Current knowledge, attitudes, and practices of certified athletic trainers regarding recognition and treatment of exertional heat stroke.

CONTEXT: Previous research has indicated that despite awareness of the current literature on the recommended prevention and care of exertional heat stroke (EHS), certified athletic trainers (ATs) acknowledge failure to follow those recommendations. OBJECTIVE: To investigate the current knowledge, attitudes, and practices of ATs regarding the recognition and treatment of EHS. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: We obtained a random sample of e-mail addresses for 1000 high school and collegiate ATs and contacted these individuals with invitations to participate. A total of 498 usable responses were received, for a 25% response rate. MAIN OUTCOME MEASURE(S): The survey instrument evaluated ATs' knowledge and actual practice regarding EHS and included 29 closed-ended Likert scale questions (1 = strongly disagree, 7 = strongly agree), 2 closed-ended questions rated on a Likert scale (1 = lowest value, 9 = greatest value), 8 open-ended questions, and 7 demographic questions. We focused on the open-ended and demographic questions. RESULTS: Although most ATs (77.1%) have read the current National Athletic Trainers' Association position statement on heat illness, only 18.6% used rectal thermometers to assess core body temperature to recognize EHS, and 49.7% used cold-water immersion to treat EHS. Athletic trainers perceived rectal thermometers as the most valid temperature assessment device when compared with other assessment devices (P

Influence of hydration status on pacing during trail running in the heat.

The purpose of this study was to determine the influence of hydration status on pacing of trail runners in the heat (wet bulb globe temperature = 26.2 +/- 1.8 degrees C). A randomized, crossover design was used and the participation occurred within a 2-week period. Seventeen competitive, well-trained distance runners (9 men, 8 women, age 27 +/- 7 years, height 171 +/- 9 cm, weight 64.2 +/- 9.0 kg, body fat 14.6 +/- 5.5%) completed the study. Subjects started maximum effort trials that were either hydrated (HYR) and dehydrated (DHR). Each trial subjects ran three 4-km loops with a 4-minute rest between loops. Significance was set at p < or = 0.05. The DHR had a significantly greater body mass loss at the pre- and posttrial time points (-2.05 +/- 1.25 and -4.3 +/- 1.25%, respectively) vs. HYR (-0.79 +/- 0.95 and -2.05 +/- 1.09%, respectively). Subjects ran the 12 km faster (p < 0.001) in HYR (3,191 +/- 366 seconds) vs. DHR (3,339 +/- 450 seconds). Differences between fastest and slowest loops during HYR (54 +/- 40 seconds) were significantly smaller than DHR (111 +/- 93 seconds; p = 0.041). Additionally, loop times were slower for loop 1 (HYR 1,039 +/- 116 seconds vs. DHR 1,071 +/- 123 seconds; p = 0.028), loop 2 (HYR 1,066 +/- 123 seconds vs. DHR 1,105 +/- 148 seconds; p = 0.01) and loop 3 (HYR 1,081 +/- 132 seconds vs. DHR 1,168 +/- 189 seconds; p = 0.003) when dehydrated. Percent of the race completed by loop as calculated by finishing time was significantly different at loop 2 between HYR (33.6 +/- 0.36%) and DHR (33.1 +/- 0.35%, p = 0.002) and loop 3 (33.8 +/- 0.75% vs. 34.9 +/- 1.35%, respectively, p = 0.01). Total variation from the mean pace for the duration of the HYR compared to the DHR approached significance (p = 0.064). Average percent of variance approached significance between trials (p = 0.057). Differences between the fastest and slowest loops between trials demonstrated an increased ability for hydrated individuals to evenly pace themselves. While total variation from the mean pace was not significantly different, it could have practical applicability. These findings reveal that dehydration is associated with decreases in a runners' ability to evenly pace themselves during a competitive situation.