Exertional Heat Stroke

Preventing Sudden Death in Sport– CoxHealth Sports Safety Conference

Brad Endres, ATC, CSCS

Assistant Director of Sports Safety Policies

The prevention of sudden death in sports begins well before a catastrophic injury occurs.

It may be true that heroes are made in how they respond when they are needed most. Many stories throughout the country give testament to the life-saving nature of an appropriate and timely response to medical emergencies in sport. While these stories are indeed uplifting, they are often the result of a great amount of effort dedicated to being prepared in the event of an emergency. During their 2017 Sports Medicine Conference, the Sports Medicine team at CoxHealth exemplified the old adage that “practice makes perfect”, and it was truly a sight to behold. This team, led by Dr. Shannon Woods, was a shining example of how to collaborate with multiple health care providers in order to create, implement, and practice “best-practice” policies and procedures intended to promote athlete safety. KSI was invited to travel to Springfield, MO to take part in the Conference, and it was inspiring to witness the rubber meet the road in regards to the practical application of research.

Throughout the two days of the conference, KSI staff led evidence-based educational sessions on exertional heat illnesses. KSI Vice-President of Communication and Education Dr. Yuri Hosokawa started off the conference on Friday morning with an evidence-based presentation about the prevention, recognition, and treatment of exertional heat illnesses. After the presentation, she led the participants through a practical lab session on the “best-practices” of responding to an individual suffering from exertional heat stroke (EHS).  The participants attending the Friday session of the conference included athletic trainers, coaches, sports medicine physicians, EMS personnel, and school administrators from local area high schools, given that these practical skills would be vital for treating one of their athletes in the event they developed EHS while participating in sports. On Friday afternoon, CoxHealth staff led mock emergency scenarios where participants  were able to gain hands-on practice of what they had learned in the morning. The participants took the scenarios seriously, which led to great discussions during the scenario debriefings. Additionally, the local Springfield news station recorded a news segment about the Conference in order to spread the word about emergency preparedness and athlete safety.

On the final day of the conference, the participants included physical therapists, physicians from other specialties, parents of young athletes, and other interested members of the community. Yuri and I geared our presentations to a slightly different audience, but the message was largely the same: evidence-based policies and procedures can indeed save lives.

Yuri and I were thankful to be invited to the 2017 CoxHealth Sports Medicine Conference, and proud to represent KSI at such an impressive collaborative event. Being in compliance with “best practice” emergency response policies is not always the easiest thing to do, but networks like CoxHealth Sports Medicine are proving that it can be done. Because of their efforts, the athletes they serve will undoubtedly be safe and well cared for.

Marine Corps Marathon Weekend

By Gabrielle Giersch, MS, Assistant Director of Education, Assistant Director of Athlete Performance and Safety

 

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KSI in the White House

 

Thursday October 27th through Sunday October 30th a group of KSI staff traveled to Washington D.C. to present at the American Medical Athletic Association’s 25th Annual Sports Medicine Symposium and worked in the medical tent at the 42nd Marine Corps Marathon (MCM). While in D.C., the KSI staff got to explore the city, tour the White House, enjoy some of the museums on Constitution Avenue, visit Arlington National Cemetery and view the changing of the guards.

 

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Tomb of the Unknown Soldiers

 

We had a great showing at the American Medical Athletic Association 25th Annual Sports Medicine Symposium at the Marine Corps Marathon at Georgetown University Friday October 28th. Brendon McDermott Ph.D., ATC, alumnus of University Connecticut and also one of KSI’s medical and science advisory board member, and his colleague, Cory Butts M.S., traveled from University of Arkansas and presented Muscle Damage and Renal Function in Athletes with Physiological and Environmental Stress. From KSI, Luke Belval, M.S., ATC, CSCS, presented Changing Guidelines on Exertional Heat Stroke Care: Point of Care to Transport to the ER, and Douglas Casa Ph.D. presented Policy Changes Save Lives in all Levels of Sport: New Evidence and Successes. All three of these presentations helped to illustrate the important role of athletic trainers and medical staff at races, and show successes that KSI has had in treating exrtional heat strokes and changing policies to reduce the prevalence of sudden death in sport.

On Saturday, the staff had a “play day” in D.C. that consisted of visiting museums and playing Escape the Room D.C. Both KSI teams escaped (photo below) with the better team just beating the losing team by a few minutes!

 

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On Sunday the real fun began. The staff was up bright and early to make it to Aid Station #9 at mile marker 21 of the MCM! We evaluated and treated several athletes who were experiencing exercise associated muscle cramps and dehydration. Our Medical Advisor, Dr. John Jardine also played a critical role in treating exertional heat stroke patients.

 

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MCM KSI Medical Tent

 

The annual trip to D.C./MCM is a great way for the staff to learn, use their expertise, and bond.

Colby Concussion Summit and Beach to Beacon Road Race

By William Adams, PhD, ATC, Vice President of Sport Safety

This past weekend, KSI’s Vice President of Sport Safety William Adams, PhD, ATC and Director of Communication and Education Yuri Hosokawa, MAT, ATC were in attendance at the first annual concussion summit held at Colby College, hosted by the Concussion Institute at Colby College. They joined representatives from the National Athletic Trainers’ Association, as well as faculty members from the University of New Hampshire, University of Pittsburgh, Colby College and others.

