Need for trained medical professionals to treat medical emergencies in high school athletes

As summer football practice gets into full swing, it's essential to be aware of the risk of exertional heat stroke (EHS) in high school athletes, according to a Safety Alert in The Journal of Strength and Conditioning Research, official research journal of the National Strength and Conditioning Association. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

Kelly D. Pagnotta, A.T.C., P.E.S., and colleagues of University of Connecticut, Storrs, highlight the critical role of certified athletic trainers (ATs) in recognizing EHS and starting appropriate treatment. They write, "A trained medical provider, particularly an AT, needs to make an accurate diagnosis to provide the most appropriate care, which can be very different based on the clinical diagnosis to prevent death."

The safety alert on EHS in high school athletes is a timely one, as July and August are the highest-risk months for EHS. Without prompt recognition and treatment, EHS can be rapidly fatal. In 2008 alone, there were 12 deaths from EHS in high-school football players (plus another two deaths in youth football players and two in soccer players) in the United States.

Although it is more likely to occur in hot, humid conditions, EHS can occur under in any type of weather, including cooler environments. Some risk factors for EHS are unique to the athlete and potentially under his or her control. Other potential contributors are out of the athlete's control, including the environmental conditions, the pace of practice, and pressure from coaches. "These extrinsic factors can be influenced by altering practice times or increasing rest breaks," Pagnotta and co-authors write.

Even for health professionals, EHS can be difficult to recognize. When an athlete collapses, the two main symptoms of EHS are a core body temperature over 105° F and the presence of central nervous system changes (such as disorientation or unconsciousness). The authors emphasize that the body temperature must be taken rectally, by a health professional—oral thermometers or other measures are unreliable.

However, athletes with EHS may have other symptoms, such as vomiting or hyperventilation. Furthermore, other serious conditions are possible, including head injury, cardiac arrest, or asthma. Because of this complexity, Pagnotta and colleagues write, "trained medical professional, such as an AT, should be the one assessing an athlete who collapses, not a coach or strength and conditioning coach."

Once EHS is recognized, proper treatment consists of rapid cooling by cold water immersion. The longer the body temperature remains above 105°, the greater the risk of death; the faster the cooling, the better the chance of survival. A cold shower or cold, wet towels can be used until a cold tub is ready. Other cooling measures—like ice bags, misting fans, and shade—have been proven ineffective.

Once the body temperature has been lowered to 102°, the athlete should be transported to the closest medical facility. "It is important to remember that EHS has been 100% survivable with proper assessment and rapid treatment," Pagnotta and co-authors write.

Consistent with the recommendations of the National Athletic Trainers Association, the authors urge high schools to have a school physician and an on-site AT to provide appropriate medical care. They conclude, "Trained medical professionals should be available on-site and ready to treat any medical emergency that arises to have the optimal outcome."

SOURCE Journal of Strength and Conditioning Research