Riana R. Pryor

The inter-association task force for preventing sudden death in secondary school athletics programs: best-practices recommendations.

Douglas J. Casa, PhD, ATC, FNATA, FACSM (Chair)*†; Jon Almquist, VATL, ATC*; Scott A. Anderson, ATC*; Lindsay Baker, PhD‡; Michael F. Bergeron, PhD, FACSM§; Brian Biagioli, EdD||; Barry Boden, MD¶; Joel S. Brenner, MD, MPH, FAAP#; Michael Carroll, MEd, LAT, ATC*; Bob Colgate**; Larry Cooper, MS, LAT, ATC*; Ron Courson, PT, ATC, NREMT-I, CSCS*; David Csillan, MS, LAT, ATC*; Julie K. DeMartini, MA, ATC†; Jonathan A. Drezner, MD††; Tim Erickson, CAA‡‡; Michael S. Ferrara, PhD, ATC, FNATA*; Steven J. Fleck, PhD, CSCS, FNSCA, FACSM§§; Rob Franks, DO, FAOASM||||; Kevin M. Guskiewicz, PhD, ATC, FNATA, FACSM*; William R. Holcomb, PhD, LAT, ATC, CSCS*D, FNATA, FNSCA§§; Robert A. Huggins, MEd, ATC†; Rebecca M. Lopez, PhD, ATC, CSCS†; Thom Mayer, MD, FACEP¶¶; Patrick McHenry, MA, CSCS*D, RSCC§§; Jason P. Mihalik, PhD, CAT(C), ATC##; Francis G. O’Connor, MD, MPH, FACSM††; Kelly D. Pagnotta, MA, ATC, PES†; Riana R. Pryor, MS, ATC†; John Reynolds, MS, VATL, ATC*; Rebecca L. Stearns, PhD, ATC†; Verle Valentine, MD††

Estimating Core Temperature with External Devices After Exertional Heat Stress in Thermal Protective Clothing

ABSTRACT Background. Temperature measurement is important for emergency medical services (EMS) providers when identifying and treating heat illness or infection. Direct measures of body core temperature (Tc) are often expensive (ingestible capsules) or impractical (rectal probes) in the field. Multiple devices for estimating Tc have been adopted by EMS providers, with little understanding of the agreement between these devices and Tc. Objective. To examine the agreement between the results of five external thermometers and Tc after subjects experienced physical exertion while wearing protective clothing. Methods. Fifty firefighters completed treadmill walking in thermal protective clothing in a hot environment. Measurements of core, temporal, tympanic, forehead, and skin temperatures were obtained during a 20-minute recovery period simulating emergency incident rehabilitation. Results. The mean bias of external thermometers ranged from −1.31°C to −3.28°C when compared with Tc and exceeded the predetermined clinical cutoff of ±0.5°C from Tc. The 95% limits of agreement ranged from 2.75°C to 5.00°C. Conclusions. External measuring devices failed to accurately predict Tc in hyperthermic individuals following exertion. Confidence intervals around the bias were too large to allow for reasonable estimation of Tc. EMS providers should exercise caution when using any of these temperature estimation techniques.

Fitness Characteristics of a Suburban Special Weapons and Tactics Team

Pryor, RR, Colburn, D, Crill, MT, Hostler, DP, and Suyama, J. Fitness characteristics of a suburban special weapons and tactics team. J Strength Cond Res 26(3): 752–757, 2012—Special Weapons and Tactics (SWAT) operators are specialized law enforcement officers who traditionally perform their duties with higher anticipated workloads because of additional body armor, weapons, and equipment used for enhanced operations and protection. This elevated workload increases the need for SWAT operators to improve or maintain their physical fitness to consistently perform routine operations. Typical tasks require trunk rotation, overhead upper extremity use, upper and lower body strength use, and long waiting periods followed by explosive movements while wearing additional equipment. Eleven male SWAT operators from 1 SWAT team performed flexibility, strength, power, and aerobic capacity tests and a variety of job-related tasks. Data were compared with age- and gender-based normative data. Fitness testing revealed that officers ranked high on tests of muscular strength (leg strength, 90th percentile; bench press, 85th percentile); however, body composition (55th percentile), core body strength, and flexibility ranked lower. Furthermore, aerobic capacity and muscular power had a wide range of scores and were also not ideal to support maximal performance during routine operations. These data can assist exercise specialists choose fitness programs specifically for job-related tasks of SWAT operators when creating fitness programs. Fitness programming for law enforcement should focus on improving aerobic fitness, flexibility, core strength, and muscular power while maintaining muscular strength to meet the needs of these specialized officers.

