Exertional Heat Stroke of Max Gilpin; A Preventable Death

Abstract

Exertional heat stroke (EHS) is a medical emergency whose likelihood in sport settings is often contingent on environmental factors, team policies, coaching strategies, and broader cultural expectations. Moreover, when it occurs, it requires immediate recognition, proper management, and care to optimize chances of survival or recovery without long-term sequelae. Max Gilpin, a secondary school American football player from Louisville, Kentucky, suffered an EHS during a football practice in August 2008, an event that resulted in his death. The purpose of this article is to use interdisciplinary methods to identify key factors that contributed to this tragedy so that similar situations do not happen again. It concludes that within a culture of inclusive gender norms and care, efforts should be made to have appropriate onsite medical expertise available to develop and implement best practices for the prevention, management, and treatment of EHS, along with coaching education specific to medical emergencies in sport and physical activity (such as EHS). This will create an environment that promotes health and safety for all student athletes participating in sport at the secondary school level.

Preseason Heat Safety in Secondary School Athletics

“…In other instances, when 1 or more aspects of the management and care lapsed, either recovery was prolonged or the event proved catastrophic. 7,16 These EHS-management and -care strategies have proven effective in reducing the EHS risk and ensuring survival if an individual experiences EHS; however, noted gaps in the current evidence-based best practices warrant further exploration and development. For heat acclimatization, the published recommendations are specific to American football, 12 which may limit their direct application to other sports that require a different type of training (eg, crosscountry).…”

Environmental Injuries: Hyperthermia and Hypothermia

“…However, there are less invasive methods that seem to pertain to sport such as "aural, tympanic, oral, temporal, forehead, and axillary" (Pryor, 2013, p. 271). Any reading above 40.5°C is EHS and is considered a medical emergency (Adams, 2019). Immediate medical attention is required because the longer the core temperature is above 40.5°C, the greater the chance of death or long-term implications (Pryor, 2013).…”

“…During CWI immersion treatment, rectal temperature should be monitored to ensure the athlete is cooling sufficiently (Pryor, 2013). The gold standard for cooling time is to have the individual cool down by 0.22°C•min-1 (Adams, 2019). It is critical that the patient is cooled in less than thirty minutes to prevent any life-threatening implications (Pryor, 2013).…”

“…Alternatively, other cooling modalities have been shown to be effective in treating individuals with EHS. Tarp assisted cooling (TACo) is an abbreviated version of cold water immersion which reduces body temperature above the accepted cooling rate (Adams, 2019). In the absence of a stationary cooling tub, TACo can serve as an alternative method to treat EHS on-site.…”

“…In the absence of a stationary cooling tub, TACo can serve as an alternative method to treat EHS on-site. TACo utilizes a tarp and allows the individual to lay in a semi-recumbent position while ice and water is poured over their body (Adams, 2019). Further cooling modalities used to treat exertional heat exhaustion include placing ice packs on main arteries, misting, or seated rest (Pryor, 2013).…”