Evidence-based medicine and the recognition and treatment of exertional heat stroke, part II: a perspective from the clinical athletic trainer.

CONTEXT: Exertional heat stroke (EHS) is one of the leading causes of death in athletes. Certified athletic trainers (ATs) demonstrate strong knowledge of recommended practices with EHS but are apprehensive in implementing 2 basic procedures: rectal temperature assessment and cold water immersion. This apprehension might lead to deaths from EHS that could have been prevented. OBJECTIVE: To investigate why collegiate and high school ATs do not implement best practices for the recognition and treatment of EHS. DESIGN: Qualitative study. SETTING: In-person focus groups consisting of 3 to 6 collegiate or high school ATs. PATIENTS OR OTHER PARTICIPANTS: A total of 19 ATs (9 men, 10 women; age = 36 ± 10 years, length of certification = 12 ± 9 years) employed at either the collegiate (n = 10) or high school (n = 9) level participated in the study. DATA COLLECTION AND ANALYSIS: Interviews were transcribed verbatim, and data were analyzed using deductive data analysis. Peer review and multiple-analyst data triangulation were conducted to establish trustworthiness of the data. RESULTS: Five emergent themes explained the lack of evidence-based practice (EBP) regarding recognition and treatment of EHS. Three themes (lack of knowledge, comfort level, lack of initiative) were common in both the collegiate and high school settings, and 2 separate themes (liability concerns, lack of resources) were present in the high school setting. CONCLUSIONS: Our findings are consistent with those in the literature on EBP and EHS. Regardless of clinical setting, ATs have basic information on recognition and treatment of EHS, but 5 themes act as barriers to implementing proper management in the clinical setting. Workshops or hands-on training sessions need to be made available to improve students' comfort levels so ATs will implement EBP into everyday settings.

Evidence-based practice and the recognition and treatment of exertional heat stroke, part I: a perspective from the athletic training educator.

CONTEXT: Athletic trainers (ATs) know to diagnose exertional heat stroke (EHS) via rectal thermometry (T(re)) and to treat EHS via cold-water immersion (CWI) but do not implement these recommendations in clinical practice. OBJECTIVE: To gain an understanding of educational techniques used to deliver content regarding EHS. DESIGN: Qualitative study. SETTING: In-person focus groups at the National Athletic Trainers' Association (NATA) Annual Meeting in June 2009 and 2 follow-up telephone interviews to confirm emergent themes. PATIENTS OR OTHER PARTICIPANTS: Thirteen AT educators (11 men, 2 women) from programs accredited by the Commission on Accreditation of Athletic Training Education, with an average of 22 ± 9 years of clinical experience and 16 ± 10 years of experience as educators. Five NATA districts were represented. DATA COLLECTION AND ANALYSIS: Data were analyzed using inductive content analysis. Peer review and data source triangulation also were conducted to establish trustworthiness. RESULTS: Four themes emerged from the analysis: educational techniques, educational competencies, previous educational training, and privacy/public opinion. Educational techniques highlighted the lack of hands-on training for T(re) and CWI. Educational competencies referred to the omission of T(re) and CWI as psychomotor skills. Previous educational training addressed educators not having the skills or comfort with the skills necessary to properly educate students. Privacy/public opinion comprised external inputs from various groups (parents and coaches), legal considerations, and social bias. CONCLUSIONS: Educators supplied students with the appropriate didactic knowledge about EHS, but their lack of training and misgivings about T(re) prevented them from allowing students to gain competence with this skill. Until the NATA competencies state the need to teach T(re) and CWI and until educators are provided with their own learning opportunities, evidence-based practice regarding EHS will be lacking.