A Randomized Controlled Trial of Aspirin and Exertional Heat Stress Activation of Platelets in Firefighters during Exertion in Thermal Protective Clothing

Abstract Purpose. Platelet aggregation is enhanced in firefighters following short bouts of work in thermal protective clothing (TPC). We sought to determine if aspirin therapy before and/or following exertion in TPC prevents platelet activation. Methods. In a double-blind, placebo-controlled study, 102 firefighters were randomized to receive daily therapy (81 mg aspirin or placebo) for 14 days before and a single dose (325 mg aspirin or placebo) following exercise in TPC resulting in four potential assignments: aspirin before and after exercise (AA), placebo before and after exercise (PP), aspirin before and placebo after exercise (AP), and placebo before and aspirin after exercise (PA). Platelet closure time (PCT) was measured with a platelet function analyzer before the 2-week treatment, after the 2 week treatment period, immediately after exercise, and 30, 60, and 90 minutes later. Results. Baseline PCT did not differ between groups. PCT changed over time in all four groups (p < 0.001) rising to a median of >300 seconds [IQR 99, 300] in AA and >300 [92, 300] in AP prior to exercise. Following exercise, median PCT decreased to in all groups. Median PCT returned to >300 seconds 30 minutes later in AA and AP and rose to 300 seconds in PA 60 minutes after exercise. Conclusions. Daily aspirin therapy blunts platelet activation during exertional heat stress and single-dose aspirin therapy following exertional heat stress reduces platelet activation within 60 minutes. Key words: firefighter; uncompensable heat stress; thermoregulation; emergency incident rehabilitation

Use of Thermal Imagery for Estimation of Core Body Temperature During Precooling, Exertion, and Recovery in Wildland Firefighter Protective Clothing

Abstract Background. Monitoring core body temperature to identify heat stress in first responders and in individuals participating in mass gatherings (e.g., marathons) is difficult. Objective. This study utilized high-sensitivity thermal imaging technology to predict the core temperature of human subjects at a distance while performing simulated field operations wearing thermal protective garments. Methods. Six male subjects participating in a study of precooling prior to exertion in wildland firefighter thermal protective clothing had thermal images of the face captured with a high-resolution thermal imaging camera concomitant with measures of core and skin temperature before, during, and after treadmill exercise in a heated room. Correlations and measures of agreement between core temperature and thermal imaging–based temperature were performed. Results. The subjects walked an average (± standard deviation) of 42.6 (±5.9) minutes and a distance of 4.2 (±0.6) km on the treadmill. Mean heart rate at the end of exercise was 152 (±33) bpm and core body temperature at the end of exercise was 38.3°C (±0.7°C). A visual relationship and a strong correlation between core temperature and thermal imaging of the face were identified in all subjects, with the closest relationship and best agreement occurring during exercise. The Bland-Altman test of agreement during exercise revealed the majority of measurement pairs to be within two standard deviations of the measured temperature. Conclusions. High-resolution thermal imaging in the middle-wave infrared spectrum (3–5 μm) can be used to accurately estimate core body temperature during exertion in a hot room while participants are wearing wildland firefighting garments. Although this technology is promising, it must be refined. Using alternative measurement sites such as the skin over the carotid artery, using multiple measurement sites, or adding pulse detection may improve the estimation of body temperature by thermal imagery.

The Effects of Ice Slurry Ingestion before Exertion in Wildland Firefighting Gear

Abstract Purpose. To investigate the effect of ice slurry ingestion precooling on body core temperature (Tc) during exertion in wildland firefighting garments in uncompensable heat stress. Methods. On two separate trials, 10 males ingested 7.5 g·kg−1 of either an ice slurry (0.1°C) or control beverage (20°C) during seated rest for 30 minutes prior to simulating the U.S. Forest Service Pack Test on a treadmill in wildland firefighting garments in a hot environment (38.8 ± 1.2°C, 17.5 ± 1.4% relative humidity). Deep gastric temperature, mean skin temperature (Tsk), and heart rate (HR) were recorded. Ratings of perceived exertion, thermal sensation, comfort, and sweating were assessed. Results. Compared with ingestion of a temperate beverage, precooling with ice slurry before exertion in a hot environment reduced Tc during the first 30 minutes of the exercise bout. Exercise time and distance completed were not different between treatments. Skin temperature, heart rate, and perceptual responses rose in both conditions during exercise but did not differ by condition. Conclusion. Pretreatment with ice slurry prior to exertion in wildland firefighting garments results in a modest reduction in Tc during the first 30 minutes of exercise when compared to pretreatment with control beverage but the ice slurry precooling advantage did not persist throughout the 45-minute exercise protocol.

