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EMS and Preseason Practice

EMS has a long and established relationship with sports. Standing by under the fall Friday night lights is a tradition in many parts of the U.S. for medics, but the evening cool temperatures are a contrast to Summer of 2016’s heat wave. Record setting temperatures have led to changes in preseason practice. Some may remember the tragic death of Minnesota Vikings Offensive Tackle Korey Stringer who died in 2001 from heat stroke during practice. Today, the Korey Stringer Institute at University of Connecticut in Storrs conducts research on the effect of heat during exercise including the influence clothing might have in rising temperatures.

According to a study by Douglas Casa, Ph.D., chief executive officer of the Korey Stringer Institute, states that have instituted guidelines for high school football preseason practices have had no deaths reported. Prior to adopting the preseason practice policies, high school athletes were at extreme risk 2.5 times more likely to succumb to heat stroke deaths.

Scientists from NOAA announced that June 2016 replaces the 1933 record as the hottest on record for the contiguous United States and the pattern does not appear to be letting up.        

For medics, EMS calls related to heatstroke or illness requires immediate intervention. Transport is critical as is prehospital care and easy access to lifesaving equipment and medicine. Companies like Ferno have developed modular workspace products accessed from a seated restrained position, protecting the patient as well as the crew.

The U.S. Department of Health and Human Services (HHS) released standards for prehospital care of heat related injuries. Under the division of Chemical Hazards – Emergency Medical Management, Heat Exhaustion is described as “a vague clinical syndrome characterized by headache, nausea, vomiting, lethargy, irritability, thirst and anorexia. Care begins with removal of the patient from the hot environment. “Mild dehydration can be managed with oral replacement of fluids i.e. 1 tsp of NxCl missed with 500 ml of wather or staock electrolyte solution given over 1 -2 hours. Severe dehydration should be treated with a bolus of 20 ml/kg of NS given oer an hour followed by rehydration protocol.”

Alternatively, Heatstroke is a “neurological dysfunctioning” when “the body is unable to dissipate heat” leading to a “rapid rise in core temperature.” Heatstroke can lead to “renal failure Rhabdomyolysis, hepatocelluar necrosis, myocardia damage, cerebral edema, and various metabolic abnormalities.”

Resources for EMS
As 2016 challenges communities around the U.S. with devastating heat not seen before, the CDC is releasing informational resources on managing and prevent heat-related illnesses and death as well as updating its Environmental Public Health Tracking Data on social and environmental conditions throughout the U.S.

Click to view pdf

Finally, the Climate Change and Extreme Heat Events Guidebook is also available online. It “describes how to prepare for and respond to extreme heat events and explains how the frequency, duration, and severity of these events are increasing as a result of climate change.”  

As for the Summer of 2016, heat related illnesses can happen indoors where no air condition exists and outdoors, making organization and workflow within the ambulance crucial as well as having equipment that can manage any location and all patient ages.


Recommendations for the 14-Day Heat-Acclimatization Period

  1. Days 1 through 5 of the heat-acclimatization period consist of the first 5 days of formal practice. During this time, athletes may not participate in more than 1 practice per day.
  2. If a practice is interrupted by inclement weather or heat restrictions, the practice should recommence once conditions are deemed safe. Total practice time should not exceed 3 hours in any 1 day.
  3. A 1-hour maximum walk-through is permitted during days 1–5 of the heat-acclimatization period. However, a 3-hour recovery period should be inserted between the practice and walk-through (or vice versa).
  4. During days 1–2 of the heat-acclimatization period, in sports requiring helmets or shoulder pads, a helmet should be the only protective equipment permitted (goalies, as in the case of field hockey and related sports, should not wear full protective gear or perform activities that would require protective equipment). During days 3–5, only helmets and shoulder pads should be worn. Beginning on day 6, all protective equipment may be worn and full contact may begin.
    1. Football only: On days 3–5, contact with blocking sleds and tackling dummies may be initiated.
    2. Full-contact sports: 100% live contact drills should begin no earlier than day 6.
  5. Beginning no earlier than day 6 and continuing through day 14, double-practice days must be followed by a single-practice day. On single-practice days, 1 walk-through is permitted, separated from the practice by at least 3 hours of continuous rest. When a double-practice day is followed by a rest day, another double-practice day is permitted after the rest day.
  6. On a double-practice day, neither practice should exceed 3 hours in duration, and student-athletes should not participate in more than 5 total hours of practice. Warm-up, stretching, cool-down, walk-through, conditioning, and weight-room activities are included as part of the practice time. The 2 practices should be separated by at least 3 continuous hours in a cool environment.
  7. Because the risk of exertional heat illnesses during the preseason heat-acclimatization period is high, we strongly recommend that an athletic trainer be on site before, during, and after all practices.

source: Journal of Athletic Training – U.S. National Library of Medicine, National Institutes of Health.


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