University of Connecticut University of UC Title Fallback Connecticut

News

The UConn Heat Lab Tests Pro Athletes Under Extreme Conditions (Hartford Courant)

Crouched in a bucket inside UConn’s heat lab, Ironman triathlon finisher Adam Chase brushed water and sweat from his body as a researcher poured water over his head.

Three other researchers held high the plastic tarp that lined the bucket and would catch every drop falling from Chase, 51. Moments later, they tossed in the towels he’d just used to mop his face and back as he ran for 45 minutes at a 7-mph clip in the 94-degree room.

“Sweat soup,” one athlete said as she waited for her turn inside the Korey Stringer Institute’s new, $700,000 heat lab.

This salty concoction is what the University of Connecticut kinesiologists would weigh and test to determine how much Chase had sweat during his sweltering workout, how many electrolytes he’d lost and other metrics he might be able to use to improve his performance and lessen the risks of heat stroke from extreme exertion.

“It’s not half as glamorous as it sounds,” Luke Belval, director of research, joked after describing the process.

The same can’t be said for the lab itself, a 450-square-foot facility that opened Sept. 22 in Gampel Pavilion. After a three-year process, the Korey Stringer Institute unveiled a major upgrade made possible by $350,000 from UConn, $100,000 from Mission Athletecare – an active wear and thermo-regulation technology company that secured the lab’s naming rights – and other donors like the NFL.

The lab’s chamber includes $20,000 treadmills, a cold-water immersion tub, strong air flow that mimics the outdoors and a climate-controlled bathroom. It simulates balmy and humid conditions for athletes who come to UConn for hours-long sessions.

In temperatures that can reach 110 degrees and 90 percent humidity, researchers work with NFL and NCAA teams, the military and apparel companies to analyze the human body’s response to extreme conditions.

On the recent Thursday when the lab studied Chase, of Colorado, it also drew professional athletes who’d traveled to Storrs from Vermont, northern California and Lithuania.

And the lab’s reputation precedes its new digs. UConn researchers have been studying the effects of heat and humidity on exertion for 25 years, since Gampel was newly built and the heat lab inside of it was no bigger than a dorm room..

Researchers would control humidity by toggling between household humidifiers and dehumidifiers. They removed ceiling tiles above the treadmills to accommodate taller athletes.

At some point, someone slapped a sticker that reads, “FUN ZONE,” above the entrance to the lab.

“I’m sure in 1999, it was state of the art,” said Robert Huggins, the institute’s vice president of research and athlete performance and safety.

Even so, it was with that lab that the Korey Stringer Institute was founded in 2010 by its CEO, Doug Casa, UConn’s director of athletic training education.

He and the family of Korey Stringer, the Minnesota Vikings offensive tackle who died from exertional heat stroke in 2001, hoped with research and education, they could maximize athletic performance and save lives.

Since then, the institute has helped demonstrate that deaths like Stringer’s are preventable with quick, correct treatment – like the kind staff members provided while doing case studies of Falmouth Road Races in Massachusetts.

The lab has studied the effects of cold water immersion and cooling tarps, hydration and caffeination, humidity and sleep.

And it opened its doors to not only athletes – and, naturally, research participants – but people who’ve already suffered heat stroke as well as laborers and military members who want to prepare for hot and humid conditions.

“It was a basic facility we were able to do some cool things in,” Casa said of the old lab. “But this one really ups our ability to help athletes, warfighters and laborers who have to do intense work in the heat.”

“The potential for research and service for people who need help is greater than it’s ever been before.”

Over the course of three years, Casa sought ideas for the new Korey Stringer Institute by visiting high-end heat labs across North America, like the Nike Sport Research Lab in Portland and facilities at the University of Arkansas and University of Ottowa.

He says he borrowed the best features he could find and added some more. This winter, the lab will install radiant heat lamps to mimic the effects of sunlight and cloudy skies.

But already, the weeks-old lab is getting plenty of traffic on campus.

UConn students are not charged to use the facility like typical clients, and the women’s cross country team has taken to using the equipment a few times a week, as Chase, the professional ultrarunner, and Lea Davison, a two-time U.S. Olympian mountain biker, learned when they began their own warm ups.

Source: Hartford Courant

New heat lab at UConn will test limits of athletes, soldiers (Washington Post)

STORRS, Conn. — Douglas Casa acknowledges his new heat laboratory at the University of Connecticut’s Korey Stringer Institute could be viewed by some as a torture chamber.

He’ll be testing athletes, soldiers and others (sometimes for hours at a time) on a treadmill, stationary bike or cooling tub in an environment that can be controlled to reach temperatures of up to 110 degrees and 90 percent humidity.

“The difference is, everyone being tested here is a volunteer,” he said. “And we’re saving lives.”

The $700,000 Mission Heat Laboratory is designed to be used by the NFL, NCAA teams, the military, apparel manufacturers, and scientists interested in preventing and treating heat-related illnesses, optimizing performance in extreme conditions, and learning the temperature limits of the human body.

“The prevention side of heat stroke is one of the big reasons this lab was built,” Casa said. “We can look at things related to hydration, body-cooling strategies, acclimatization and the effects of certain medications, supplements and clothing on how much you heat up.”

Casa decided to make the study of heat and the human body his life’s work after nearly dying of heat stroke while competing in a 10K race at the Empire State Games in 1985.

He helped found the Korey Stringer Institute in 2010, after being approached by the family of the former Minnesota Vikings lineman who died of a heat stroke in 2001.

