J Athletic Training
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Transcript J Athletic Training
Gary Clinton MS, AT/C, AT/L
Sports Medicine Instructor Yelm HS
WCTSMA President
If a patient is suspected of Exertional Heat Stroke, what
should be the first action taken in treatment of the
condition?
A) Drive them to the hospital by parent/yourself.
B) Contact EMS and wait for them to arrive. Don’t
move athlete.
C) Get them a bottle of water and put ice towels on
them.
D) Apply Biofreeze to the entire body.
E) Contact EMS, but place athlete in cold water immersion
and stir the water aggressively before transport.
Isaiah Laurencin- FL, Exertional Sickling
Tyquan Xavier Brantley- SC, Exertional Sickling
Lewis Ogloba- PA, Asthma led to Cardiac Arrest
DJ Searcy- GA, Heat related
Forrest Jones- GA, Heat stroke
Montel Williams- AR, Exertional Sickling
Sam Dickson- PA, (Congenital)Coronary Artery
Al Smith, Jr.- TX, unknown, 2nd day of FB practice
Latrell Dunbar-MS, Cardiac Event
Candace Ortiz- TX, unknown
Angela Gettis- CA, Cardiac Event
David Stinson, head coach Pleasure Ridge Park HS
criminally charged in death of 15 year old, Aug. 20th 2008.
All coaches present, AD who was present, and Principal
were named in a separate civil lawsuit.
“Reckless Homicide”- When a person fails to perceive a
risk that a reasonable person in that situation would have
seen.
Another player that day also collapsed and spent 2 days in
the hospital.
Coach alleged to have withheld water and continued practice
with a heat index of 94.
Coach “would run the players until someone quit the team”.
It took 15 minutes to call 911.
Coach Stinson was on paid administrative leave,
reassigned, no longer coaches.
Community & school district torn apart.
Coach Stinson was acquitted of criminal charges.
Civil suit was settled out of court for 1.75 million
dollars.
Focuses on two issues in HS Football
Concussions
Heat Stroke
Arkansas, 2010
Two heat stroke scenarios
1 died (Tyler Davenport)
1 lived (Will James)
What was the difference in care?
Frontline- “No one should die of Heatstroke”
A set of guidelines that safely prepares athletes for
competition.
Released by the NATA in 2009 for Secondary Schools.
100% of heat related deaths are preventable!!
WIAA currently has no guidelines.
Korey Stringer Institute is pushing for all 50 states to
adopt guidelines for all high schools.
NCAA has had guidelines in place since 2003.
One collegiate death in August since inception!
No more than 1 practice
per day.
No longer than 3 hours
1 hour max. ( walk thru)
permitted after 3 hours
minimum rest.
Football:
Days 1 & 2 Helmets only
Days 3-5 Helmets &
shoulder pads only
Double practice days
followed by a single
On single days, 1 walk thru
permitted w/3 hrs rest.
Rest day doesn’t count
towards 14 day total.
Doubles don’t exceed 3
hours for each. Not to
exceed 5 hours total.
All activities included as
practice time:
conditioning, walk thru,
weight room, etc.
Recommend certified AT
onsite for all practices.
National Athletic Trainers Association
American College of Sports Medicine
Gatorade Sports Science Institute
National Strength and Conditioning Association
US Army Research Institute for Environmental
Medicine
American Orthopaedic Society for Sports Medicine
American Medical Society for Sports Medicine
American Academy of Pediatrics
Korey Stringer Institute is doing extensive research
“New Jersey, first to
adopt heat guidelines”
From 1995 through 2008,
39 football players died
of heatstroke.
Second most common
cause of death for high
school athletes, after
spinal cord injury.
EAP’s in place
Earlier AM full gear
practices
Shells for later PM
practices, install
Emphasize pre-practice
hydration
Efficient hydration
available
Discourage supplements,
caffeine & stimulants
Heat exhaustion symptoms include:
Paleness
Cramping
Heavy sweating
Fainting or nausea
Fast or shallow breathing
Dizziness
The pulse rate is fast and weak.
Core body temperature below 104 degrees
Heatstroke symptoms include both physical and
neurological manifestations—a fast pulse and
extremely high temperature (above 104 degrees)
coupled with confusion or hallucination.
People may experience nausea, fatigue, vomiting,
diarrhea, loss of balance, irritability, irrational or
unusual behavior, apathy, hysteria, and headaches, as
well as dizziness and disorientation.
With NEHS, the body stops or decreases sweat
production so the skin feels hot and dry.
With EHS, the body can still produce sweat, so the
skin can be moist though the core temperature
remains just as high.
