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Gary Clinton MS, AT/C, AT/L Sports Medicine Instructor Yelm HS WCTSMA President. Heat Acclimatization? Is it necessary in Washington State?. Pre-Test. If a patient is suspected of Exertional Heat Stroke, what should be the first action taken in treatment of the condition?

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pre test
Pre-Test

If a patient is suspected of Exertional Heat Stroke, what should be the first action taken in treatment of the condition?

A) Drive them to the hospital by parent/yourself.

B) Contact EMS and wait for them to arrive. Don’t

move athlete.

C) Get them a bottle of water and put ice towels on

them.

D) Apply Biofreeze to the entire body.

E) Contact EMS, but place athlete in cold water immersion and stir the water aggressively before transport.

another bad summer nata news nov 2011
“Another bad Summer”NATA News, Nov. 2011
  • Isaiah Laurencin- FL, ExertionalSickling
  • Tyquan Xavier Brantley- SC, ExertionalSickling
  • Lewis Ogloba- PA, Asthma led to Cardiac Arrest
  • DJ Searcy- GA, Heat related
  • Forrest Jones- GA, Heat stroke
  • Montel Williams- AR, ExertionalSickling
  • Sam Dickson- PA, (Congenital)Coronary Artery
  • Al Smith, Jr.- TX, unknown, 2nd day of FB practice
  • Latrell Dunbar-MS, Cardiac Event
  • Candace Ortiz- TX, unknown
  • Angela Gettis- CA, Cardiac Event
kentucky hs football coach charged with reckless homicide
Kentucky HS Football Coach Charged with Reckless Homicide
  • David Stinson, head coach Pleasure Ridge Park HS criminally charged in death of 15 year old, Aug. 20th 2008.
  • All coaches present, AD who was present, and Principal were named in a separate civil lawsuit.
  • “Reckless Homicide”- When a person fails to perceive a risk that a reasonable person in that situation would have seen.
  • Another player that day also collapsed and spent 2 days in the hospital.
    • Coach alleged to have withheld water and continued practice with a heat index of 94.
    • Coach “would run the players until someone quit the team”.
    • It took 15 minutes to call 911.
end results from kentucky
End results from Kentucky
  • Coach Stinson was on paid administrative leave, reassigned, no longer coaches.
  • Community & school district torn apart.
  • Coach Stinson was acquitted of criminal charges.
  • Civil suit was settled out of court for 1.75 million dollars.
football high frontline documentary
“Football High” Frontline documentary
  • Focuses on two issues in HS Football
    • Concussions
    • Heat Stroke
  • Arkansas, 2010
  • Two heat stroke scenarios
    • 1 died (Tyler Davenport)
    • 1 lived (Will James)
  • What was the difference in care?
  • Frontline- “No one should die of Heatstroke”
what does heat acclimatization mean
What does heat acclimatization mean?
  • A set of guidelines that safely prepares athletes for competition.
    • Released by the NATA in 2009 for Secondary Schools.
  • NFHS “A guide to Heat Acclimatization & Heat Illness Prevention” released this summer.
    • 7 components of plan released by NFHS this summer.
  • 100% of heat related deaths are preventable!!
  • WIAA currently has no guidelines?
  • Korey Stringer Institute is pushing for all 50 states to adopt guidelines for all high schools.
  • NCAA has had guidelines in place since 2003.
    • One collegiate death in August since inception!
  • Acclimatization is not “conditioning”
days 1 5
Days 1-5
  • No more than 1 practice per day.
  • No longer than 3 hours
  • 1 hour max. ( walk thru) permitted after 3 hours minimum rest.
  • Football:
    • Days 1 & 2 Helmets only
    • Days 3-5 Helmets & shoulder pads only
days 6 14
Days 6-14
  • Double practice days followed by a single
  • On single days, 1 walk thru permitted w/3 hrs rest.
  • Rest day doesn’t count towards 14 day total.
  • Doubles don’t exceed 3 hours for each. Not to exceed 5 hours total.
  • All activities included as practice time: conditioning, walk thru, weight room, etc.
  • Recommend certified AT onsite for all practices.
slide10

