Advertisement

Management of Exertional Heat Stroke in Athletics: Interdisciplinary Medical Care

  • Yuri Hosokawa
Chapter

Abstract

Management of exertional heat stroke (EHS) requires seamless coordination between medical (e.g., team physician, primary care physician, emergency physician, athletic trainer, physiotherapist) and nonmedical (e.g., athlete, coaches, administrative officials, parents) stakeholders of athlete’s health and safety. These individuals are expected to work together to optimize EHS prevention, pre-hospital care, transport, in-hospital care, and return to physical activity. At each level of EHS management, both medical and nonmedical stakeholders must understand and implement current best practices from leading sports medicine associations. In athletic settings, it is often the qualified on-site medical personnel’s job (e.g., athletic trainer, physiotherapist) to serve as the gatekeeper of relevant information and ensure medical and nonmedical stakeholders understand the need and responsibility to execute current best practices. In the last decade, various guidelines and statewide policies on EHS management have been introduced by medical and athletic organizations. Among those that mandated the use of evidence-based best practices, longitudinal and cross-sectional data are now starting to observe favorable reductions in heat-related injuries. These data demonstrate the effectiveness of systemic policy implementation and further support the need to involve all stakeholders of athlete’s health and safety to take part in the management of EHS.

Keywords

Pre-hospital care Emergency medicine Emergency medical service Athletic trainer Exertional heat illness Heat acclimatization Cold water immersion 