The effect of prolonged light intensity exercise in the heat on executive function

OBJECTIVE When people are involved in outdoor activities, it is important to be able to assess a situation and make rational decisions. The goal of this study is to determine the effects of 90 minutes of light-intensity exercise in a hot environment on executive functioning capabilities of healthy individuals. METHODS In this prospective laboratory study, 40 healthy male and female subjects 18 to 45 years of age performed treadmill exercise while wearing athletic clothing and a backpack in either a hot or temperate environment. Vital signs, core and skin temperature, and perceptual measures (thermal sensation, sweating, comfort, and perceived exertion) were measured before, during, and after the treadmill test. Cognitive function was measured before and after the treadmill test using the Wisconsin Card Sorting Test (WCST) and a Psychomotor Vigilance Test (PVT). RESULTS Subjects in the hot condition reached a similar core temp of 38.2° ± 0.5°C vs 37.7° ± 0.3°C (P = .325) in the temperate group but had a higher heart rate (P < .001) and skin temperature (P < .001). Hot and normal temperature groups did not differ in their PVT performance. There were more correct responses (P < .001), fewer errors (P < .001), and more conceptual responses (P = .001) on the WCST after exertion in both the hot room and normal temperature room conditions. Perseverations and perseverative errors (P = .002) decreased in both groups after exertion. CONCLUSIONS Conditions of mild heat stress coupled with modest rehydration and short hiking treks do not appear to negatively affect executive function or vigilance.

Maximizing Athletic Performance in the Heat

ABSTRACT ATHLETES TRAIN AND PERFORM AT OPTIMAL LEVELS IN COOL ENVIRONMENTS; HOWEVER, MANY INDIVIDUALS DO NOT ALTER THEIR TRAINING IN HOT ENVIRONMENTS. THE PURPOSE OF THIS REVIEW IS TO EXPLORE EXISTING RESEARCH RELATED TO ENHANCING PERFORMANCE IN THE HEAT BY MODIFYING THE FOLLOWING PRACTICES: (A) HYDRATION, (B) BODY COOLING, (C) HEAT ACCLIMATIZATION, (D) CLOTHING AND PROTECTIVE EQUIPMENT, (E) NUTRITION AND SUPPLEMENTATION, (F) SLEEP, AND (G) TECHNOLOGY. THIS REVIEW EXPLORES PRACTICAL WAYS ATHLETES CAN CHANGE THEIR EXERCISE HABITS WITH THE GOAL OF INCREASING PERFORMANCE IN HOT ENVIRONMENTS.

Exertional Heat Illness: Emerging Concepts and Advances in Prehospital Care

Exertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. Although evidence is available primarily from case series and healthy volunteer studies, the consensus for treating exertional heat illness, coupled with altered mental status, is whole body rapid cooling. Cold or ice water immersion remains the most effective treatment to achieve this goal. External thermometry is unreliable in the context of heat stress and direct internal temperature measurement by rectal or esophageal probes must be used when diagnosing heat illness and during cooling. With rapid recognition and implementation of effective cooling, most patients suffering from exertional heat stroke will recover quickly and can be discharged home with instructions to rest and to avoid heat stress and exercise for a minimum of 48 hours; although, further research pertaining to return to activity is warranted.

Athletic Trainer Services in US Private Secondary Schools

CONTEXT Availability of athletic trainer (AT) services in US secondary schools has recently been reported to be as high as 70%, but this only describes the public sector. The extent of AT coverage in private secondary school settings has yet to be investigated and may differ from the public secondary school setting for several reasons, including differences in funding sources. OBJECTIVE To determine the level of AT services in US private secondary schools and identify the reasons why some schools did not employ ATs. DESIGN Concurrent mixed-methods study. SETTING Private secondary schools in the United States. PATIENTS OR OTHER PARTICIPANTS Of 5414 private secondary schools, 2044 (38%) responded to the survey. MAIN OUTCOME MEASURE(S) School administrators responded to the survey via telephone or e-mail. This instrument was previously used in a study examining AT services among public secondary schools. Descriptive statistics provided national data. Open-ended questions were evaluated through content analysis. RESULTS Of the 2044 schools that responded, 58% (1176/2044) offered AT services, including 28% (574/2040) full time, 25% (501/2042) part time, 4% (78/1918) per diem, and 20% (409/2042) from a hospital or clinic. A total of 84% (281 285/336 165) of athletes had access to AT services. Larger private secondary schools were more likely to have AT services available. Barriers to providing AT services in the private sector were budgetary constraints, school size and sports, and lack of awareness of the role of an AT. CONCLUSIONS More than half of the surveyed private secondary schools in the United States had AT services available; however, only 28% had a full-time AT. This demonstrates the need for increased medical coverage to provide athletes in this setting the appropriate level of care. Budgetary concerns, size of the school and sport offerings, and lack of awareness of the role of the AT continued to be barriers in the secondary school setting.