High Schools' Adoption of Evidence-Based Practices for the Management of Exertional Heat Stroke

Abstract

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.

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.…”

Spinal Cord Injury Management Policies in High School Sports as Reported by Athletic Administrators

“…We acknowledge the possibility that those who had adopted such policies may have been more likely to respond to the survey. Nevertheless, this rate of adoption of a comprehensive emergency management policy was higher than that reported in most other domains, such as for heat acclimatization (3.9%) (9), environmental monitoring (28%) (7), and exertional heat illness recognition/management (16.9%) (26). Given that nearly 30% of nonfatal catastrophic injuries are spinal cord injuries, it is encouraging that AA reported being prepared for these life-threatening injuries.…”

Exertional Heat Illness: Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators

“…Previous literature shows that 16.9% to 33.3% of ATs reported adopting policy components for the recognition (ie, assessment of rectal temperature) and treatment (ie, CWI) of EHS patients. 14,25 Further, in the assessment of ATs who reported treating a patient suspected cases of EHS, only 3.2% and 51.6% assessed rectal temperature and immersed the patient in ice water, respectively. 18 Despite the low adoption of EHS best practices among ATs, state-level mandates have been proposed as facilitators for adoption of both EHS-related and emergency action plan policies; the latter is supported by a greater number of emergency action plan policies in states with requirements than without.…”

“…These findings are extremely interesting given 28% of ATs have decided not to act on this policy, and ATs have stated in previous literature that support from an authoritative position would facilitate their implementation of this policy. 25 Knowledge of the PAPM suggests that those who fall in the stages other than the "decided not to act" stage, may be more impressionable to implement a new behavior (or policy in this case). 28,29 Given that AAs appear to be, at minimum, willing to learn what rectal temperature is, may indicate their support to identify strategies to implement this best practice.…”

“…25 Athletic administrators (AAs) such as athletic directors are a vital component of the sports medicine team and have been regarded as key persons to facilitate positive change for policies related to emergency action plans, lightning, and EHI. 9,21,23,25…”