Background and Objectives: Emergency Medical Service (EMS) protocols vary widely and may not implement best practices for exertional heat stroke (EHS). EHS is 100% survivable if best practices are implemented within 30 min. The purpose of this study is to compare EMS protocols to best practices for recognizing and treating EHS. Materials and Methods: Individuals (n = 1350) serving as EMS Medical or Physician Director were invited to complete a survey. The questions related to the EHS protocols for their EMS service. 145 individuals completed the survey (response rate = 10.74%). Chi-Squared Tests of Associations (χ²) with 95% confidence intervals (CI) were calculated. Prevalence ratios (PR) with 95% CI were calculated to determine the prevalence of implementing best practices based on location, working with an athletic trainer, number of EHS cases, and years of directing. All PRs whose 95% CIs excluded 1.00 were considered statistically significant; Chi-Squared values with p values < 0.05 were considered statistically significant. Results: A majority of the respondents reported not using rectal thermometry for the diagnosis of EHS (n = 102, 77.93%) and not using cold water immersion for the treatment of EHS (n = 102, 70.34%). If working with an athletic trainer, EMS is more likely to implement best-practice treatment (i.e., cold-water immersion and cool-first transport-second) (69.6% vs. 36.9%, χ² = 8.480, p < 0.004, PR = 3.15, 95% CI = 1.38, 7.18). Conclusions: These findings demonstrate a lack of implementation of best-practice standards for EHS by EMS. Working with an athletic trainer appears to increase the likelihood of following best practices. Efforts should be made to improve EMS providers’ implementation of best-practice standards for the diagnosis and management of EHS to optimize patient outcomes.

Exertional heat stroke is a severe heat illness involving the central nervous system and other organ systems induced by strenuous exercise, usually in hot and humid environments, associated with an elevation in core body temperature. By definition, exertional heat stroke is present when the core body temperature measured rectally exceeds 105 degrees F and central nervous system dysfunction is present. If recognized early and treated promptly, deaths from exertional heat stroke are completely preventable. Despite the well-described management option of cooling the body with ice water immersion, which is affordable and easy to use, deaths from exertional heat stroke continue to occur. In the 5-year period from 2005–2009, more deaths related to exertional heat stroke in organized sports occurred than in any other 5-year period in the past 35 yr. In the summer of 2011 alone, six high school football players died from exertional heat stroke. Every individual involved in the care of athletes, particularly those participating in hot and humid environments, must be aware of signs and symptoms of exertional heat stroke and understand the importance of prompt treatment to prevent catastrophic outcomes.

Background: Sickle cell trait (SCT) has received attention as a cause of death in college athletes, leading to mandatory lab SCT screening in National Collegiate Athletic Association (NCAA) athletes. High-school athletes are commonly screened by self-report. There are no known studies for evaluating whether this method is effective as a screening tool. Hypothesis: The local prevalence rate of SCT as self-reported on the preparticipation evaluation (PPE) forms would be lower than the national accepted average. Methods: PPE forms from the Department of Orthopedics and Rehabilitation of the University of Florida (UF) were reviewed between January 1, 2017, and April 30, 2018. The Florida High School PPE form includes a yes/no question to assess the diagnosis of SCT. The prevalence established by self-report was then compared with the national prevalence for SCT in the comparable race/ethnicity groups reported by the CDC. The response rate of SCT questions was also compared to other common cardiac screening questions. Results: A total of 401 forms were reviewed. Six (1.5%) students answered “yes,” 351 answered “no,” and 44 left the SCT question blank. All six athletes who self-reported “yes” were Black and made up 3.7% of the 162 known Black respondents. This self-report rate for Black/African Americans was well below the expected 7.3% described by the CDC. Response rates were also lower than the comparable cardiac screening questions. Conclusions: Self-report SCT status rates are lower than the accepted prevalence in a similar population. Significant inconsistencies in reporting were also determined. Clinical relevance: This is a rare study to evaluate the self-reported prevalence of SCT in high-school athletes. Below average reporting of SCT and inconsistency in completion of the forms increase the concern for accuracy and effectiveness of current high-school SCT screening methods relying on self-report.