Epidemiology of exertional heat illnesses in organised sports: A systematic review

Gamage, Prasanna; Fortington, Lauren V; Finch, Caroline F.

doi:10.1016/j.jsams.2020.02.008

Cited by 42 publications

(30 citation statements)

References 70 publications

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“…We consider that this is strong justification for a rethink on prevention strategies particularly given that for every exertional heat fatality there are likely to be several near miss cases. At present, we do not have suitable data for a fatality-to -near-miss ratio within Australia or directly related to sport, 5,22 though evidence from other studies suggest the near miss numbers could be substantial; a 5-year study focused on heat illness in the Grand Canyon, USA, identified 6 deaths and 474 non-fatal heat illness. 23 Noted in the introduction is a lack of agreed and consistent terminology for heat morbidity in active populations.…”

Section: Equipmentmentioning

confidence: 85%

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Exertional heat fatalities in Australian sport and recreation

Fortington

Gamage

Cartwright

et al. 2021

Journal of Science and Medicine in Sport

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Objectives: To describe the number and case characteristics of sport and recreation-related exertional heat deaths in Australia and summarise recommendations derived from case narratives. Design: Descriptive, population-based, retrospective cohort study. Methods: Cases were identified using the National Coronial Information System (NCIS) through multiple search strategies comprising queries, keywords and cause of death codes. Cases were included where there was evidence that the deceased was actively engaged in sport or recreation and exertional heat illness was causal or contributory to the death. Data extraction were performed independently, in duplicate, to ensure accuracy. Descriptive statistics are used to report deceased's socio-demographic characteristics, incident characteristics, type of sport/recreational activity and time sequence of events. Content analysis is used to summarise recommendations. Results: Thirty-eight deaths (males n = 29, 74%; median age = 40 years, range 8-77) were identified during the study period (2001 to 2018), with 22 recommendations for five cases. Two cases occurred during organised sport and 36 during active recreation, of which 27 were in hiking. Eleven (29%) individuals were international visitors. There were 22 recommendations across 5 cases presented, with a focus on education and training. Conclusions: Exertional heat deaths in outdoor recreation in Australia were far more prevalent than cases in organised sport. The largest proportion of deaths occurred in hiking with two populations featuring: males aged 15-45 years and international visitors. Considering the incident characteristics and time sequence of events, measures such as early recognition of symptoms, provision of first aid and timely access to emergency medical care are important to prevent fatalities.

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Section: Equipmentmentioning

confidence: 85%

“…4 Epidemiological studies of heat injury in sport were recently summarised in a systematic review, where an increased trend in deaths over the last three decades was noted. 5 The review also highlighted a general lack of detailed sport-specific information on cases, particularly outside of the USA.…”

Section: Introductionmentioning

confidence: 99%

Exertional heat fatalities in Australian sport and recreation

Fortington

Gamage

Cartwright

et al. 2021

Journal of Science and Medicine in Sport

Self Cite

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“…From a training perspective, additional workload monitoring tools such as GPS devices and force plate testing (external) and/or subjective ratings and heart rate monitors (internal) should be used if available to continue the workload tracking during conditioning sessions and field practice. Additionally, heart rate monitoring technology can be used to more closely monitor any potential heat injury issues during practice [ 64 , 65 , 66 , 67 ].…”

Section: Phasesmentioning

confidence: 99%

COVID-19 Surveillance and Competition in Sport: Utilizing Sport Science to Protect Athletes and Staff during and after the Pandemic

Hagen

Stone

Hornsby

et al. 2020

JFMK

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The ongoing Coronavirus 2 (COVID-19) pandemic abruptly halted athletic competition and standard training practices, consequently generating great confusion surrounding when and how to safely reintroduce sports. Therefore, tangible solutions disseminated to performance staff, coaches, and athletes are warranted to ensure optimal levels of health and physical performance for all personnel during both the current social distancing standards as well as the impending return of competition despite continued risks. In this commentary, we offer strategies for utilizing technology and data tools as components of longitudinal COVID-19 surveillance based on ongoing research efforts as well as current guidance from governing bodies, while also serving the performance needs of the athletes and staff. Recommended data sources include digital symptom and well-being surveys, standardized and routine physical performance testing, sleep and sleep physiology monitoring, cognitive applications, and temperature. This system is flexible to numerous commercially available products and is designed for easy implementation that permits instant feedback provided directly to the athlete as well as their support staff for early intervention, ultimately mitigating COVID-19 risks. We will discuss multiple options, including examples of data, data visualizations and recommendations for data interpretation and communication.

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“…A growing abundance of applied sport science initiatives include strategies for mitigating the deleterious effects of heat stress, which are preventable through the implementation of proper training and effective heat stress monitoring (HSM) protocols. The ramifications of heat stress, such as heat-induced severe cramping, edema, rhabdomyolysis, or heat strokes to name a few, are often characterized as exertional heat illnesses (EHI) [ 1 , 2 , 3 , 4 ], and arise when homeostasis cannot maintain a core body temperature beneath 40.5 °C (considered as excessive elevations in core body temperature during physical exertion). This process is primarily achieved through constant heat exchange between the human body and the ambient environment via evaporation, radiation, convection, and conduction [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, the National Collegiate Athletic Association (NCAA) recently made drastic alterations to the practice specifications (e.g., number of practices per day, amount of collision contact) permitted during preseason training camp periods. The NCAA’s deliberate attempt to mitigate EHI is a result of the increased awareness surrounding EHI in athletes [ 1 , 2 , 6 , 12 ], which ultimately stem from tragic events that saturated mainstream media including but not limited to the deaths of pro-bowl offensive tackle, Korey Stringer, in August of 2001 and University of Maryland football athlete, Jordan McNair, who sustained an EHI in May 2018, and succumbed in June 2018. Both athletes suffered exertional heat strokes during the summer months.…”

Section: Introductionmentioning

confidence: 99%

Test and Evaluation of Heart Rate Derived Core Temperature Algorithms for Use in NCAA Division I Football Athletes

Hagen

Himmler

Clark

et al. 2020

JFMK

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The purpose of this study was to assess the validity of utilizing heart rate to derive an estimate of core body temperature in American Football athletes. This was evaluated by combining commercially available Zephyr Bioharness devices, which includes an embedded estimated core temperature (ECT) algorithm, and an ingestible radio frequency core temperature pill during the highest heat injury risk timepoint of the season, summer training camp. Results showed a concordance of 0.643 and 78% of all data points fell within +/−1.0 °F. When the athletes were split into Upper (>/=6.0%) and Lower (<6.0%) body composition groups, there was a statistical improvement in accuracy with the Upper Body Fat% reaching 0.834 concordance and 93% of all values falling within +/−1.0 °F of the Gold Standard. Results suggest that heart rate derived core temperature assessments are a viable tool for heat stress monitoring in American football, but more work is required to improve on accuracy based on body composition.

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Epidemiology of exertional heat illnesses in organised sports: A systematic review

Cited by 42 publications

References 70 publications

Exertional heat fatalities in Australian sport and recreation

Exertional heat fatalities in Australian sport and recreation

COVID-19 Surveillance and Competition in Sport: Utilizing Sport Science to Protect Athletes and Staff during and after the Pandemic

Test and Evaluation of Heart Rate Derived Core Temperature Algorithms for Use in NCAA Division I Football Athletes

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