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Open AccessArticle

Exertional Heat Illness Preparedness Strategies: Environmental Monitoring Policies in United States High Schools

Division of Athletic Training, School of Medicine, West Virginia University, Morgantown, WV 26508, USA
Institute for Exercise and Environmental Medicine, University of Texas Southwestern and Texas Health Resources Presbyterian Hospital Dallas, Dallas, TX 75231, USA
Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan
Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA
Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
Author to whom correspondence should be addressed.
Medicina 2020, 56(10), 486;
Received: 11 August 2020 / Revised: 8 September 2020 / Accepted: 14 September 2020 / Published: 23 September 2020
(This article belongs to the Special Issue Prevention, Recognition, and Treatment of Exertional Heat Illnesses)
Background and objectives: Environmental monitoring allows for an analysis of the ambient conditions affecting a physically active person’s ability to thermoregulate and can be used to assess exertional heat illness risk. Using public health models such as the precaution adoption process model (PAPM) can help identify individual’s readiness to act to adopt environmental monitoring policies for the safety of high school athletes. The purpose of this study was to investigate the adoption of policies and procedures used for monitoring and modifying activity in the heat in United States (US) high schools. Materials and Methods: Using a cross-sectional design, we distributed an online questionnaire to athletic trainers (ATs) working in high schools in the US. The questionnaire was developed based on best practice standards related to environmental monitoring and modification of activity in the heat as outlined in the 2015 National Athletic Trainers’ Association Position Statement: Exertional Heat Illness. The PAPM was used to frame questions as it allows for the identification of ATs’ readiness to act. PAPM includes eight stages: unaware of the need for the policy, unaware if the school has this policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining. Invitations were sent via email and social media and resulted in 529 complete responses. Data were aggregated and presented as proportions. Results: Overall, 161 (161/529, 30.4%) ATs report they do not have a written policy and procedure for the prevention and management of exertional heat stroke. The policy component with the highest adoption was modifying the use of protective equipment (acting = 8.2%, maintaining = 77.5%). In addition, 28% of ATs report adoption of all seven components for a comprehensive environmental monitoring policy. Conclusions: These findings indicate a lack of adoption of environmental monitoring policies in US high schools. Secondarily, the PAPM, facilitators and barriers data highlight areas to focus future efforts to enhance adoption. View Full-Text
Keywords: environment; exertional heat illness; policies and procedures; health behavior environment; exertional heat illness; policies and procedures; health behavior
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Scarneo-Miller, S.E.; Belval, L.N.; Yeargin, S.W.; Hosokawa, Y.; Kerr, Z.Y.; Casa, D.J. Exertional Heat Illness Preparedness Strategies: Environmental Monitoring Policies in United States High Schools. Medicina 2020, 56, 486.

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