Abstract
Background and objectives: Exertional heat stroke (EHS) continues to be a prevalent health issue affecting all athletes, including our pediatric populations. The purpose of this study was to evaluate the effect of a state policy requirement for EHS prevention and treatment on local high school policy adoption in the United States (US). Materials and Methods: Athletic trainers (ATs) from high schools across the US participated in an online survey (n = 365). This survey inquired about their compliance with nine components of an EHS policy which was then compared to their state requirements for the policies. Evaluation of the number of components adopted between states with a requirement versus states without a requirement was conducted with a Wilcoxon Sign Rank test. Finally, an ordinal logistic regression with proportional odds ratios (OR) with 95% confidence intervals (CI) were run to determine the effect of a state requirement and regional differences on the number of components adopted. Results: ATs working in states with a requirement reported adoption of more components in their heat modification policy compared to states that did not require schools to develop a heat modification policy (with requirement mean = 5.34 ± 3.68, median = 7.0; without requirement mean = 4.23 ± 3.59, median = 5.0; Z = −14.88, p < 0.001). ATs working in region 3 (e.g., hotter regions) reported adopting more components than those in region 1 (e.g., cooler regions) (OR = 2.25, 95% CI: 1.215–4.201, p = 0.010). Conclusions: Our results demonstrate a positive association between state policy requirements and subsequently increased local policy adoption for EHS policies. Additionally, the results demonstrate that regional differences exist, calling for the need for reducing disparities across the US. These findings may imply that policy adoption is a multifactorial process; furthermore, additional regional specific investigations must be conducted to determine the true determinants of high school policy adoption rates for EHS policies.
Highlights
As exertional heat stroke (EHS) is one of the top three causes of sport-related death, it is imperative to implement strategies to prevent and treat this catastrophic injury [1]
Association Position Statement: Exertional Heat Illness” (NATA-PS) sets forth guidelines supporting the assertion that the occurrence of EHS can be reduced and death can be prevented when proper strategies are in place [2]
When states required both a heat modification policy and use of an on-site wet bulb globe temperature (WBGT) device in their policy, Athletic trainers (ATs) were more likely to incorporate the on-site WBGT device in their policy compared to HEAT only and with-out Heat and Component Mandates (WITHOUT)
Summary
As exertional heat stroke (EHS) is one of the top three causes of sport-related death, it is imperative to implement strategies to prevent and treat this catastrophic injury [1]. The purpose of this study was to evaluate the effect of a state policy requirement for EHS prevention and treatment on local high school policy adoption in the United States (US). Materials and Methods: Athletic trainers (ATs) from high schools across the US participated in an online survey (n = 365) This survey inquired about their compliance with nine components of an EHS policy which was compared to their state requirements for the policies. Results: ATs working in states with a requirement reported adoption of more components in their heat modification policy compared to states that did not require schools to develop a heat modification policy (with requirement mean = 5.34 ± 3.68, median = 7.0; without requirement mean = 4.23 ± 3.59, median = 5.0; Z = −14.88, p < 0.001).
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