NOTE: warm-up, stretching, cool-down, walk-through, conditioning, and weight-room activities are Included as part of practice time

Secondary School Guidelines

Preseason Heat-Acclimatization Guidelines for Secondary School Athletics. Journal of Athletic Training. 2009;44(3):332-333.

guideline contributors
Guideline contributors
  • National Athletic Trainers Association
  • American College of Sports Medicine
  • Gatorade Sports Science Institute
  • National Strength and Conditioning Association
  • US Army Research Institute for Environmental Medicine
  • American Orthopaedic Society for Sports Medicine
  • American Medical Society for Sports Medicine
  • American Academy of Pediatrics
  • Korey Stringer Institute is doing extensive research
goal is all 50 states ksi institute
“Goal is all 50 States” KSI Institute
  • “New Jersey, first to adopt heat guidelines”
  • From 1995 through 2008, 39 football players died of heatstroke.
  • Second most common cause of death for high school athletes, after spinal cord injury.
  • Currently 7 states meeting guidelines

WA has guidelines but is classified by KSI as deficient.

common sense
Common Sense?
  • EAP’s in place
  • Earlier AM full gear practices
  • Shells for later PM practices, install
  • Emphasize pre-practice hydration
  • Efficient hydration available
  • Athlete differences
  • Discourage supplements, caffeine & stimulants
  • Lower intensity & increase breaks whenever necessary
heat exhaustion vs heat stroke
Heat Exhaustion vs. Heat Stroke
  • Heat exhaustion symptoms include:

Paleness Cramping

Heavy sweating Fainting or nausea

Fast or shallow breathing Dizziness

The pulse rate is fast and weak.  

  • Core body temperature below 104 degrees
heat exhaustion vs heat stroke1
Heat Exhaustion vs. Heat Stroke
  • Heatstroke symptoms include both physical and neurological manifestations—a fast pulse and extremely high temperature (above 104 degrees) coupled with confusion or hallucination.
    • NFHS recommends taking WBGT at location
  • People may experience nausea, fatigue, vomiting, diarrhea, loss of balance, irritability, irrational or unusual behavior, apathy, hysteria, and headaches, as well as dizziness and disorientation.
heat exhaustion vs heat stroke2
Heat Exhaustion vs. Heat Stroke
  • With NEHS, the body stops or decreases sweat production so the skin feels hot and dry.
  • With EHS, the body can still produce sweat, so the skin can be moist though the core temperature remains just as high.
  • Sometimes, there will be no clear evidence of a problem until the athlete collapses.
core temperature
Core Temperature
  • Is the only valid measure of body temperature.
  • Can only be measured rectally or with an ingestible thermometer (Gastrointestinal).
core temperature1
Core Temperature
  • What if I don’t have/don’t want to measure temperature rectally?
  • Common sense:
    • Signs & Symptoms
      • Fast pulse
      • Confusion
      • Nausea
      • Disorientation
      • Altered level of Consciousness
      • Irrational/Unusual Behavior
      • Dizziness
      • Loss of Balance
exertional heat stroke treatment
Exertional Heat Stroke Treatment
  • Activate EAP
    • Call 911, but…
  • Cool the body rapidly, before transport
    • Remove from heat
    • Cold water immersion
      • If not available:
        • Douse with cold water
        • Ice bags/towels, rotate : 3 mins.
        • Put in any available water source
cold water immersion
Cold Water Immersion
  • Goal is to get body temperature below 102 degrees within 30 minutes.
  • Water temperature between 35-59 degrees.
    • Ice always visible on surface
  • Continuously stirred.
  • Cooling rate in general is 1 degree: 3 minutes.
  • Basic guideline:
    • Water temp of 38-42 degree
    • 10-15 minutes of immersion time
exertional sickling signs symptoms
ExertionalSickling Signs & Symptoms

Affects athletes with Sickle Cell Trait

  • Muscle Cramping
  • Pain
  • Swelling
  • Weakness
  • Tenderness
  • Inability to catch breath
  • Fatigue
daily treatment of sct athletes
Daily Treatment of SCT Athletes
  • Longer periods of recovery within conditioning
  • Excluded from performance tests
    • Timed mile run & serial sprints
  • Adjust work-rest cycles during hotter days
  • Emphasize hydration
  • Don’t work out if feeling ill
  • Control asthma
  • Have supplemental oxygen available
proper hydration
Proper Hydration
  • Study of hydration

1. Proper pre practice hydration

      • ½ given water
      • ½ withheld water
    • No significant difference in core temperature!

