Cooling Rates of Hyperthermic Humans Wearing American Football Uniforms When Cold-Water Immersion Is Delayed

Miller, Kevin; Mango, Timothy A. Di; Katt, Grace E.

doi:10.4085/1062-6050-398-17

Cited by 7 publications

(4 citation statements)

References 36 publications

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“…This standard-of-care management strategy is easy and quick to implement. Cold-water immersion may be just as effective without removal of football padding, 13,14 yet removing protective equipment permits optimal cooling because the body surface area exposed to the cooling modality is maximized. However, if the patient is combative or exhibiting aggressive behavior, initiating cooling with protective equipment on and then removing it during the cooling process may allow for a more rapid temperature reduction.…”

Section: Removal Of Protective Equipmentmentioning

confidence: 99%

“…[9][10][11][12] Once EHS is confirmed (rectal temperature .40.58C with obvious central nervous system dysfunction), rapid, wholebody cooling using cold-water immersion (CWI) until internal body temperature (ie, rectal temperature) reaches 38.98C is recommended before the patient is transported for higher-level medical care. 2 Researchers 13,14 have demonstrated that adequate rates of cooling (0.28C/min) can occur with CWI, even while wearing protective equipment.…”

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confidence: 99%

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Exertional Heat-Stroke Management Practices and Intentions Among Secondary School Football Athletic Trainers

Nedimyer

Chandran

Hirschhorn

et al. 2020

Journal of Athletic Training

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Context Athletic trainers (ATs) are educated and trained in appropriate exertional heat-stroke (EHS) management strategies, yet disparities may exist between intended and actual uses in clinical practice. Objective To examine the intended and actual uses of EHS management strategies among those who did and those who did not treat patients with suspected cases of EHS during the 2017 high school (HS) American football preseason. Design Cross-sectional study. Setting Online questionnaire. Patients or Other Participants A total of 1016 ATs who oversaw patient care during the 2017 HS American football preseason. Main Outcome Measure(s) Responding HS ATs recorded whether they had or had not managed patients with suspected EHS events during the 2017 HS American football preseason. Those who had managed patients with suspected cases of EHS reported the management strategies used; those who had not managed such patients described their intended management strategies. For each management strategy, z tests compared the proportions of actual use among ATs who managed patients with suspected EHS with proportions of intended use among ATs who did not manage such patients. Results Overall, 124 (12.2%) ATs treated patients with suspected EHS cases during the 2017 HS American football preseason. Generally, the proportions of intended use of management strategies among ATs who did not treat patients with suspected EHS were higher than the actual use of those strategies among ATs who did. For example, ATs who did not treat patients with suspected EHS were more likely than those who did not treat such patients to intend to take rectal temperature (19.6% versus 3.2%, P < .001) and immerse the athlete in ice water (90.1% versus 51.6%, P < .001). Conclusions Inconsistencies occurred between intended and actual use of EHS management strategies. The standard of care for managing patients with suspected cases of EHS were not consistently used in clinical practice, although ATs who did not treat EHS stated they intended to use these management strategies more frequently. Future researchers should identify factors that preclude ATs from using the standard of care when treating patients with suspected cases of EHS.

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Section: Removal Of Protective Equipmentmentioning

confidence: 99%

mentioning

confidence: 99%

Exertional Heat-Stroke Management Practices and Intentions Among Secondary School Football Athletic Trainers

Nedimyer

Chandran

Hirschhorn

et al. 2020

Journal of Athletic Training

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“…Thermal sensation 8,9 is a useful measure for determining the intensity of temperatures experienced by individuals. Similarly, the 16-item environmental symptom questionnaire (ESQ) [10][11][12] provides useful information about the severity and presence of heat-related signs or symptoms (e.g., lightheadedness, feverish). Authors have used these scales to identify whether individuals experience higher or lower degrees of thermal stress 10,13 and the usefulness of various treatments.…”

Section: Introductionmentioning

confidence: 99%

Excellent Rectal Temperature Cooling Rates in the Polar Life Pod Consistent With Stationary Tubs

Miller

Amaria

2022

Journal of Athletic Training

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Context Several tools exist to reduce rectal temperature (TREC) quickly for patients experiencing exertional heatstroke (EHS). Stationary tubs effectively treat EHS but are bulky and impractical in some situations. More portable cold-water immersion techniques, such as tarp-assisted cooling with oscillation, are gaining popularity because of their benefits (eg, less water needed, portability). The Polar Life Pod (PLP) may be another portable way to reduce TREC, but few researchers have examined its effectiveness. Objectives To determine whether the PLP and stationary tub reduced TREC at acceptable or ideal rates, whether TREC cooling rates differed by method, and how participants felt before, during, and after cooling. Design Randomized crossover study. Setting Laboratory. Patients or Other Participants Thirteen individuals (8 men, 5 women; age = 21 ± 2 years, mass = 73.99 ± 11.24 kg, height = 176.2 ± 11.1 cm). Intervention(s) Participants exercised in the heat until TREC was 39.5°C. They immersed themselves in either the PLP (202.7 ± 23.8 L, 3.2 ± 0.6°C) or a stationary tub (567.8 ± 7.6 L, 15.0 ± 0.1°C) until TREC was 38°C. Thermal sensation and environmental symptom questionnaire (ESQ) responses were recorded before, during, and after exercise and cooling. Main Outcome Measure(s) Rectal temperature cooling rates, thermal sensation, and ESQ responses. Results Participants had similar exercise durations (PLP = 41.6 ± 6.9 minutes, tub = 42.2 ± 9.3 minutes, t12 = 0.5, P = .31), thermal sensation scores (PLP = 7.0 ± 0.5, tub = 7.0 ± 0.5, P > .05), and ESQ scores (PLP = 25 ± 13, tub = 29 ± 14, P > .05) immediately postexercise each day. Although TREC cooling rates were excellent in both conditions, the PLP cooled faster than the stationary tub (PLP = 0.28 ± 0.09°C/min, tub = 0.20 ± 0.09°C/min, t12 = 2.5, P = .01). Thermal sensation in the PLP condition was lower than that in the tub condition halfway through cooling (PLP = 1 ± 1, tub = 2 ± 1, P < .05) and postcooling (PLP = 2 ± 1, tub = 3 ± 1, P < .05). The ESQ scores were higher for PLP than for the stationary tub postcooling (PLP = 25 ± 14, tub = 12 ± 9, P < .05). Conclusions The PLP and the stationary tub cooled individuals with hyperthermia at ideal rates for treating patients with EHS (ie, >0.16°C/min). The PLP may be an effective tool for treating EHS when limited water volumes and portability are concerns. Clinicians should have rewarming tools and strategies (eg, heating blankets) available to improve patients' comfort after PLP use.

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“…Mental status and vital signs (including rectal temperature) guide the cooling treatment of exertional heat illness causalities (45,56,61,132).…”

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confidence: 99%

ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity

Roberts

Armstrong

Sawka

et al. 2023

Curr Sports Med Rep

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Exertional heat stroke is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and exertional heat stroke. Identifying the athlete with suspected exertional heat stroke early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from exertional heat stroke is variable and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

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Cooling Rates of Hyperthermic Humans Wearing American Football Uniforms When Cold-Water Immersion Is Delayed

Cited by 7 publications

References 36 publications

Exertional Heat-Stroke Management Practices and Intentions Among Secondary School Football Athletic Trainers

Exertional Heat-Stroke Management Practices and Intentions Among Secondary School Football Athletic Trainers

Excellent Rectal Temperature Cooling Rates in the Polar Life Pod Consistent With Stationary Tubs

ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity

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