The institute’s work has helped rewrite heat-related protocols for the military along with the NFL, college football and other sports. Casa’s research, for example, proved that treating a heat stroke immediately on site to bring a body’s temperature down below 104 degrees can dramatically increase survival rates. That led to NFL teams putting cooling tubs at practice sites.

But Casa’s team had been working in a tiny 100-square-foot closet-like lab, using household humidifiers and dehumidifiers to conduct their research. Some of the lab’s ceiling tiles had to be removed to accommodate one of the taller athletes they tested.

UConn provided about $350,000 for the new high-tech lab with its environmental controls, $20,000 treadmills and computer monitoring equipment. It even has a bathroom so test subjects don’t have to leave the controlled environment during longer sessions.

The other half of the lab’s funding came from donors including the NFL, its players association and athletic trainers’ organization. Mission, an athletic apparel company co-founded by tennis star Serena Williams, basketball star Dwayne Wade and soccer star David Villa, spent $100,000 to secure the naming rights.

Josh Shaw, Mission’s chief executive, said it plans to use the lab to test new garments that will not only wick moisture from the body, but eliminate it from the clothing entirely. The lab also will be used to test new wearable technologies, sensors that can be placed in T-shirts for example, that could alert someone when they begin overheating.

“Serena Williams competes at 120 degrees at the Australian Open, that’s pretty extreme,” Shaw said. “So, if we can create a product that will help her be safe, we’re probably going to be able to use that technology for people, say, who do roofing or gardening, or contracting.”

The military, which has similar labs, is working in conjunction with Casa and Korey Stringer to conduct tests on people and materials to optimize how soldiers perform in places such as the Middle East, and determine whether certain people are fit for duty in the heat.

“Understanding different stresses in the heat, whether it’s combat load or uniforms that can be mitigated with different materials, different load carriages, different hydration or cooling strategies — those are things we can work out in the lab before they are worked out in the field,” said. Dr. Francis O’Connor, a retired colonel who studies heat-related issues at Uniformed Services University.

The lab also will be used by UConn’s athletic teams to help them prepare for hot-weather competitions and by individual athletes who have suffered heat-related illnesses to help them determine their new heat tolerances levels and develop a recovery plan.

Offensive lineman Hunter Knighton credits the institute with getting him back on the football field following a near-fatal heat stroke during an offseason practice at the University of Miami in 2014. His family donated money for the new lab.

“It’s been kind of a miracle for me,” said Knighton, who now plays for Tulsa. “I was just really blessed to be able to find the institute and Dr. Casa. They were able to guide me back.”

Source: Washington Post

New Lab Opens to Test Human Performance Limits in Heat (UConn Today)

UConn’s Korey Stringer Institute and MISSION have teamed up to open one of the nation’s premier academic heat research labs at the University of Connecticut’s main campus in Storrs.

Outfitted with the latest in climate control technologies and human performance monitoring systems, the MISSION Heat Lab at the Korey Stringer Institute will allow researchers to explore new ways to improve human performance, endurance, and safety in the heat.

“Exertional heat stroke is a constant concern for athletes, active military personnel, laborers, and others who are called on to perform in hot conditions,” says UConn professor Douglas Casa, a national expert on heat stroke and chief executive officer of the Korey Stringer Institute. “This lab will increase our understanding of heat illness and how body temperature impacts performance. It will also help us develop better methods for cooling, which is an important part of our commitment to keeping athletes, warfighters, and laborers safe.”

Gabrielle Giersch, a Ph.D. student and KSI assistant director of athlete performance and safety, looks on while Ryan Curtis, a Ph.D. student and KSI associate director of athlete performance and safety, rides an exercise bicycle at the Mission Heat Lab at the Korey Stringer Institute at Gampel Pavilion on Sept. 21, 2017. (Peter Morenus/UConn Photo)
Gabrielle Giersch, left, a Ph.D. student and KSI assistant director of athlete performance and safety, looks on while Ryan Curtis, a Ph.D. student and KSI associate director of athlete performance and safety, rides an exercise bicycle at the new MISSION Heat Lab at the Korey Stringer Institute in Gampel Pavilion. (Peter Morenus/UConn Photo)

The partnership between the Korey Stringer Institute and MISSION is a natural one. Named after a Minnesota Vikings lineman who died from exertional heat stroke in 2001, the Korey Stringer Institute (KSI) is one of the nation’s leading sports safety research and advocacy organizations specializing in heat illness research. MISSION is a pioneer in the development of temperature-controlling technologies for athletic and active accessories and gear. Co-founded by some of the world’s greatest athletes including Serena Williams, Dwyane Wade, Carli Lloyd, and David Villa in 2009, MISSION is dedicated to providing athletes, workers, and active individuals at all levels with solutions to maximize performance and optimize safety in the heat.

The MISSION Heat Lab at UConn features a first-of-its-kind cooling area that will allow researchers to monitor how the human body responds to different cooling treatments after experiencing heat-related stress and conditions.

“Rooted in sports and science, MISSION works with professional athletes, scientists, and medical doctors to deliver game-changing temperature-control technologies that enhance performance, safety, and comfort,” says Josh Shaw, founder and CEO of MISSION. “Since 2014, we’ve been working hand-in-hand with the KSI, and we are thrilled to sponsor the new state-of-the-art MISSION Heat Lab. For the next 10 years, the MISSION Heat Lab will set new standards in research, development, and testing to combat heat-related illness for athletes, workers, military, and active individuals – globally. As the market leader for cooling technologies, the new MISSION Heat Lab is yet another testament to our commitment to combatting the dangerous effects on everyone who lives, works, and plays in the heat.”