2. Start practice dehydrated

      • ½ given water
      • ½ withheld water
    • Significant difference in core temperature
  • Emphasis needs to be on effective hydration by the athlete!
preventing sudden death in sports journal of athletic training february 2012
Preventing Sudden Death in SportsJournal of Athletic Training, February 2012
  • Asthma
  • Catastrophic Brain Injuries
  • Cervical Spine injuries
  • Diabetes
  • Exertional Heat Stroke
  • ExertionalHyponatremia
  • ExertionalSickling
  • Lightning
  • Head-down contact
  • Sudden Cardiac Arrest

10 Most common conditions with treatment and Emergency Action Plans included.

post test
Post-Test

If a patient is suspected of Exertional Heat Stroke, what should be the 1st action taken in treatment of the condition?

A) Drive them to the hospital by parent/yourself.

B) Contact EMS and wait for them to arrive. Don’t

move athlete.

C) Get them a bottle of water and put ice towels on

them.

D) Apply Biofreeze to the entire body.

E) Contact EMS, but place athlete in cold water immersion and stir the water aggressively before transport.

resources
Resources
  • Korey Stringer Institute, www.ksi.uconn.edu
    • EAP’s
    • CWI guidelines
    • Exertional Heat Stroke survival kit
    • Rectal Probes & thermometers
    • Hydration kits
    • Hot weather practice procedures outline
    • State athletic association guidelines
references
References
  • Binkley HM, Beckett J, Casa DJ, Kleiner DM, Plummer PE. National Athletic Trainers’ Association position statement: exertional heat illnesses. J Athletic Training. 2002; 37(3):329–343.
  • Casa DJ, Guskiewicz KM, Anderson SA, Courson RW, Heck JF, Jimenez CC, McDermott BP, Miller MG, Stearns RL, Swartz EE, Walsh KM. National Athletic Trainers’ Association position statement: preventing sudden death in sports. J Athletic Training. 2011; 47(1):96–118.
  • Casa DJ,McDermott BM, Lee EC, Yeargin SW, Armstrong LE, Maresh CM. Cold-water immersion: The gold standard for exertional heat stroke treatment. Exercise and Sports Science Reviews. 2007; 35(3):141-149.
  • Heatstroke. eMedicine website. http://emedicine.medscape.com/article/166320-overview. Updated September 2009
references continued
References continued
  • Mueller FO, Colgate B. Annual survey of football injury research 1931–2008. The American Football Coaches Association, the National Collegiate Athletic Association, and the National Federation of State High School Associations. www.unc.edu/depts/nccsi/FootballAnnual.pdf.
  • No sweat: Recognizing and preventing heat-related illnesses . CMA Today. 2010; 43(4) July/August.
  • Understanding heat-related illness: symptoms. WebMD. http://www.webmd.com/a-to-z-guides/understanding-heat-related-illness-symptoms.
  • Yeargin SW, Casa DJ, Judelson DA, McDermott BP, Ganio MS, Lee EC, Lopez RM, Stearns RL, Anderson JM, Armstrong LE, Kraemer WJ, Maresh CM. Thermoregulatory Responses and Hydration Practices in Heat-Acclimatized Adolescents During Preseason High School Football. J Athletic Training. 2010; 45(2): 136–146.
thank you for your time
Thank you for your time!

Gary Clinton MS, AT/C, AT/L

Sports Medicine Instructor Yelm HS

WCTSMA President

gclinton@ycs.wednet.edu

(360)458-7777