions are present, TACO represents an effective alternative to traditional CWI in the emergency treatment of patients with exertional hyperthermia.

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“…[1][2][3][4][5][6] Given that many such deaths are avoidable through proper prevention, recognition, and treatment protocols, those involved with secondary school athletics can benefit from policy considerations regarding health and safety for participation in sport. The health and safety of secondary school athletes is paramount, but barriers that jeopardize the delivery of optimal safety and preventive measures remain prevalent across the secondary school athletic landscape.…”

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confidence: 99%

The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations

Casa

Almquist

Anderson

et al. 2013

Journal of Athletic Training

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Epidemiology of Exertional Heat Illness Among U.S. High School Athletes

Cited by 139 publications

References 15 publications

Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Cooling Effectiveness of a Modified Cold-Water Immersion Method After Exercise-Induced Hyperthermia

The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations

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