Located within UConn’s Gampel Pavilion sports arena, the MISSION Heat Lab is capable of creating a broad range of environmental conditions. High-end exercise bikes and treadmills along with advanced temperature controls will allow researchers to mimic specific environments for races, competitions, and events – from a hilly 10K New England road race on a cloudy 70 degree day with 40 percent humidity to a stifling hours-long military march in 100 degree heat under hot sun with 90 percent humidity. Radiant heat panels being installed later this year will further enhance lab simulations.

A full suite of continuous physiological monitoring systems will capture a test subject’s heart rate, internal temperature, skin temperature, and other vital signs hundreds of times per second. The test chamber also includes restroom facilities and resting areas designed to allow test subjects to remain in a designated environment for hours at a time without the need for outside breaks that might skew data regarding how their body is reacting to conditions.

Private donations supported the lab’s creation. One of those donors was Carole Knighton, whose son Hunter nearly died of exertional heat stroke during a 2014 football practice at the University of Miami. Hunter, whose body temperature was reportedly 109 degrees when he collapsed, spent two weeks on a ventilator in a medically induced coma, but ultimately survived the ordeal.

“This is a cause that is near and dear to my heart,” says Knighton, who lives in Fort Myers, Florida. “If it were not for the Korey Stringer Institute, my son would not be where he is today.”

With a desire to return to football, Hunter, now 23, visited the Korey Stringer Institute on several occasions to have his heat tolerance tested. In the process, he and his family learned a lot about heat illness and how it can be avoided. Winner of the 2015 Brian Piccolo Award for being the ”most courageous” football player in the Atlantic Coast Conference, Hunter now plays for Tulane.

Another donor, Jonny Class of Maryland, shares a similar story. His son, Gavin, suffered an exertional heat stroke during a Towson University football practice in 2013. Like Hunter, Gavin was hospitalized as his liver and other organs began to fail. His heart stopped and he was resuscitated, beginning what was to be a very long road to recovery that included a liver transplant. And like Hunter, Gavin was subsequently tested at the Korey Stringer Institute to make sure his body was ready to return to football.

“With their help, he was able to return to all physical activities and is now able to lead a normal life,” says Jonny Class, Gavin’s father. “The knowledge we learned from KSI was amazing. We have since started a foundation, YOLT (You Only Live Twice) to help raise awareness about heat illness and the importance of organ donation.”

University officials say the new MISSION lab will be a strong addition to UConn’s nationally renowned kinesiology program.

“This new state-of-the art lab will be one of very few such facilities in the U.S., and has some design elements that make it stand alone,” says Cameron Faustman, interim dean for UConn’s College of Agriculture, Health, and Natural Resources, which houses the program. “We are confident it will attract even more research funding, research scholars, and students to our campus. The cost of this initiative has been met with contributions from the University, college, department, private donors, and companies. This speaks not only to the recognized need for the types of research that this facility will support, but also to the confidence that many others have in our faculty members.”

The MISSION Heat Lab will be available for use by outside companies and organizations to maximize research opportunities in heat safety awareness, as well as other areas of temperature-related studies.

Source: UConn Today

Is your school prepared to protect your student athlete from potentially life threatening conditions? (WTNH)

By 

STORRS, Conn. (WTNH) – High school sports create a frenzy, on the field, in the gym, and in the stands.

But the first study of its kind — a state by state analysis into safety practices — reveals what needs to be done to better protect student athletes.

“We’re looking at the key things that can cause death in high school sports. So cardiac issues, heat issues, head injuries and other things that can protentially prevent serious consequences from playing high school sports,” says lead researcher Douglas Casa, who heads up the Korey Stringer Institute at UConn – a national sports research and advocacy organization.

Connecticut he says ranks 38th — among the other states and District of Columbia.

But Casa stresses that statewide policy changes at little or no cost, could easily boost that ranking.

Such as a detailed emergency action plan, “Like kind of set policy-like a recipe to follow like I call this number, open this gate, meet this ambulance driver and take the person there.”

He also recommends — modifying routines when needed, “When it’s really extreme environmental conditions, you make modifications, so like the state of Georgia has an outstanding policy that when it gets hotter outside, you have more rest breaks, and you have longer rest breaks.”

The unexpected can happen anytime.

Baseball pitcher Joey Ciancola died soon after collapsing on the first day of winter workouts on a practice field at a New England college.

“He was in perfect health and pushed to his limits,” says his mother, Michelle Ciancola.

She says that visible symptoms of exertional heat stroke went unchecked, “Joey became delirious, started to run backwards instead of forward. He was definitely struggling. When he collapsed he was having seizures.” She adds, “I strongly urge all parents and athletes that are going off to school — going off to high school — or going off to college in the next few weeks — to check in with your athletic department and ensure that they are following proper protocol and that they are trained.”

Casa says, “We need parents to make sure that when every time their kid goes out to a playing field, that there is an athletic trainer there, that there’s treatment for heat stroke, that they have an A-E-D just in case there’s a cardiac event.”

Even if a state doesn’t have a policy, Casa says that individual schools can set their own.

For example he says, E-O Smith High School in Storrs has immersion tubs on the practice field, even though it’s not required by the state.

Source: WTNH

Protecting Student-Athletes From Heat, Head Injuries (The Pew Charitable Trusts)

By Michael Ollove

Another high school football player, this one a 14-year-old in the Bronx, collapsed on the field and died last week, possibly the result of high heat and humidity.

The death of Dominick Bess of apparent cardiac arrest came at a time when thousands of high school athletes have returned to practice fields. It again raises the question of whether states are doing enough to ensure that student-athletes are safe as they collide into one another, run wind sprints, or dig in against hard-throwing pitchers.

Nearly 8 million kids participated in high school sports last year, the most in U.S. history. The shocking deaths of young student-athletes have prompted some states to weigh major changes.

The California Legislature is considering a bill that would bring athletic trainers under state regulation. Others, including Texas and Florida, are strengthening policies on training during high heat and humidity and on the use of defibrillators during sporting events and practices. They are also moving to require schools to devise emergency plans for managing catastrophic sports injuries. And in response to growing concerns about concussions, the state of Texas recently embarked on the largest study ever of brain injuries to young athletes.

But overall, a just released study of state laws and policies on secondary school sports found that all states could do more to keep high school athletes safe. And some have a long way to go.

The study has prompted a strong pushback, including from the national organization that represents state high school athletic associations. But it also has encouraged some athletic trainers and sports medicine physicians who hope poor rankings will impel their states to make improvements and avoid exposing student-athletes to needless risk.

“I was embarrassed we were last,” said Chris Mathewson, head athletic trainer at Ponderosa High School in Parker, Colorado, speaking of his state’s showing in the study’s ranking of state safety efforts. “My hope is it will kick people in the pants and get people to do something about it.”

The rankings were devised by the Korey Stringer Institute (KSI), also known as Stringer, which is a part of the University of Connecticut and provides research, education and advocacy on safety measures for athletes, soldiers and laborers engaging in strenuous physical activity. It was named for a Minnesota Vikings offensive lineman who died of heat stroke during a preseason practice in 2001. His death sparked changes in NFL training practices and influenced reforms at the college and high school levels as well.

The rankings are based on whether states have adopted more than three dozen policies or laws derived from recommendations published in 2013 by a task force that included representatives from KSI, the National Athletic Trainers’ Association and the American College of Sports Medicine. The recommendations cover such areas as prevention of heat stroke, cardiac arrest and head trauma, as well as qualifications of school athletic trainers and educating coaches in safe practices.

Some state athletic associations, including Colorado’s, and the National Federation of State High School Associations, known as NFHS, which represents the associations that govern high school extra-curricular activities, have objected to the methodology of those rankings. They say it relies too much on information found on the websites of state athletic associations while failing to note efforts those groups have undertaken to reduce risks to high school athletes.

“By ‘grading,’ state high school associations based on a limited number of criteria, KSI has chosen to shine a light on certain areas, but it has left others in the dark,” said Bob Gardner, NFHS executive director. He pointed to steps his group and its members have taken related to safe exertion in heat and humidity, use of defibrillators and tracking head injuries, which Stringer didn’t take into account.

In Colorado, Rhonda Blanford-Green, commissioner of the state’s High School Activities Association, said officials are “comfortable and confident that our [policies] meet or exceed standards for student safety.”

She complained that Stringer’s methodology is too rigid. For example, she noted that Stringer penalized states that did not require that all football coaches receive safety training taught by USA Football, the governing body for amateur football. But, she said, Colorado coaches are trained in other programs that she described as more comprehensive.

She also noted that her association was penalized because it made policy recommendations to its high school members, rather than making them requirements, as Stringer prefers.

The scholastic association in California, which finished just ahead of Colorado, also objected to the survey. Its executive director, Roger Blake, suggested that funding was a chief barrier to progress.

California Interscholastic Federation “member schools will need more funding, more AEDs [automated external defibrillators], more athletic trainers and more research to help support our efforts to minimizing risk,” Blake said. “With the assistance of everyone who cares about young athletes, including KSI, we can continue to progress.”

High School Deaths

Between 1982 and 2015, 735 high school students died as a result of their participation in school sports, according to the National Center for Catastrophic Sport Injury Research at the University of North Carolina. The vast majority of those deaths were related to football, and three-quarters of the overall deaths were attributed to cardiac arrest, respiratory failure or other ailments associated with physical exertion. The rest were linked to trauma, such as head injuries.

More of those deaths occurred in the 15 years prior to the year 2000 rather than the 15 years after — likely a reflection of the fact that most of the policies and laws pertaining to safety in high school sports were put in place after 2000, particularly in the last nine years.

In 2014-15, the last year for which there are statistics, 22 high school athletes died, 14 of them football players.

Some of the reforms carry the names of student-athletes who died while participating in school sports. That was true in North Carolina after the 2008 death of Matthew Gfeller, a 15-year-old sophomore linebacker who died in the fourth quarter of his first varsity game in Winston-Salem after colliding helmet-to-helmet with another player.

Now a foundation and a brain injury research institute at the University of North Carolina are named after Matthew. His name and that of another North Carolina high school football player, Jaquan Waller, who died the same year as a result of on-field head injuries, are attached to a 2011 North Carolina law that specifies concussion education for coaches and concussion protocols to be followed in high school athletics.

“Was the information out there in ’08?” said Matthew’s father Robert, who created the foundation. “No, but it’s out there now, big time.”

Despite the progress, the Stringer rankings demonstrate the distance many athletic trainers and doctors believe states still need to go to protect student-athletes.

For instance, although North Carolina finished No. 1 in the Stringer rankings, it has adopted only 79 percent of the laws or policies used in the rankings. In particular, Stringer found the state hadn’t done enough to make certain that defibrillators — and people trained to use them — were present at sporting events.

A Sense of Urgency

Many athletic trainers, such as Jason Bennett, president of the California Athletic Trainers’ Association, say the rankings should create urgency in his state and others. “This is life and death,” Bennett said. “The sad thing is that in many of these cases, the deaths were 100 percent preventable.”

California fared particularly poorly because it is the only state that does not regulate athletic trainers.

“Sometimes it’s the school’s janitor or maybe a friend of the coach,” said Democratic California Assembly member Matt Dababneh, who introduced a bill that would create state licensure for athletic trainers. “These are people who are making decisions about whether a kid who has just been hit in the head can safely go back into a game. And they have no qualifications to make that decision.”

The bill would not require all schools to employ an athletic trainer, although that’s exactly what many athletic trainers and sports medicine doctors say would best ensure the safety of student-athletes.

“The No. 1 thing we can do to make high school and youth sports safer is to have athletic trainers at any sporting event,” said Michael Seth Smith, co-medical director of a sports medicine program at the University of Florida focused on sports medicine for adolescents and high school students.

A survey from Stringer and others published this year found that fewer than 40 percent of public secondary schools in the U.S. had a full-time athletic trainer.

Mathewson, the athletic trainer in Colorado, said he has little sympathy for smaller schools who say they can’t afford athletic trainers. “If you can afford to put a football team on the field, you should be able to afford an athletic trainer.”

In a number of places, including in Florida and North Carolina, hospitals subsidize athletic trainers working in public schools, some in the expectation that after a year or two, the school district will pick up the costs.

Aside from the salary of an athletic trainer, schools could adopt most of the best practices at an initial cost of $5,000 and an outlay of less than $2,500 a year thereafter, according to Stringer CEO Doug Casa.

Source: The Pew Charitable Trusts

How Older Men and Women Can Safely Beat the Heat (Health Central)

When 60-year-old Joseph Lorenc set out on the 7-mile Falmouth Road Race in mid-August, 2015, he was his usual highly-motivated self: healthy, in good shape and used to running longer distances. At 9 a.m. temperatures on Cape Cod, Massachusetts, registered in the mid-70s, rising to around 80 at race’s end an hour later. A 5-mile per hour wind blew at Lorenc’s back instead of helpfully cooling him from the front.

Early on, the former high-tech professional strained a lower abdominal muscle and then he had to “work harder,” Lorenc told HealthCentral in a telephone interview. That led to an “exertional heat event” that could have become life-threatening.

“An exertional heatstroke can happen in otherwise healthy, active people, when the metabolic heat produced from exercise or activity exceeds the physiological limit to regulate their body heat effectively,” says Yuri Hosokawa, Ph.D., ATC, LAT, and vice president of communication and education at the Korey Stringer Institute at the University of Connecticut (UCONN). She responded to HealthCentral in an email interview. “More common classic heatstroke occurs when an individual is passively exposed to heat — being in a hot room during a heat wave.”

Other risk factors for exertional heatstroke include dehydration, partaking in an activity not matched to a person’s fitness level, recent illness, and sleep deprivation, Dr. Hosokawa says.

Medical tent personnel fully submerged Lorenc — totally coherent, but exhausted and wobbly with a body temperature of more than 107 degrees — in a tub of ice water for 20 minutes. The decidedly uncomfortable treatment worked, and later he reflected on his near-miss.

“As an experienced runner, I never saw this coming. It was fortuitous that I was in the right place at the right time,” Lorenc says.

The heat is on

Earth reached its highest temperature on record in 2016, according to NASA and the National Oceanic and Atmospheric Administration (NOAA). Rising summer temperatures around the globe will continue to put humans at risk — especially older adults, very young children, and those with chronic conditions.

 “Unrelenting heat over days or weeks above target temperatures, with no nighttime cool-down preventing recovery, can contribute to heat-related illness,” says Rade Vukmir, M.D., J.D., FACEP of Pittsburgh in a telephone interview with HealthCentral. He’s also a professor adjunct of emergency medicine at Temple University and a spokesperson for the American College of Emergency Physicians.

A heatstroke is the most dangerous form of hyperthermia or over-heating, affecting the body’s central nervous system and causing changes in consciousness and behavior. “Cognitive damage is a real risk because the brain is a precisely regulated instrument,” adds Dr. Vukmir. “An overheated brain that fails to compensate normally can produce altered mental status.”

The National Institute on Aging (NIA) notes that when heat rises in the body to uncontrollable levels, symptoms of heatstroke can include:

  • Mental confusion or agitation.
  • Abnormal pulse: In earlier stages of hyperthermia, the pulse may be strong and rapid as the body tries to cope, but as heatstroke progresses, the pulse can become weak.
  • Hot and dry skin.
  • Fainting, staggering or coma.

Other forms of hyperthermia can also put anyone at risk for less severe problems: unpleasant heat stress, heat syncope (fainting), sudden dizziness after exercising in heat, heat cramps, and heat exhaustion, says Basil A. Eldadah, M.D., Ph.D, program officer and chief of the geriatrics branch of the NIA in a telephone interview with HealthCentral.

Seniors take extra care

Age-related changes increase risk in the elderly, Dr. Hosokawa says. “They may have a reduced ability to sweat, which is the body’s natural cooling mechanism. Normally, the intricate network of blood vessels dilates and constricts, like the radiator of a car, bringing blood closer to the surface of the skin to cool it as heat is exchanged with outside air.”

“Symptoms of hyperthermia may not be very specific, unlike pain in a toe, for example,” Dr. Eldadah says. “They may include fatigue, exhaustion, headache, nausea, or dizziness. Older adults who regularly experience those symptoms may not immediately think the cause is heat-related illness. Also, hyperthermia can affect thinking and planning, which may make it more difficult to take appropriate action in the heat.”

 Be aware of seniors in your community who may need help, Dr. Vukmir says. “Remember that elderly adults with cognitive impairment may simply forget to open windows if they don’t have air conditioning. Maybe they’re on a diuretic to reduce fluid levels due to congestive heart failure, for example. Then they could be conflicted, less prone to drink more fluids to cool themselves, which could cause dehydration.”

The NIA suggests elders go to places with air conditioning, such as senior centers, shopping malls, movie theaters, and libraries. Cooling centers, which may be set up by local public health agencies, religious groups, and social service organizations in many communities, are another option.

Treat heat-related illness

If you suspect someone is suffering from a heat-related illness, you should:

  • Call 911 if you suspect heatstroke.
  • Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge them to lie down.
  • If the person can swallow safely, offer fluids such as water, fruit, and vegetable juices, but not alcohol or caffeine.
  • Apply a cold, wet cloth to the wrists, neck, armpits, and groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
  • Encourage the individual to shower, bathe, or sponge off with cool water if it is safe to do so.

In the event of a heatstroke, Dr. Vukmir says EMS personnel or those in an emergency department would actually apply ice packs to the armpit and groin to cool the femoral vessels in the leg, as well as the axillary vessels in the armpit — all responsible for major blood flow in the body. Cooling blankets or a cooling vest may also be applied.

Emergency personnel may also remove the patient‘s clothing so a mist of water can be applied to the skin while a fan circulates air, aiding evaporative cooling. In life-or-death situations, separate procedures involving cooled IV fluids, a bladder catheter or gastric tube might also be utilized, as well as a medical device that positions a catheter-type cooling system directly into a large groin vessel.

In the event of exertional heat stroke, as in Lorenc’s case, on-site rapid cooling with whole body, ice water immersion before transporting to the hospital can be a life-saver, adds Dr. Hosokawa. See UCONN’s TEDEd video for more information on heatstroke.

“Know your risk for heat-related illness so you don’t take unnecessary chances,” says Lorenc.

Source: Health Central

The Falmouth Road Race Sets The Stage For Exercise Studies (The Falmouth Enterprise)

By ANDREA F. CARTER

Scientists and staff with the Korey Stringer Institute will be conducting studies again this year during New Balance Falmouth Road Race.

The institute, based at the University of Connecticut, studies conditions and exercise habits that can lead to heat-related illnesses and was founded in memory of Korey D. Stringer, an NFL football player who died from complications associated with heat stroke during a game.

This is the fifth year that the institute has come to the road race for collaborative studies.

The Falmouth Road Race, which is relatively short and where people can exert themselves to finish in the hot humid month of August, offers a venue to study ways to prevent heat illness, explained Yuri Hosokawa, vice president of communications and education with the institute.

The institute’s weekend here started Thursday, August 17, where staff presented at the New Balance Falmouth Road Race Sports Medicine Symposium, held with Falmouth Hospital, which staffs the race medical tent.

“It’s an opportunity for runners interested in the science behind running in the heat and medical professionals to receive continuing credit,” Dr. Hosokawa said.

The institute is conducting two studies at the race. The surveillance study, being done for a second year in a row, is following a number of racers as they prepared and trained after watching an informational video on healthy and safe tips for exercising in the heat.

Scientists will follow up with the racers after the race to learn how they felt during the race and how the pre-race information affected their training and experience. Every person who registers for the road race received a study survey. As of Tuesday of this week Dr. Hosokawa said that about 2,000 runners were participating.

“We appreciate their interest and support and hope to get 80 percent response for the post-race,” Dr. Hosokawa said.

Study results will be shared with the Falmouth Road Race and medical staff to better inform pre-race education programs, Dr. Hosokawa said.

The second project selected about 30 runners, ages 20 to 65, for a more in-depth exercise study.

These participants visited the University of Connecticut campus for exercise testing at slower and faster paces to monitor  cardiovascular fitness and how these athletes respond to heat and humidity. Their lab results will be compared to data gathered during and after the race.

Dr. Hosokawa said many studies look at the elite runners; here, the institute is following competitive recreational runners, who make up a majority of the race participants.

Medical practices developed at the race to treat heat illness with no fatalities have become the gold standard, she said.

“The Falmouth Road Race sets the standard for medical professionals on how to prepare for exertion-related heat illness,” Dr. Hosokawa said.

Source: The Falmouth Enterprise

16-year-old killed when log falls on him during football drill (ESPN)

FARMINGVILLE, N.Y. — A high school football player lifting a large log with teammates as part of a Navy SEALs-style drill was hit in the head by the log and died Thursday, raising questions about adapting such military training to young athletes.

Joshua Mileto, a 16-year-old Sachem East High School junior, and about five of his teammates were carrying the log overhead when the accident happened at a preseason exercise camp supervised by a half-dozen coaches, Suffolk County police said.

The 5-foot-6, 134-pound wide receiver and defensive back was declared dead later at a hospital.

Sachem East graduate Carlin Schledorn, who played football as a junior, said carrying the log — about 12 feet (3.7 meters) long and the diameter of a utility pole — was a “team building” exercise.

“It’s very big. It’s like a tree, and it’s a challenge for people who weightlift,” he said. “Five or six people do it at once. I feel horrific for the team and coaches because I know them, and they are all great men.”

School officials, including the head coach, did not comment on the exercise.

A person at Mileto’s home declined to speak with reporters.

Classmate Olivia Cassereli said Mileto “cared about everyone else.”

“He put others before himself, and everyone loved him and was friends with him,” said Cassereli, who called him her best friend.

Some colleges and other high schools around the country have incorporated log-carrying drills and other military-inspired exercises into their football preparations in recent years, sometimes bringing in SEALs to teach and motivate.

Players at Indiana’s New Albany High School teamed up last month to tote 6-foot-long, 200-pound logs two miles from a local amphitheater to the school.

SEALs and Green Berets trained the players first on how to lift the logs and carry them on their shoulders, coach Steve Cooley said. Accompanied by coaches and a police escort, the groups paused for water and put the logs down every one or two blocks, and each six-person squad had an extra man who could sub in if someone got tired.

“The purpose was not to try to see how tough they are … the purpose was to accomplish a goal,” Cooley said. “It was very rewarding for all of us.”

But after Mileto’s death on Thursday, sports safety expert Douglas Casa questioned the wisdom of having teenagers perform an exercise that involves carrying a heavy object and that was developed for Navy SEALs, who are “potentially a very different clientele.”

“There’s so much potential for things to go wrong that I would really want people to think twice before doing something like that,” said Casa, executive director of the University of Connecticut’s Korey Stringer Institute, which works to improve safety for athletes.

Football, at all levels, has become more safety-conscious in recent years amid scrutiny of head injuries in the sport. In college football, for instance, the NCAA this year barred the two-a-day contact practices that coaches once used to toughen up their teams in the preseason, though many teams had ended them already.

For high schools in Suffolk County, offseason practices are permitted as long as they are not mandated and are open to everyone, said Tom Combs, executive director of the athletic organization that oversees high school sports in the county.

“What exercises that are conducted are the privy of the school district and individuals running the workouts,” he said.

In an unrelated incident, another player fell and hit his head Wednesday at the school during training, police said. His injuries were not life-threatening.

Sachem Superintendent Dr. Kenneth Graham extended condolences to Mileto’s family and friends and said support services will be offered “for as long as needed.”

The team’s training officially starts Monday, and the football season starts in September.

Source: ESPN

UConn Study Finds High School Athletes At Risk; Connecticut Ranks 38th Nationally (Hartford Courant)

By: Mike Anthony

Connecticut ranks in the bottom third nationally in implementation of requirements at the state level to keep high school athletes safe from some life-threatening conditions, a new nationwide assessment of safety guidelines shows.

In fact, most states are failing to properly protect athletes against heatstroke, sudden cardiac arrest and other conditions, according to the study by UConn’s Korey Stringer Institute. The results were made public Tuesday morning at NFL Headquarters on Park Avenue.

Connecticut ranked No. 38 of 51 (each state and the District of Columbia) in graded assessments of the implementation of policies pertaining to the four leading causes of death among secondary school athletes — sudden cardiac arrest, traumatic head injury, exertional heat stroke and exertional sickling, which is a medical emergency that can occur in athletes carrying the sickle cell trait.

“What Connecticut has in place that is really a model program right now is the heat acclimatization policy,” said Douglas Casa, CEO of the Korey Stringer Institute. “That’s the phasing in of activity across time during the first couple of weeks of football practices. Connecticut has every single point you can attain on our rubric related to the first five days of not having two-a-days, not having successive days of two-a-days, phasing in the amount of equipment.

“An example where we need improvement is something related to environmental monitoring. A state like Georgia, for instance, has a great program where if it’s a really hot day, they measure the environmental conditions and make modifications [to practices] based on the conditions. Because we know that almost all heatstroke deaths happen when it’s hotter than usual for where you live.”

States were given a score reflecting how well they have implemented policy aimed toward preventing and managing life-threatening conditions, related mostly to exertion, with scores (the best being 20) assigned in five categories.

Connecticut received a score of 40.001 out of 100, with scores of seven in exertional heatstroke, six in traumatic head injuries, six in sudden cardiac arrest, 15 in appropriate health care coverage and 6.001 in emergency preparedness.

The study did not take into account practices, many of them common and consistent, that take place through policy set by school districts.

“We’re disappointed that the survey is communicated in such a way that seems to be reflective of an entire state’s efforts when in fact it’s really only a very generalized approach to certain categories, and it’s only about state association policy,” CIAC executive director Karissa Niehoff said. “Our state has some of the most stringent requirements for coaching certification and education. We’re required to educate all parents and student-athletes about concussions and cardiac arrest, and we do that. We’re not an association that imposes requirements such as trainers at every single event, or requires certain [weather] measurement systems, because frankly we think that districts are best able to decide what’s appropriate for them and, truthfully, what they can afford.”

North Carolina was found to have the most comprehensive policies and received a top score of 79, followed by Kentucky (71.13) and Massachusetts (67.4). The states with the lowest grades were Colorado (23), California (26) and Iowa (26). The median state score was 47.

The KSI study recommended a course of action for all states to implement the following policies:

• Automatic external defibrillators and certified athletic trainers on site at all athletic events.

• Phasing in summer practices and taking other steps to protect athletes from heat stroke.

• Training coaches on concussion symptoms.

• Detailed emergency action plans for all life-threatening emergencies.

• Mandated screening of athletes for sickle cell trait.

The report notes that there have been 735 deaths and 626 catastrophic injuries among high school athletes between 1982-2015. More than 7.8 million secondary school athletes participate in sanctioned sports annually, the study states.

Korey Stringer was an All-America football player at Ohio State and first-round draft pick of the Minnesota Vikings in 1995. He died at age 27 in 2001 after suffering heatstroke during Vikings training camp in 2001.

The Korey Stringer Institute, founded at UConn in 2010, is a nonprofit organization dedicated to promoting the prevention of sudden death in athletes and active individuals. It has a staff of 20, and 60 volunteers.

Each state’s governing body for high school sports was notified of the study’s results and given 30 days to respond with questions, clarifications, disputes or confirmations. Scores will continue to be updated as new information is provided and policies change.

“We offer the strongest encouragement for best practices, we offer guidelines,” Niehoff said. “We were disappointed that the emphasis was on a ranking as opposed to a really comprehensive and authentic look at everything that’s being done in a state. … Whether or not it feels good to look at study results, it does spark conversation and it’s always good to revisit with urgency whether your health and safety policies are as relevant and supportive as they can be.

“Quite frankly, we appreciate that the legislature does not get involved too deeply in statutory language around implementation around athletic programs because to change legislation is quite an involved process that takes time. When our association develops policy, we can be nimble and respond quickly if there’s new research or something that needs to change in a rapid way.”

The NFL allowed Tuesday’s announcement to take place at its headquarters because it sponsors the Korey Stringer Institute, though the NFL did not sponsor the study.

“While we focus a lot of treating injuries and illnesses, Our role in prevention is just as important,” said another speaker, Morgan Busko Anderson, an internal medicine physician specializing in primary care sports medicine and a sports medicine fellow at Wake Forest University. “Prevention of injuries, prevention of illnesses, prevention of deaths. The evidence shows that prevention practices and policies can prevent these deaths. So why do we have this gap now, between what we know is evidence-based, best-practice medicine, and what some of our high school athletes are receiving?”

Casa said many of the fixes are simple.

“We believe you can get to 85 points out of 100 for less than $5,000 a year,” Casa said. “We’re trying to institute policy and do whatever we can before [young athletes] die, to not have to wait for your particular state to have an emergency or tragedy to implement policy, to maybe learn from a tragedy that happens across a state line. A lot of the states did react in a very positive way after having a tragedy, and we’re trying to prevent them from happening in the future.”

Source: Hartford Courant

Understanding environmental heat stress (Training and Conditioning)

By: Yuri Hosokawa, PhD, ATC, LAT, Korey Stringer Institute, University of Connecticut

As the brutal summer heat takes a toll across the country, high school athletes and youth sport leagues are ramping up their summer camps and pre-season workouts in preparation for the fall season. While the importance of hydration is often emphasized during summer workouts, the use of environmental-based activity modification guidelines is often overlooked. The two major roles of environmental monitoring and activity modification guidelines are: (1) to minimize prolonged exposure to dangerous heat stress and (2) to optimize the use of practice time in the heat without overstraining the athletes.

Two of the well-accepted environmental-based activity modification guidelines for exercise in the heat are published by the National Athletic Trainers’ Association and the American College of Sports Medicine. Each guideline provides specific wet bulb globe temperature (WBGT) ranges and recommended modifications, with different types of athletic activities and populations in mind. Understanding the differences between the two guidelines will help clinicians decide which guideline better fits their needs.

National Athletic Trainers’ Association’s Guidelines (2015)1

The most recent position statement from the National Athletic Trainers’ Association (NATA) provides example WBGT guidelines from the Georgia High School Athletics Association. The uniqueness of these guidelines is that it provides activity modification recommendations that best suits fall American football training. Epidemiological studies suggest that youth football athletes are one of the most vulnerable populations to exertional heat stroke given the time of the year they start the season and the unique physical demands in the heat that is amplified with wearing protective equipment. Therefore, having football specific modification guidelines required at the high school level across the country could direct not only the athletic trainers, but also the coaches and referees in what the appropriate modifications should be given the environmental temperatures.

It should be noted that the example provided by the NATA is adjusted for the regional environmental conditions normally observed in the state of Georgia during fall football training. Consequently, the temperature threshold may not be realistic for states in the northern part of the continental U.S. (i.e., the threshold temperatures are set too high to be practical). To address this potential regional discrepancy, Dr. Andrew Grundstein and his colleagues have proposed adjustment to the WBGT threshold by regions to account for the environmental differences observed (i.e. environmental conditions observed in Louisiana versus environmental conditions observed in Maine).

American College of Sports Medicine Guidelines (2007)2

Football is not the only form of physical activity that takes place during the summer months. While other team sports, such as soccer and lacrosse, may benefit from adapting the NATA guidelines, sports such as cross country may not find the guidelines as helpful due to the different nature of activity (i.e., intermittent vs. continuous activity). In such case, coaches and clinicians may be referred to the guidelines published by the American College of Sports Medicine (ACSM). Their activity modification recommendations are less specific to the type of sport, making it easier to implement as a global precaution for any type of physical activity in the heat. For that reason, the ACSM guidelines are also often implemented by various road race organizers in deciding if they should cancel, modify, or postpone mass participation events such as road running races.

It should also be noted that the same study by Dr. Grundstein and his colleagues have made the regional adjustments based on the ACSM guidelines to accommodate for the various climatology we observe in different part of the country.

Take Home Message

Environmental monitoring is a simple way for athletic trainers and coaches to reduce the risk of heat related injuries. It also ensures that the athletes are getting quality practice time during the summer days, where many athletes may be just getting ready to not only get used to the heat but also to exercise itself. For more information regarding the activity modification guidelines, please visit our website at ksi.uconn.edu or contact us here. #KnowYourCondition

 

References:

1. Casa DJ, DeMartini JK, Bergeron MF, et al. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. J Athl Train. 2015;50(9):986-1000. doi:10.4085/1062-6050-50.9.07.

2. Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39(3):556-572. doi:10.1249/MSS.0b013e31802fa199.

3. Grundstein A, Williams C, Phan M, Cooper E. Regional heat safety thresholds for athletics in the contiguous United States. Appl Geogr. 2015;56:55-60. doi:10.1016/j.apgeog.2014.10.014.