Sometimes, there will be no clear evidence of a
problem until the athlete collapses.
Is the only valid measure of body temperature.
Can only be measured rectally or with an ingestible
thermometer (Gastrointestinal).
What if I don’t have/don’t want to measure
temperature rectally?
Common sense:
Signs & Symptoms
Fast pulse
Confusion
Nausea
Disorientation
Altered level of Consciousness
Irrational/Unusual Behavior
Dizziness
Loss of Balance
Activate EAP
Call 911, but…
Cool the body rapidly, before transport
Remove from heat
Cold Water Immersion
If not available:
Douse with cold water
Ice bags/towels, rotate : 3 mins.
Put in any available water source
Goal is to get body temperature below 102 degrees
within 30 minutes.
Water temperature between 35-59 degrees.
Ice always visible on surface
Continuously stirred.
Cooling rate in general is 1 degree: 3 minutes.
Basic guideline:
Water temp of 38-42 degree
10-15 minutes of immersion time
Affects athletes with Sickle Cell Trait
Muscle Cramping
Tenderness
Pain
Inability to catch breath
Swelling
Fatigue
Weakness
Longer periods of recovery within conditioning
Excluded from performance tests
Timed mile run & serial sprints
Adjust work-rest cycles during hotter days
Emphasize hydration
Don’t work out if feeling ill
Control Asthma
Have supplemental oxygen available
Study of hydration
1. Proper pre practice hydration
½ given water
½ withheld water
No significant difference in core temperature!
2. Start practice dehydrated
½ given water
½ withheld water
Significant difference in core temperature
Emphasis needs to be on effective hydration by the
athlete!
10 Most common conditions with treatment and
Emergency Action Plans included.
Asthma
Exertional Hyponatremia
Catastrophic Brain
Exertional Sickling
Injuries
Cervical Spine injuries
Diabetes
Exertional Heat Stroke
Lightning
Head-down contact
Sudden Cardiac Arrest
If a patient is suspected of Exertional Heat Stroke, what
should be the 1st action taken in treatment of the
condition?
A) Drive them to the hospital by parent/yourself.
B) Contact EMS and wait for them to arrive. Don’t
move athlete.
C) Get them a bottle of water and put ice towels on
them.
D) Apply Biofreeze to the entire body.
E) Contact EMS, but place athlete in cold water immersion
and stir the water aggressively before transport.
Korey Stringer Institute, www.ksi.uconn.edu
EAP’s
CWI guidelines
Exertional Heat Stroke survival kit
Rectal Probes & thermometers
Hydration kits
Hot weather practice procedures outline
State athletic association guidelines
Binkley HM, Beckett J, Casa DJ, Kleiner DM, Plummer PE. National
Athletic Trainers’ Association position statement: exertional heat
illnesses. J Athletic Training. 2002; 37(3):329–343.
Casa DJ, Guskiewicz KM, Anderson SA, Courson RW, Heck JF, Jimenez
CC, McDermott BP, Miller MG, Stearns RL, Swartz EE, Walsh KM.
National Athletic Trainers’ Association position statement: preventing
sudden death in sports. J Athletic Training. 2011; 47(1):96–118.
Casa DJ, McDermott BM, Lee EC, Yeargin SW, Armstrong LE, Maresh
CM. Cold-water immersion: The gold standard for exertional heat
stroke treatment. Exercise and Sports Science Reviews. 2007; 35(3):141149.
Heatstroke. eMedicine website.
http://emedicine.medscape.com/article/166320-overview. Updated
September 2009
Mueller FO, Colgate B. Annual survey of football injury research 1931–
2008. The American Football Coaches Association, the National
Collegiate Athletic Association, and the National Federation of State
High School Associations.
www.unc.edu/depts/nccsi/FootballAnnual.pdf.
No sweat: Recognizing and preventing heat-related illnesses . CMA
Today. 2010; 43(4) July/August.
Understanding heat-related illness: symptoms. WebMD.
http://www.webmd.com/a-to-z-guides/understanding-heat-relatedillness-symptoms.
Yeargin SW, Casa DJ, Judelson DA, McDermott BP, Ganio MS, Lee EC,
Lopez RM, Stearns RL, Anderson JM, Armstrong LE, Kraemer WJ,
Maresh CM. Thermoregulatory Responses and Hydration Practices in
Heat-Acclimatized Adolescents During Preseason High School
Football. J Athletic Training. 2010; 45(2): 136–146.
Gary Clinton MS, AT/C, AT/L
Sports Medicine Instructor Yelm HS
WCTSMA President
[email protected]
(360)458-7777