References

  1. 1.
    Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, et al. National Athletic Trainers’ Association position statement: exertional heat illnesses. J Athl Train. 2015;50(9):986–1000.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Hosokawa Y, Adams WM, Stearns RL, Casa DJ. Heat stroke in physical activity and sports. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud. 2014;12(2):1–22. http://www.redalyc.org/html/4420/442042967002/index.html.Google Scholar
  3. 3.
    Hosokawa Y, Adams WM, Stearns RL, Casa DJ. Comparison of gastrointestinal and rectal temperatures during recovery after a warm-weather road race. J Athl Train. 2016;51(5):382–8.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Racinais S, Moussay S, Nichols D, Travers G, Belfekih T, Schumacher YO, Periard JD. Core temperature up to 41.5oC during the UCI Road Cycling World Championships in the heat. Br J Sports Med. 2019;53(7):426–9.PubMedGoogle Scholar
  5. 5.
    Wingo JE, Crandall CG, Kenny GP. Human heat physiology. In: Casa DJ, editor. Sport and physical activity in the heat maximizing performance and safety. Cham: Springer; 2018. p. 15–30.Google Scholar
  6. 6.
    Schlader Z. The relative overlooking of human behavioral temperature regulation: an issue worth resolving. Temperature. 2014;1(1):20–1.Google Scholar
  7. 7.
    Binkley HM, Beckett J, Casa DJ, Kleiner DM, Plummer PE. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. J Athl Train. 2002;37(3):329–43.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Casa DJ, McDermott BP, Lee EC, Yeargin SW, Armstrong LE, Maresh CM. Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev. 2007;35(3):141–9.Google Scholar
  9. 9.
    Belval LN, Casa DJ, Adams WM, et al. Consensus statement—prehospital care of exertional heat stroke. Prehosp Emerg Care. 2018;22(3):392–7.Google Scholar
  10. 10.
    Scarneo SE, Kerr ZY, Kroshus E, Register-Mihalik JK, Hosokawa Y, Stearns RL, et al. The socio-ecological framework: a multi-faceted approach to prevent sport-related death in high school sports. J Athl Train. 2019;54(4):356–60.  https://doi.org/10.4085/1062-6050-173-18.PubMedGoogle Scholar
  11. 11.
    American College of Sports Medicine, Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39(3):556–72.Google Scholar
  12. 12.
    Adams WM, Hosokawa Y, Huggins RA, Mazerolle SM, Casa DJ. An exertional heat stroke survivor’s return to running: an integrated approach on the treatment, recovery, and return to activity. J Sport Rehabil. 2016;25(3):280–7.Google Scholar
  13. 13.
    Grundstein AJ, Ramseyer C, Zhao F, Pesses JL, Akers P, Qureshi A, et al. A retrospective analysis of American football hyperthermia deaths in the United States. Int J Biometeorol. 2012;56(1):11–20.Google Scholar
  14. 14.
    Grundstein AJ, Hosokawa Y, Casa DJ. Fatal exertional heat stroke and American football players: the need for regional heat-safety guidelines. J Athl Train. 2018;53(1):43–50.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Pryor RR, Casa DJ, Adams WM, Belval LN, DeMartini JK, Huggins RA, et al. MSMaximizing athletic performance in the heat. Strength Cond J. 2013;35(6):24–33.Google Scholar
  16. 16.
    Adams WM, Hosokawa Y, Casa DJ. Body-cooling paradigm in sport: maximizing safety and performance during competition. J Sport Rehabil. 2016;25(4):382–94.Google Scholar
  17. 17.
    Armstrong LE, Maresh CM. The induction and decay of heat acclimatisation in trained athletes. Sports Med. 1991;12(5):302–12.Google Scholar
  18. 18.
    Kerr ZY, Register-Mihalik JK, Pryor RR, Pierpoint LA, Scarneo SE, Adams WM, et al. The association between mandated preseason heat acclimatization guidelines and exertional heat illness during preseason high school American football practices. Environ Health Perspect. 2019;127(4):47003.Google Scholar
  19. 19.
    Casa DJ, Csillan D; Inter-Association Task Force for Preseason Secondary School Athletics Participants, Armstrong LE, Baker LB, Bergeron MF, et al. Preseason heat-acclimatization guidelines for secondary school athletics. J Athl Train 2009;44(3):332–3.Google Scholar
  20. 20.
    Casa DJ, Guskiewicz KM, Anderson SA, Courson RW, Heck JF, Jimenez CC, et al. National Athletic Trainers’ Association position statement: preventing sudden death in sports. J Athl Train. 2012;47(1):96–118.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Racinais S, Alonso JM, Coutts AJ, Flouris AD, Girard O, González-Alonso J, et al. Consensus recommendations on training and competing in the heat. Br J Sports Med. 2015;49(18):1164–73.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Mazerolle SM, Scruggs IC, Casa DJ, Burton LJ, McDermott BP, Armstrong LE, Maresh CM. Current knowledge, attitudes, and practices of certified athletic trainers regarding recognition and treatment of exertional heat stroke. J Athl Train. 2010;45(2):170–80.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Ganio MS, Brown CM, Casa DJ, et al. Validity and reliability of devices that assess body temperature during indoor exercise in the heat. J Athl Train. 2009;44(2):124–35.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Casa DJ, Becker SM, Ganio MS, Brown CM, Yeargin SW, Roti MW, et al. Validity of devices that assess body temperature during outdoor exercise in the heat. J Athl Train. 2007;42(3):333–42.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Adams WM. Exertional heat stroke within secondary school athletics. Curr Sports Med Rep. 2019;18(4):149–53.Google Scholar
