Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series involving EHS patients were searched in the following online databases: PubMed, Scopus, SPORTDiscus, Medline, CINAHL, Academic Search Premier, and the Cochrane Library: Central Registry of Clinical Trials. Cooling methods were subdivided into “adequate” (>0.15 °C/min) versus “insufficient” (0.15 °C/min for EHS patients were significantly associated with surviving EHS without medical complications. In order to provide the best standard of care for EHS patients, an aggressive cooling rate >0.15 °C/min can maximize survival without medical complications after exercise-induced hyperthermia.

The purpose of this consensus document was to develop feasible, evidence‐based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus‐based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best‐practices and protect worker health and productivity.

Background: Exertional heat stroke (EHS) is a leading cause of secondary school sport-related death; however, a longitudinal analysis on observed trends is lacking. Our purpose was to describe EHS deaths in United States secondary school athletes since the 1982/1983 academic year. Hypothesis: EHS deaths will be primarily represented by football athletes and have a stable or increasing trend across a decade-by-decade analysis. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: EHS deaths in secondary school sports from July 1, 1982 through June 30, 2022 captured in the National Center for Catastrophic Sports Injury Research database were included (n = 67). Chi-square test of goodness of fit (alpha = 0.05), incidence rate ratios, and 95% CIs of differences in number of deaths between the 4 decades are reported. Results: Of 67 deaths, 66 (98.5%) were male. Ages ranged from 13 to 18 years. Football accounted for 63 (94%) of deaths, with basketball (n = 2), soccer (n = 1), and track and field (n = 1) accounting for the remainder. The southern region had the largest number of deaths, n = 50 (74.6%). Most deaths occurred in August (n = 38), followed by July (n = 15) and September (n = 9). Stratified into 4 separate 10-year periods, the proportion of EHS deaths differed significantly across time ( χ²(3, n = 67) = 8.72; P = 0.03). The period 2002-2011 had the highest number of EHS deaths (n = 26), 1982-1991 had 9, while both 1992-2011 and 2012-2021 had 16 deaths. Conclusion: The most recent decade shows a 38% reduction from the peak decade (2002-2011, n = 26), but remains similar to 1982-1991. Clinical Relevance: Continued efforts are required to prevent catastrophic sport-related death due to EHS. Secondary school EHS deaths are overwhelmingly represented by football, most commonly in August, and in the south. This emphasizes the need for secondary schools to be equipped with basic tools and policies to saves lives.

Assessing the adaptation of rectal temperature (T_rec) is critical following heat acclimatization (HAz) and heat acclimation (HA) because it is associated with exercise performance and safety; however, more feasible and valid methods need to be identified. The purpose of this study was to predict adaptations in T_rec from heart rate (HR), sweat rate (SR), and thermal sensation (TS) using predictive modeling techniques. Twenty-five male endurance athletes (age, 36 ± 12 y; VO_2max, 57.5 ± 7.0 mL⋅kg⁻¹⋅min⁻¹) completed three trials consisting of 60 min running at 59.3 ± 1.7% vVO_2max in a hot environment. During trials, the highest HR and TS, SR, and T_rec at the end of trials were recorded. Following a baseline trial, participants performed HAz followed by a post-HAz trial and then completed five days HA, followed by a post-HA trial. A decision tree indicated cut-points of HR (<−13 bpm), SR (>0.3 L·h⁻¹), and TS (≤−0.5) to predict lower T_rec. When two or three variables met cut-points, the probability of accuracy of showing lower T_rec was 95.7%. Greater adaptations in T_rec were observed when two or three variables met cut-points (−0.71 ± 0.50 °C) compared to one (−0.13 ± 0.36 °C, p < 0.001) or zero (0.0 3 ± 0.38 °C, p < 0.001). Specificity was 0.96 when two or three variables met cut-points to predict lower T_rec. These results suggest using heart rate, sweat rate, and thermal sensation adaptations to indicate that the adaptations in T_rec is beneficial following heat adaptations, especially in field settings, as a practical and noninvasive method.

Context: Geographic disparities exist in trauma care (ie, “trauma center desert”) within the United States. An athletic trainer (AT) on site at secondary schools (SSs) may help enhance collaboration with emergency medical systems and potentially lead to better outcomes after catastrophic injuries. However, access to AT services relative to the location of level I or II (ie, tertiary) trauma centers remains unknown. Objectives: To visualize and describe the distance between SSs and trauma centers and compare access to AT services across the United States. Design: Cross-sectional study. Setting: Public and private SSs with interscholastic athletics programs in the United States. Patients or Other Participants: Survey data obtained through the Athletic Training Locations and Services (ATLAS) project database between September 2019 and April 2023. Main Outcome Measure(s): The minimum distance from each SS to a tertiary trauma center was calculated on Tableau Desktop by geocoding with longitude and latitude. The status and level of AT employment were obtained from the ATLAS project database. The odds and percentages of access to AT services were examined by distance ranges. Results: A total of 18 244 SSs were included in the analyses. Of these, 75% (n = 13 613) were located within 50 miles (81 km) of a tertiary trauma center. The odds of access to AT services were 2.74 (95% CI = 2.56, 2.93) times greater in SSs situated within 50 miles of a tertiary trauma center (P < .001). Additionally, SSs located more than 60 miles (97 km) from a tertiary trauma center had decreased access to AT services (R2 = 0.9192). Conclusion: This study highlighted the geographic disparities in distance to trauma care for SSs in the United States. Those SSs located more than 60 miles from trauma centers had reduced odds of access to AT services. Identification of geographic trends of AT services relative to the location of tertiary trauma centers is a critical first step in preventing fatal consequences of catastrophic injuries.

Context: A healthy, 22-year-old, male NCAA Division I baseball shortstop was experiencing confusion, chest pain, and tightness during an off-season intersquad scrimmage. The patient did not have any significant medical history or mechanism of head injury. After initial evaluation from the athletic trainer, the patient’s cognitive status began to quickly decline. The emergency action plan was put in place rapidly and referred the patient to the local emergency clinic. Case Presentation: Upon arrival at the emergency department, an electrocardiogram was performed to rule out myocardial infarction or stroke. The first electrocardiogram results returned negative for any cardiac pathology, but a stroke alert was called. The patient was then transported to a level II trauma center due to continual cognitive decline. The patient was diagnosed with transient ischemic attack (TIA) secondary to an undiagnosed patent foramen ovale (PFO) that would later be diagnosed with further evaluation 2 months after the initial TIA incident. After multiple diagnostic and laboratory tests, the PFO went undetected until a 2D echocardiogram was performed and evaluated by a cardiologist. Management and Outcomes: After the confirmation of the congenital defect, surgical intervention was performed to correct the PFO using catheterization. Despite multiple preparticipation examinations, electrocardiograms, and examination of past family history, the PFO went undetected until the patient experienced symptoms of TIA. The discovery of PFO in this 22-year-old athletic individual is unusual because traditional screening techniques (electrocardiogram and preparticipation examinations) failed to detect the congenital defect. Conclusions: Due to the emergent and timely actions of the athletic trainer, the patient has made a full recovery and is able to compete fully in athletic events. This case study amplifies the need for athletic trainers at all sporting events, updated and reviewed emergency action plans, rapid recognition of TIA in athletic individuals, and return-to-play protocol for an athletic individual after TIA.