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Editorial
Enhancing exertional heat stroke patient care: where are we now and where do we need to go?
  1. William M Adams1,2,3,4,
  2. Yuri Hosokawa5,
  3. Samantha E Scarneo-Miller6,
  4. Luke N Belval7,8
  1. 1 Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, Colorado, USA
  2. 2 US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
  3. 3 School of Sport, Exercise and Health Science, Loughborough University, Leicestershire, UK
  4. 4 Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
  5. 5 Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
  6. 6 Division of Athletic Training, West Virginia University, Morgantown, West Virginia, USA
  7. 7 Naval Submarine Medical Research Laboratory, Groton, Connecticut, USA
  8. 8 Leidos Inc, Reston, Virginia, USA
  1. Correspondence to Dr William M Adams, Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, Colorado 80909, USA; william.adams{at}usopc.org

https://doi.org/10.1136/bjsports-2023-106713

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    Despite progress in prevention, recognition and treatment, exertional heat stroke (EHS) persists across multiple levels of sport and physical activity, and society remains burdened with preventable deaths. In most EHS-related deaths, an absence of appropriate healthcare, failure to properly recognise and diagnose the condition, and either lack of knowledge or resistance to using best practices are contributing factors responsible for catastrophic outcomes. The purpose of this editorial is to discuss the current landscape related to EHS management, followed by strategies to enhance patient outcomes (box 1).

    Box 1

    Key recommendations to enhance patient outcomes from exertional heat stroke (EHS)

    Preparedness

    • All local, regional, national and international sport organisations should require the adoption and implementation of contemporary, evidence-based best practices for the prevention, management and care of EHS.

    • For all sanctioned sporting events (ie, both training and competition) where there is a risk of EHS (eg, hot environmental conditions, intense exercise, equipment laden sports), appropriate healthcare providers trained in the management and care of EHS should provide onsite medical coverage.

    Management and care

    • When a patient presents with altered mental status during or following physical activity where EHS is suspected, assessment of internal body temperature after confirmation of intact circulation and airway using rectal thermometry is warranted.

    • On confirmation of a rectal temperature >40.5°C and accompanying altered mental status, onsite care is required using whole-body cooling methods (eg, cold water immersion, tarp-assisted cooling).

    • Following onsite treatment, patients should be transported to a higher-level healthcare facility for further monitoring and testing.

    Where are we now?

    Proper management of EHS is predicated on (1) assessment of hyperthermia (>40.5°C) via validated assessments of internal body temperature and (2) rapid, whole-body cooling.1–4 EHS treatment is grounded in …

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    Footnotes

    • Contributors WMA conceptualised this editorial. All authors took part in drafting, writing and approving the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The views expressed in this editorial are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government. The views expressed in this editorial also do not reflect the views or opinions of the United States Olympic & Paralympic Committee, or any of its members or affiliates.

    • Competing interests WMA has previously received grants from the following sponsors for work related to the prevention, management and care of exertional heat stroke: Statim Technologies and Techguard. WMA has also received monies from the following entities that may be, in part, relevant to this work: Springer Nature (Royalties), Emerja Corporation (Consulting), Korey Stringer Institute (Consulting). WMA is also the owner of Adams Sports Medicine Consulting. SES-M has received monies from the Korey Stringer Institute (Consulting) and legal firms as an expert witness (Consultant).

    • Provenance and peer review Not commissioned; externally peer reviewed.