Roundtable on Preseason Heat Safety in Secondary School Athletics: Prehospital Care of Patients With Exertional Heat Stroke

Abstract

Objective First, we will update recommendations for the prehospital management and care of patients with exertional heat stroke (EHS) in the secondary school setting. Second, we provide action items to aid clinicians in developing best-practice documents and policies for EHS. Third, we provide practical strategies clinicians can use to implement best practice for EHS in the secondary school setting. Data Sources An interdisciplinary work group of scientists, physicians, and athletic trainers evaluated the current literature regarding the prehospital care of EHS patients in secondary schools and developed this narrative review. When published research was nonexistent, expert opinion and experience guided the development of recommendations for implementing life-saving strategies. The workgroup evaluated and further refined the action-oriented recommendations using the Delphi method. Conclusions Exertional heat stroke continues to be a leading cause of sudden death in young athletes and the physically active. This may be partly due to the numerous barriers and misconceptions about the best practice for diagnosing and treating patients with EHS. Exertional heat stroke is survivable if it is recognized early and appropriate measures are taken before patients are transported to hospitals for advanced medical care. Specifically, best practice for EHS evaluation and treatment includes early recognition of athletes with potential EHS, a rectal temperature measurement to confirm EHS, and cold-water immersion before transport to a hospital. With planning, communication, and persistence, clinicians can adopt these best-practice recommendations to aid in the recognition and treatment of patients with EHS in the secondary school setting.

Development and evaluation of a predictive nomogram for survival in heat stroke patients: a retrospective cohort study

“…There have been several studies on the risk factors, pathogenesis, treatment, and prevention of HS, such as evidence within sports medicine to support good prognosis with proper management and care, [8][9][10] but little is known about how to determine the prognosis of HS early. Moreover, the lack of early, noninvasive, predictable biomarkers of organ damage hinders the identification of timely and effective treatments to mitigate it.…”

Exertional Heat Stroke in a Male High School Runner with Disordered Eating: A Disablement Model Case Study

“…Rectal thermometry is the gold standard of care to assess core body temperature during a heat illness event. 9,[11][12][13][14] Methods such as oral or temporal temperature assessment are inaccurate. 15 However, recent literature still demonstrates that most secondary school ATs do not assess a rectal temperature during suspected cases of EHS.…”

“…15 However, recent literature still demonstrates that most secondary school ATs do not assess a rectal temperature during suspected cases of EHS. 9,[11][12][13][14] Less than half of surveyed ATs reported that they were comfortable using a rectal thermometer to assess for EHS. 15 In this situation, the ATs wanted to protect themselves in case the parents did not give consent.…”

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

“…Recent studies have examined policies and perceptions related to the prehospital care of EHS in the secondary school setting. [16][17][18]24,27,28 A study 24 analyzing high school athletic association barriers and progress toward implementing health and safety polices within secondary school athletics found executive members of the athletics department had a lack of understanding in mandating a health and safety policy to use at the state level or only making it a recommendation to secondary high schools. 24 Perceived barriers can also strongly impact whether ATs follow best practice.…”