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Regional Requirements Influence Adoption of Exertional Heat Illness Preparedness Strategies in United States High Schools
Open AccessArticle

Emergency Medical Service Directors’ Protocols for Exertional Heat Stroke

Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
Division of Athletic Training, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
Department of Orthopedics and Rehabilitation, University of Florida, Gainesville, FL 32607, USA
Author to whom correspondence should be addressed.
Medicina 2020, 56(10), 494;
Received: 21 August 2020 / Revised: 11 September 2020 / Accepted: 22 September 2020 / Published: 24 September 2020
(This article belongs to the Special Issue Prevention, Recognition, and Treatment of Exertional Heat Illnesses)
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. View Full-Text
Keywords: cool-first transport-second; EHS; heat illness; cold-water immersion cool-first transport-second; EHS; heat illness; cold-water immersion
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Szymanski, M.R.; Scarneo-Miller, S.E.; Smith, M.S.; Bruner, M.L.; Casa, D.J. Emergency Medical Service Directors’ Protocols for Exertional Heat Stroke. Medicina 2020, 56, 494.

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