  26. 26.
    Stearns RL, Casa DJ, O’Connor FG, Lopez RM. A tale of two heat strokes: a comparative case study. Curr Sports Med Rep. 2016;15(2):94–7.PubMedGoogle Scholar
  27. 27.
    Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25):1978–88.Google Scholar
  28. 28.
    McDermott BP, Casa DJ, Ganio MS, Lopez RM, Yeargin SW, Armstrong LE, Maresh CM. Acute whole-body cooling for exercise-induced hyperthermia: a systematic review. J Athl Train. 2009;44(1):84–93.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Hosokawa Y, Adams WM, Belval LN, Vandermark LW, Casa DJ. Tarp-assisted cooling as a method of whole-body cooling in hyperthermic individuals. Ann Emerg Med. 2017;69(3):347–52.Google Scholar
  30. 30.
    Stearns RL, Deuster PA, Kazman JB, Heled Y, O’Connor FG. Heat tolerance testing. In: Casa DJ, editor. Sport and physical activity in the heat maximizing performance and safety. Cham: Springer; 2018. p. 213–27.Google Scholar
  31. 31.
    Adams WM, Belval LN. Return-to-activity following exertional heat stroke. Athl Train Sports Health Care. 2018;10(1):5–6.Google Scholar
  32. 32.
    Kazman JB, Heled Y, Lisman PJ, Druyan A, Deuster PA, O’Connor FG. Exertional heat illness: the role of heat tolerance testing. Curr Sports Med Rep. 2013;12(2):101–5.PubMedGoogle Scholar
  33. 33.
    Pagnotta KD, Mazerolle SM, Pitney WA, Burton LJ, Casa DJ. Implementing health and safety policy changes at the high school level from a leadership perspective. J Athl Train. 2016;51(4):291–302.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Casa DJ, Almquist J, Anderson SA, Baker L, Bergeron MF, Biagioli B, et al. The inter-association task force for preventing sudden death in secondary school athletics programs: best-practices recommendations. J Athl Train. 2013;48(4):546–53.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Casa DJ, Anderson SA, Baker L, Bennett S, Bergeron MF, Connolly D, et al. The inter-association task force for preventing sudden death in collegiate conditioning sessions: best practices recommendations. J Athl Train. 2012;47(4):477–80.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Huggins RA, Scarneo SE, Casa DJ, Belval LN, Carr KS, Chiampas G, et al. The inter-association task force document on emergency health and safety: best-practice recommendations for youth sports leagues. J Athl Train. 2017;52(4):384–400.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Arkansas Educational Television Network. 108°: critical response. https://www.aetn.org/programs/108degrees. Accessed 5 May 2019.
  38. 38.
    Ingram P. HB 1743; Act 1214. An act to promote the health and safety of students in public school athletic activities through the use of athletic trainers and professional development for coaches; and for other purposes. 28 Feb 2011. http://www.arkleg.state.ar.us/assembly/2011/2011R/Acts/Act1214.pdf. Accessed 29 Jan 2019.
  39. 39.
    Ferrara MS, Swearngin R, Adams WM, Casa DJ. Developing safety policies for organized sports. In: Casa DJ, Stearns RL, editors. Emergency management for sport and physical activity. Burlington, MA: Jones & Bartlett Learning; 2015. p. 1–16.Google Scholar
  40. 40.
    Adams WM, Scarneo SE, Casa DJ. State-level implementation of health and safety policies to prevent sudden death and catastrophic injuries within secondary school athletics. Orthop J Sports Med. 2017;5(9):2325967117727262.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Mazerolle SM, Pinkus DE, Casa DJ, McDermott BP, Pagnotta KD, Ruiz RC, et al. Evidence-based medicine and the recognition and treatment of exertional heat stroke, part ii: a perspective from the clinical athletic trainer. J Athl Train. 2011;46(5):533–42.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Pike AM, Adams WM, Huggins RA, Mazerolle SM, Casa DJ. Analysis of states’ progress towards and barriers to health and safety policy implementation for secondary school athletics. J Athl Train. 2019;54(4):361–73.Google Scholar
  43. 43.
    Hosokawa Y, Grundstein AJ, Vanos JK, Cooper ER. Environmental condition and monitoring. In: Casa DJ, editor. Sport and physical activity in the heat maximizing performance and safety. Cham: Springer; 2018. p. 147–62.Google Scholar
  44. 44.
    Attanasio SM, Adams WM, Stearns RL, Huggins RA, Casa DJ. Occurrence of exertional heat stroke in high school football athletes before and after implementation of evidence-based heat acclimatization guidelines. J Athl Train. 2016;51(6):S–168.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Yuri Hosokawa
    • 1
  1. 1.Faculty of Sport Sciences, Waseda UniversityTokorozawaJapan

Personalised recommendations