Abstract
Background and Objectives: Emergency Medical Service (EMS) protocols vary widely and may not implement best practices for exertional heat stroke (EHS). EHS is 100% survivable if best practices are implemented within 30 min. The purpose of this study is to compare EMS protocols to best practices for recognizing and treating EHS. Materials and Methods: Individuals (n = 1350) serving as EMS Medical or Physician Director were invited to complete a survey. The questions related to the EHS protocols for their EMS service. 145 individuals completed the survey (response rate = 10.74%). Chi-Squared Tests of Associations (χ2) with 95% confidence intervals (CI) were calculated. Prevalence ratios (PR) with 95% CI were calculated to determine the prevalence of implementing best practices based on location, working with an athletic trainer, number of EHS cases, and years of directing. All PRs whose 95% CIs excluded 1.00 were considered statistically significant; Chi-Squared values with p values < 0.05 were considered statistically significant. Results: A majority of the respondents reported not using rectal thermometry for the diagnosis of EHS (n = 102, 77.93%) and not using cold water immersion for the treatment of EHS (n = 102, 70.34%). If working with an athletic trainer, EMS is more likely to implement best-practice treatment (i.e., cold-water immersion and cool-first transport-second) (69.6% vs. 36.9%, χ2 = 8.480, p < 0.004, PR = 3.15, 95% CI = 1.38, 7.18). Conclusions: These findings demonstrate a lack of implementation of best-practice standards for EHS by EMS. Working with an athletic trainer appears to increase the likelihood of following best practices. Efforts should be made to improve EMS providers’ implementation of best-practice standards for the diagnosis and management of EHS to optimize patient outcomes.
Highlights
9000 exertional heat illness cases are treated each year in high school athletics [1].Over 3332 deaths attributed to heat stroke were reported in the United States from 2006–2010 [2]
These findings demonstrate a lack of implementation of best-practice standards for exertional heat stroke (EHS)
The percentages for different cooling modalities used for the treatment of EHS are summarized in Figure 1, with 30% of participants indicating that they use cold-water immersion (CWI) for the treatment of EHS
Summary
9000 exertional heat illness cases are treated each year in high school athletics [1].Over 3332 deaths attributed to heat stroke were reported in the United States from 2006–2010 [2]. 1995 to 2017, exertional heat stroke was responsible for 63 deaths in American football players. 79 heat-related deaths were reported in the occupational setting during the span of 2014 through 2016 [5] Exertional heat stroke (EHS) is characterized by an internal body temperature ≥40.5 ◦ C (105 ◦ F) accompanied by neurological dysfunction [6,7]. Emergency Medical Service (EMS) protocols vary widely and may not implement best practices for exertional heat stroke (EHS). The purpose of this study is to compare EMS protocols to best practices for recognizing and treating EHS. Prevalence ratios (PR) with 95% CI were calculated to determine the prevalence of implementing best practices based on location, working with an athletic trainer, number of EHS cases, and years of directing
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