 

The purpose of the meeting was to discuss the diagnosis and management of concussion and to establish the next steps that are needed from a research perspective to enhance clinician’s objective assessment of concussion in athletes.  The meeting concluded with an action plan to examine specific areas of concussion diagnosis and management to continue to add to the body of scientific literature surrounding the validity and reliability of tools that clinicians can use in their toolbox for concussion management.

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Following the concussion summit, KSI traveled south to Portland, Maine for the Beach to Beacon Road Race. The race weekend began with the medical symposium, where both William Adams and Yuri Hosokawa were two of the invited speakers. Adams spoke on hydration in today’s athletes while Hosokawa presented a case series examining the treatment and management of two exertional cases recently published by Stearns et al. in Current Sports Medicine Reports. The symposium was a huge hit and was extremely well received by all of the attendees.

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The road race occurred on Saturday in Cape Elizabeth, Maine. For those unfamiliar, Beach to Beacon is a 10-kilometer (6.1 mile) road race finishing at the picturesque Portland Headlight Lighthouse in Fort Williams. KSI staff members William Adams, Yuri Hosokawa and Samm Scarneo had the opportunity to volunteer as medical staff during the race. The day finished off with roughly 6,500 runners finishing the race and the medical volunteers providing excellent care to those needing it, including four individuals who had suffered exertional heat stroke. The best part of the race weekend were the new friendships that were made with the other physicians, nurses and athletic trainers who were also volunteering in the medical tent.

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KSI Fellowship

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By Savannah Knighton, Korey Stringer Institute Fellow

My name is Savannah Knighton and I am an undergraduate athletic training student at Louisiana State University. I became aware of the Korey Stringer Institute (KSI) in 2014 after my brother suffered a heat stroke. KSI played an integral role in his return to the football field. I have always admired the work that they have done, and this summer I was fortunate enough to become part of the team when I was offered the 2016 summer fellowship.

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My main focus this summer was the Athletic Training Locations and Services (ATLAS) project. The goal of ATLAS is to create a real-time database of the athletic training services in secondary schools across the country. Being an athletic training student and a strong advocate for the importance of the presence of athletic trainers at all levels, this was a very appropriate task. I spent much of my time uploading the information from new surveys to our database. I also created numerous contact lists of athletic trainers from different states to help promote ATLAS.  This was my first real experience working with excel, but I was able to learn numerous tips and tricks.

 

I was also asked to write letters to authors that inadequately described exertional heat stroke. I have become very knowledgeable about heat illnesses, especially exertional heat stroke; so I was glad to be able share this knowledge. I was even able to learn a little bit more about the specifics and misconceptions of heat illnesses while writing these letters.  My creative side was put to the test by designing some social media graphics to help promote KSI and its initiatives.

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During my last few weeks here, I was able to help out with some of the research studies. I spent many hours in the heat chamber, helping out with  max testing, and collecting data before and after testing. This was my first experience with research, but it has definitely made me consider about going into research in the future.

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I cannot thank the KSI team enough for all the mentoring they have done. The amount of knowledge I have acquired from them this summer is unfathomable. I am excited to bring everything I have learned back to Louisiana and carry it with me throughout my career. I can only hope that future fellows learn just as much as I have. KSI does some amazing work, and being apart of the team even for a summer is an experience I would recommend to any athletic training student.

KSI at the Vermont City Marathon & Relay

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By Andrea Fortunati, Assistant Director of Elite Athlete Health and Performance

Korea Stringer Institute was represented for the first time at the 27th annual People’s United Bank Vermont City Marathon & Relay that was held on May 24th, 2015 in Burlington, VT. The race included 8,000 participants and began promptly at 8:00am with the Wheelchair participants, followed by the runners at 8:03am.

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Members of the KSI, William Adams, Yuri Hosokawa, Luke Belval, and Andrea Fortunati worked in the main medical tent located at the finish line as well as at medical tents located at the midpoint of the race.

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This year, there were approximately 150 medical visits seen throughout the day with a total of six athletes transported to the University of Vermont Medical Center.

Four cases of exertional heat stroke were seen and treated at the marathon. During all of these cases at least one member of KSI was present and aided in the treatment process. One case was treated at the medical tent located at mile 13 and the other three cases were treated in the main medical tent at the finish line. In the critical care tent there were two cold-water immersion tubs and members of KSI ready to implement proper protocols and procedures that have been profoundly researched to treat EHS. Treatment for the cases in the critical care tent where done with cold water immersion, which is found to be the quickest and most effective way to cool the body, and rectal thermometers were used for the body temperatures assessment, which is critical in assessing the body temperature in people who are suffering from exertional heat stroke. Once the athletes had been properly cooled, all EHS cases were transported to the UVMMC following the medical organizer’s protocol for a follow-up examination.

This is the second of several marathons KSI will be involved with this year, the first being at the Boston Marathon. Other road races KSI are attending include the Lake Placid Ironman, the Falmouth Road Race, New Haven Road Race, the Marine Corps Marathon, and more.

This is the second of several marathons KSI will be involved with this year, the first being at the Boston Marathon. Other road races KSI are attending include the Lake Placid Ironman, the Falmouth Road Race, New Haven Road Race, the Marine Corps Marathon, and more.