High school football programs not using most effective heatstroke management measures, study finds

Sept. 6, 2013
Despite their awareness of the dangers of heatstroke, trainers in most high school football programs still do not employ the most effective measures to manage the condition.
These are the findings of a new study, “Exertional Heath Stroke Management Strategies in United States High School Football,” led by Zachary Kerr, epidemiology doctoral candidate at The University of North Carolina at Chapel Hill’s Gillings School of Global Public Health.
Zachary Kerr

Zachary Kerr

The study, available online at The American Journal of Sports Medicine, is the first systematic investigation of strategies used by certified athletic trainers to treat exertional heat stroke in the high school football preseason.
Exertional heatstroke (EHS) has potentially deadly consequences – 46 football players in the U.S. died from EHS between 1995 and 2010. However, the study found that, despite certified athletic trainers having increased their awareness and proactive treatment of EHS, certain more effective, more easily implemented management strategies still are not widely utilized when student athletes first exhibit the onset of EHS symptoms.
“Most certified athletic trainers reported using relatively low-level therapeutic interventions, such as removing equipment and clothing, and moving the athlete to a shaded area,” Kerr said. “Perhaps more concerning, the trainers did not employ more active strategies that could properly identify and manage the condition in a timely fashion.”
These active management strategies include using a rectal thermometer to verify core temperature elevation, employing ice water immersion onsite to accelerate cooling and notifying emergency medical services (EMS) as quickly as possible.

“Creating a protocol for these methods also requires educational outreach to the student athletes and their parents on why these measures in particular are essential,” Kerr said. “Parents need to know that their children’s safety is the primary objective.”
The study, which surveyed 1,142 certified athletic trainers nationwide who work with high school football teams, found that certified athletic trainers from states (including Arizona, Arkansas, Florida, Georgia, New Jersey, North Carolina and Texas) in which high school athletic associations had mandated National Athletic Trainers’ Association (NATA) preseason heat acclimatization guidelines were more likely to report using the more advanced strategies to manage exertional heatstroke events.
“This suggests that more states should consider mandating implementation of these NATA guidelines, as doing so will help increase the usage of heat-related prevention strategies,” said Stephen Marshall, PhD, professor of epidemiology at the Gillings School and director of UNC’s Injury Prevention Research Center.
Douglas J. Casa, PhD, professor in the kinesiology department and director of athletic training education in the University of Connecticut’s Neag School of Education, chief operating officer at the university’s Korey Stringer Institute and study co-author, said the findings clearly showed the need for continued progress in preventing, recognizing and treating heatstroke.

“Specifically,” Casa said, “modifications need to be made based on environmental conditions, heat acclimatization policies, rectal temperature assessment, cold water immersion for rapid cooling, and the policy to cool in place before transporting the heatstroke victim. These components have proven efficacy to prevent heatstroke and assure survival when it does occur.”

“We don’t want to blame the certified athletic trainers,” emphasizes Dawn Comstock PhD, associate professor of epidemiology at the Colorado School of Public Health and another study co-author. “Most certified athletic trainers are knowledgeable of prevention guidelines but lack either the resources to put them into place or the authority over coaches to enforce them.”

Implementing NATA mandates will empower trainers and help them employ effective treatments in timely fashion, the researchers said.
“We hope our findings will highlight the benefits of mandated implementation of guidelines regarding preseason heat acclimatization,” Kerr said. “Given the increased media coverage and knowledge regarding heat-related events, we’re hoping the implementation of such prevention strategies will increase rapidly in the next few years.”
The study is available online (PDF).

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu