Exertional Heat-Stroke Preparedness in High School Football by Region and State Mandate Presence

Abstract

Context Exertional heat stroke (EHS) is a leading cause of sudden death in high school football players. Preparedness strategies can mitigate EHS incidence and severity. Objective To examine EHS preparedness among high school football programs and its association with regional and state preseason heat-acclimatization mandates. Design Cross-sectional study. Setting Preseason high school football programs, 2017. Patients or Other Participants A total of 910 athletic trainers (ATs) working with high school football (12.7% completion rate). Main Outcome Measure(s) We acquired data on high school football programs' EHS preparedness strategies in the 2017 preseason via an online questionnaire, looking at (1) whether schools' state high school athletic associations mandated preseason heat-acclimatization guidelines and (2) heat safety region based on warm-season wet-bulb globe temperature, ranging from the milder region 1 to the hotter region 3. Six EHS-preparedness strategies were assessed: EHS recognition and treatment education; policy for initiating emergency medical services response; emergency response plan enactment; immersion tub filled with ice water before practice; wet-bulb globe temperature monitoring; and hydration access. Multivariable binomial regression models estimated the prevalence of reporting all 6 strategies. Results Overall, 27.5% of ATs described their schools as using all 6 EHS-preparedness strategies. The highest prevalence was in region 3 schools with state mandates (52.9%). The multivariable model demonstrated an interaction in which the combination of higher heat safety region and presence of a state mandate was associated with a higher prevalence of reporting all 6 strategies (P = .05). Controlling for AT and high school characteristics, the use of all 6 strategies was higher in region 3 schools with state mandates compared with region 1 schools without state mandates (52.9% versus 17.8%; prevalence ratio = 2.68; 95% confidence interval = 1.81, 3.95). Conclusions Our findings suggest a greater use of EHS-preparedness strategies in environmentally warmer regions with state-level mandates for preseason heat acclimatization. Future researchers should identify factors influencing EHS preparedness, particularly in regions 1 and 2 and in states without mandates.

Regional Requirements Influence Adoption of Exertional Heat Illness Preparedness Strategies in United States High Schools

“…When state officials and athletics administrators are considering their ability to affect high school student athlete health and safety, we would strongly encourage a state requirement for a heat modification policy that takes into account geographical meteorological conditions, work-to-rest ratios, types, timing and length of physical activity, and protective equipment considerations. Such a requirement appears to have a strong effect on both policy adoption and patient outcomes, as suggested in our results and previous research [ 12 , 18 , 25 , 26 , 27 , 31 ]. These results are paralleled by previous discoveries of Kerr et al [ 18 ], who found that when states required heat acclimatization policies, high schools were more likely to be fully compliant with the NATA Inter-Association Task Force guidelines on heat acclimatization in states that mandated the guidelines.…”

“…In the US, each state can set forth its own set of policy requirements for local high schools to follow. State policies have been shown to be effective at reducing EHS risk and has been identified as a facilitator for local emergency policy adoption [ 12 , 25 , 26 , 27 ]. Despite this, Adams et al [ 28 , 29 ] found that very few states require their high school athletics programs to follow best practice recommendations with regards the prevention and treatment of EHS.…”

From theory to practice: operationalizing a climate vulnerability for sport organizations framework for heat hazards among US High schools

“…A growing body of research supports this assumption by showing that the implementation of policies at the state level has been effective at reducing exertional heat illness rates 4,27 and has also shown success with improving high school adoption of the policies. [28][29][30] Yet, the lack of policy compliance would of course increase vulnerability and local implementation of a policy stronger than the statewide mandate would be protective. Finally, Orr and Inoue 11 point out that the CVSO framework is new and untested.…”

The Evolution of the Athletic Training Profession

“…This information has been widely shared for the past 20 years in NATA sponsored consensus statement, position statements, and education competencies. Yet, recent evidence by Kerr et al (2019) has shown that approximately 50% of ATs working at the high school level recently reported not using CWI to treat EHS. In 2011, the educational competencies for ATs were updated to include the addition of various acute care skills to help stabilize a patient before emergency medical services transport an athlete (Commission on Accreditation of Athletic Training Education, 2011).…”