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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.
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.
Context: Lightning-related injuries are among the top ten causes of sport-related death at all levels of sport, including the nearly 8 million athletes participating in secondary school sports. Objective: The purpose of this study was to investigate the adoption of lightning policies and the influencing factors for the development of a comprehensive policy in United States secondary schools. Design: Cross-Sectional. Setting: Secondary School. Patients or Other Participants: Athletic trainers (ATs). Main Outcome Measure(s): An online questionnaire was developed using the NATA Position Statement: Lightning Safety for Athletics and Recreation using a health behavior model, the Precaution Adoption Process Model (PAPM), along with facilitators and barriers to identify current adoption of lightning-related policies and factors influencing adoption of lightning policies. PAPM stage (unaware for need, unaware if have, unengaged, undecided, decided not to act, decided to act, acting, maintaining) responses are presented as frequencies. Chi-square tests of associations and prevalence ratios were calculated to compare respondents in higher and lower vulnerability states, defined based on data regarding lightning-related deaths. Results: The response rate for this questionnaire was 13.43% (n=365), with additional questionnaires completed via social media (n=56). A majority of ATs reported “maintaining” (69%, n=287) and “acting” (6.5%, n=27) a comprehensive lightning policy. Approximately 1 in 4 athletic trainers (25.1%, n=106) reported using flash-to-bang as an evacuation criterion. ATs practicing in higher-vulnerability states were more likely to adopt a lightning policy than those in lower-vulnerability states (57.4% v 42.6%, PR=1.16 (1.03, 1.30); p=0.009). The most commonly reported facilitator and barrier were a requirement from a state high school athletics association and financial limitations, respectively. Conclusions: A majority of ATs reported adopting (e.g., “maintaining” and “acting”) the best practices for lightning safety. However, many AT's also reported continued use of outdated methods (e.g., flash-to-bang).
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