Exertional heat stroke prehospital management on-site preparation and training checklist
| Preparation (site visit/ venue assessment) | Training (hands-on training) | During competition |
| Deciding heat deck location | Heat deck operation | Daily pre-event meeting |
| ❑ Access to FoP ❑ Access to ambulance ❑ Separated and minimal exposure from mix zone ❑ Within or adjacent to the AMS ❑ Access to water and drainage ❑ Access to electricity ❑ Temperature control (availability of air conditioning) ❑ Location of ice stock (preferably within heat deck, method of ice transfer if outside) | ❑ Label ice baths with numbers and identify a heat deck leader that guides medical volunteers to use ❑ Check time to fill (ie, poor water pressure in temporarily structures) and drain ice baths ❑ Check ice quantities in heat deck and who will collect more ice ❑ Instruct on cleaning method | ❑ Go through the full medical process from FoP triage to EHS management ❑ Identify heat deck leader for the day ❑ Identify who is assessing rectal temperature ❑ Identify who is in charge of continuous monitoring vital signs ❑ Identify who is helping with the transfer (may need assistance from FOP medical volunteer) ❑ Appropriate triage and communication if heat deck separated from AMS ❑ Check communication method with the team medical staff of collapsed athlete ❑ Check on ice storage, provision and how to get more ice |
| Triage | ||
| ❑ Chain of command from FoP triage to heat deck (radio, responsibility, transfer of patient) ❑ Chain of command with AMS and within heat deck ❑ Contingency plan for collapsed athlete far away from AMS and heat deck ❑ Control of wheelchairs, stretchers, and other evacuation devices | ||
| Transfer lines to be tested | Patient management to know | Ice bath management |
| ❑ From FoP to heat deck (clear, accessible to wheelchair and stretcher) ❑ From heat deck to ambulance (clear, accessible for stretcher transfer) ❑ Within heat deck (spacious enough for medical staff to provide care) | ❑ Familiarise with EHS-specific medical chart ❑ Average cooling pattern (know when to doubt incorrect measurements) ❑ Discharge criteria (continuous monitoring heat deck, follow-up care) ❑ Communication with collapsed athlete (reassurance athletes) ❑ Communication with team medical staff (explanation to medical staff) | ❑ Water temperature should be kept between 5°C and 15°C |
| Equipment | Patient management to practice | |
| ❑ Purchase equipment needed to operate heat deck (see Hosokawa et al. BJSM, 2021.) ❑ Label (number) all rectal thermometers ❑ Rectal thermometer probe≥2 m long (with insertion mark at 10 cm) ❑ Check time and calibration for all monitors (eg, thermometer, point-of-care blood analyser) | ❑ Rectal temperature assessment ❑ Handling patient using pole-less mesh stretcher ❑ Transfer of patient to ice bath ❑ Handling of patient while using ice bath ❑ Handling of patient while using ice towels ❑ Taking vitals (eg, blood pressure, heart rate) during EHS management ❑ Blood sodium assessment using equipment provided ❑ Blood glucose assessment using equipment provided ❑ Preparation of intravenous therapy | |
| Education | Sport-specific considerations | |
| ❑ Aetiology of exertional heat stroke ❑ Distribution of medical policies and procedures to key medical stakeholders ❑ Environmental heat policies and how it may influence the event operation and EHS risk | ❑ Access to rectal temperature assessment (eg, swimsuit, protective equipment) ❑ Average size of athletes competing in the event ❑ Identify high risk section, event, situation, etc that can be observed in respective sports ❑ Review of games rule to identify who has the right to access athletes first ❑ Extrication of collapsed athlete from unique environment (eg, water, sand and forest) |
AMS, Athlete Medical Station; EHS, exertional heat stroke; FoP, field of play.