Football Equipment Removal in an Exertional Heat Stroke Scenario: Time and Difficulty

Long

Edwards

2015

Context: The National Athletic Trainers' Association and the American College of Sports Medicine have recommended removing American football uniforms from athletes with exertional heat stroke before cold-water immersion (CWI) based on the assumption that the uniform impedes rectal temperature (T rec ) cooling. Few experimental data exist to verify or disprove this assumption and the recommendations.Objectives: To compare CWI durations, T rec cooling rates, thermal sensation, intensity of environmental symptoms, and onset of shivering when hyperthermic participants wore football uniforms during CWI or removed the uniforms immediately before CWI.Design: Crossover study. Conclusions: Whereas participants cooled faster in NO pads , we still considered the PADS cooling rate to be acceptable (ie, .0.168C/min). Therefore, if clinicians experience difficulty removing PADS or CWI treatment is delayed, they may immerse fully equipped hyperthermic football players in CWI and maintain acceptable T rec cooling rates. Otherwise, PADS should be removed preimmersion to ensure faster body core temperature cooling.Key Words: clothing, equipment, exertional heat stroke, rectal temperature Key PointsBody core temperature decreased faster when participants wore undergarments, shorts, and crew socks than when they wore the full American football uniform (PADS) without shoes during cold-water immersion (CWI). If CWI is delayed or clinicians have difficulty removing PADS, they can immerse hyperthermic football players in PADS and maintain acceptable core temperature cooling rates. The PADS should be removed before CWI if that can be done properly, easily, and within 30 minutes of athlete collapse.A merican football players (AFPs) may be at higher risk of developing exertional heat stroke (EHS) in part because of the equipment-intensive uniform worn during the sport.1 These athletes compete and often practice while wearing a full uniform consisting of shoes; crew socks; undergarments; shorts; game pants; undershirt; shoulder pads; jersey; helmet; and padding over the thighs, knees, hips, and tailbone (PADS).2,3 The increased metabolic demand and physiologic strain of exercising while wearing PADS, combined with a decreased evaporative surface area to dissipate heat, can result in substantial heat storage 2-5 and may contribute to the development of exertional heat illness. In fact, the rate of exertional heat illness in secondary school AFPs is 11 times higher than that in all other sports combined. 6 If EHS develops and body core temperature stays above the critical threshold for cell damage (approximately 40.58C) longer than 30 minutes, the risk of morbidity and mortality increases. 7,8 Therefore, it is paramount to develop efficient protocols for treating AFPs with hyperthermia.The criterion standard treatment for EHS is cold-water immersion (CWI) because of its superior cooling rates (ie, .0.168C/min) 7,9 and high survival rates when implemented shortly after the onset of symptoms.

Section: -15mentioning

confidence: 99%

Section: -15mentioning

confidence: 99%

mentioning

confidence: 99%

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Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

Long

Edwards

2015

“…This issue requires clarification because removing athletic equipment before CWI may take several minutes depending on personnel, location, and the size and temperament of the athlete. 23 Any reduction in the delay in treatment, regardless of how small, would help clinicians more efficiently treat football athletes with EHS and ensure prompt CWI.…”

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confidence: 99%

Cold-Water Immersion for Hyperthermic Humans Wearing American Football Uniforms

Swartz

Long

2015

Self Cite

We speculate that higher skin temperatures before CWI, less shivering, and greater conductive cooling explained the faster cooling in full uniform. Cooling rates were considered ideal when the full uniform was worn during CWI, and wearing the full uniform did not cause a greater postimmersion hypothermic afterdrop. Clinicians may immerse football athletes with hyperthermia wearing a full uniform without concern for negatively affecting body-core cooling.

“…We chose the 5minute delay because this is the approximate time needed for medical personnel to remove football equipment and obtain T rec during a simulated EHS scenario. 25 The 30minute delay was chosen because experts 4,26 have advised that EHS patients have their T rec reduced to ,38.98C within 30 minutes of collapse. Rectal temperature was measured every 30 seconds during this waiting period.…”

Section: Methodsmentioning

confidence: 99%

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

Mango

Katt

2018

Context Treatment delays can be contributing factors in the deaths of American football athletes from exertional heat stroke. Ideally, clinicians begin cold-water immersion (CWI) to reduce rectal temperature (Trec) to <38.9°C within 30 minutes of collapse. If delays occur, experts recommend Trec cooling rates that exceed 0.15°C/min. Whether treatment delays affect CWI cooling rates or perceptual variables when football uniforms are worn is unknown. Objective To answer 3 questions: (1) Does wearing a football uniform and delaying CWI by 5 minutes or 30 minutes affect Trec cooling rates? (2) Do Trec cooling rates exceed 0.15°C/min when treatment delays have occurred and individuals wear football uniforms during CWI? (3) How do treatment delays affect thermal sensation and Environmental Symptoms Questionnaire responses? Design Crossover study. Setting Laboratory. Patients or Other Participants Ten physically active men (age = 22 ± 2 y, height = 183.0 ± 6.9 cm, mass = 78.9 ± 6.0 kg). Intervention(s) On 2 days, participants wore American football uniforms and exercised in the heat until Trec was 39.75°C. Then they sat in the heat, with equipment on, for either 5 or 30 minutes before undergoing CWI (10.6°C ± 0.1°C) until Trec reached 37.75°C. Main Outcome Measure(s) Rectal temperature and CWI duration were used to calculate cooling rates. Thermal sensation was measured pre-exercise, postexercise, postdelay, and post-CWI. Responses to the Environmental Symptoms Questionnaire were obtained pre-exercise, postdelay, and post-CWI. Results The Trec cooling rates exceeded recommendations and were unaffected by treatment delays (5-minute delay = 0.20°C/min ± 0.07°C/min, 30-minute delay = 0.19°C/min ± 0.05°C/min; P = .4). Thermal sensation differed between conditions only postdelay (5-minute delay = 6.5 ± 0.6, 30-minute delay = 5.5 ± 0.7; P < .05). Environmental Symptoms Questionnaire responses differed between conditions only postdelay (5-minute delay = 27 ± 15, 30-minute delay = 16 ± 12; P < .05). Conclusions Treatment delays and football equipment did not impair CWI's effectiveness. Because participants felt cooler and better after the 30-minute delay despite still having elevated Trec, clinicians should use objective measurements (eg, Trec) to guide their decision making for patients with possible exertional heat stroke.