Table 1

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
❑ 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.