Heat

CamelBak Elite Athlete Testing

Gabe Giersch, MS

Associate Director of Education and Assistant Director of Athlete Performance and Safety

KSI had the awesome, unique opportunity to test two CamelBak sponsored pro-athletes over

the course of two days! The athletes were Lea Davison, a two-time Olympian Mountain Biker (2012 & 2016), and Gediminas Grinius a decorated Lithuanian trail runner. Some very fit, athletically decorated media personnel underwent testing as well. The athletes were able to undergo heat and sweat testing, where they exercised for 60-minutes total. Because it was a hot environment, the athletes were asked to collect their sweat in a specially prepared towel,and atthe end of their hour, we didwhole-body wash downs to collect samples to assess their sweat electrolyte concentrations. Whole-body wash downs are the gold standard for assessing whole-body sweat electrolyte concentration and very few labs across the country still use this technique. Many have moved over to local collection in sweat pouches, which is a great method of assessing local sweat, but not necessarily valid for whole-body calculations.

The athletes were also able to complete an anaerobic threshold test or a VO2max test where we tested their ability to ward-off an accumulation of lactate (a by-product of anaerobic metabolism) where we could extrapolate their anaerobic threshold based on continual readings, or their maximal oxygen uptake by exercising until volitional fatigue, respectively. This was a great opportunity for KSI and allowed us to use our expertise to interact with some incredible athletes.

Back in Falmouth– 2017

Yuri Hosokawa, PhD, ATC

Vice President of Communication, Vice President of Education

Ryan Curtis, MS, ATC, CSCS

Associate Director of Athlete Performance and Safety

 

Our summer is not complete without going to Falmouth, MA, to work at the New Balance Falmouth Road Race medical tent and continue our research and educational initiatives. We have been very fortunate to have the support from the race board members to have KSI presence at the pre-race medical symposium, health & fitness expo, and at the race as medical volunteers and research staff.

 

NB Falmouth Road Race Medical Symposium

With a host of medical volunteers and invited guests in attendance, this year’s NB Falmouth Road Race Medical Symposium featured presentations on a range of relevant topics including recognition and treatment of running-related orthopedic injuries, physiological concerns when developing strategies to optimize performance in the heat, and wearable technologies that can assist in optimizing performance.

 

Veteran NB FRR orthopedic medical provider, Dr. Don O’Malley, drew upon his experneces to give a thorough review of his top 10 running related orthopedic injuries. Dr. William Adams, a member of KSI’s medical and science advisory board and current assistant professor at the University of North Carolina at Greensboro, presented on physiological concerns and strategies when optimizing performance in the heat. The third invited speaker was Ryan Curtis, MS, ATC, CSCS, Associate Director of Athlete Performance and Safety, who discussed integration of wearable technology to optimize performance in the heat.  The symposium was concluded with our Chief Medical Officer, Dr. John Jardine, who also serves as the Co-Medical Director of the NB Falmouth Road Race. He briefed attendees on the logistics and chain of command that will be followed on the day of the race. Overall, the 2017 NB FRR Medical Symposium featured not only relevant topics in medicine but additionally offered a glance into the future of health and performance optimization.

 

Health & Fitness Expo

This year was our first time to participate in the Health & Fitness Expo as an exhibitor. The increased recognition of the KSI among the Falmouth runners was evident. We had many runners come stop by, and it was such a rewarding experience to have some of them share their personal stories about how they or their family members and friends were saved from exertional heat stroke by the NB Falmouth Road Race medical volunteers.

 

 

At the expo, we also met with this year’s study participants who already participated in a series of laboratory tests at the University of Connecticut in mid-July to early August. These runners were provided with an ingestible thermistor pill, which allow researchers to readily measure their internal body temperature on the day of the race.

 

 

Race Day

Race day for both medical and research volunteers started before dawn on Falmouth Sunday. The research crew set up the morning data collection booth at Lawrence School, which was where all runners met to get on shuttle buses to the starting line in Woods Hole. The research data collection included measurements such as participants’ gastrointestinal temperature, sweat rate, and pre- and post-race blood and urine collection.

 

 

At the medical tent, medical volunteers gathered to review the triage protocol and proper methods for treating exertional heat stroke. Chris Troyanos, Medical Coordinator of the NB Falmouth Road Race, Dr. Jardine and Dr. Robert Davis, the co-medical directors, and Dr. Douglas Casa from KSI lead the group of veteran and novice medical volunteers so that the medical tent was ready for runners who would be finishing the 7.1-mile course in the forecasted warm and humid conditions.

 

 

Findings from the NB Falmouth Road Race study will be analyzed over the course of the next several months and will be prepared for scientific presentations at the National Athletic Trainers’ Association and American College of Sports Medicine annual meetings in 2018.

 

 

 #RunFalmouth #Strive2Protect #RaceMedicine

NATA Clinical Symposia & Expo

Alexandra Finn

Assistant Director of Education

Athletic trainers from around the country gathered in Houston, Texas for the 2017 Annual NATA Clinical Symposia & AT Expo. The four day Clinical Symposia provided athletic trainers with the ability to explore new areas and benefit from the latest research. KSI was well represented by fifteen presenters who continued the mission of educating athletic trainers about our latest research. The warm weather of Texas was a constant reminder of the significance of heat in our southern states, but the strong interest showed by attendees from across the country demonstrated that athletic trainers are gaining an understanding that exertional heat illnesses are an issue of national concern. The selection of so many KSI members provided a unique opportunity for KSI to further its educational mission to maximize performance, optimize safety and prevent sudden death in sport.

Presentations kicked off early Tuesday morning when Andres Almeraya presented in the Master’s Oral Student Finalist session. His research about “Implementation of Automated Defibrillator Policies in Secondary School Athletics” demonstrated the strong need for additional state legislation to mandate that all secondary schools follow best practices. Andres entered the day as a finalist and was selected overall the best oral presentation in this section. Congratulations and well done, Andres! Dr. William Adams presented his work on the “Implementation of Heat Acclimatization Policies in Secondary School Athletics” during the Treat the Heat Session.

This year four KSI staff members: Luke Belval, Alexandra Finn, Rachel Katch and Brad Endres were selected to present a Free Communication Poster Presentation on Tuesday morning. Luke Belval presented on “Sex-based Comparison of Exertional Heat Stroke Incidence in a Warm-Weather Road Race.” Alexandra Finn presented on the “Implementation of Wet Bulb Globe Temperature Policies in Secondary School Athletics.” This research revealed that currently there are only three states that meet all the best practice recommendations in this area. Rachel Katch presented data titled “Cold Water Immersion in the Treatment of Exertional Heat Stroke Remains the Gold Standard at the Falmouth Road Race,” which demonstrated the significance of a road race having immediate cold water immersion available to treat exertional heat stroke. Finally, Brad Endres presented on the “Epidemiology of Sudden Cardiac Death in American Youth Sports.” Congratulations to both Alexandra Finn and Brad Endres who were selected as Master’s Poster Presentation Finalists. Brad’s poster proved to be the judges’ favorite taking home top honors for KSI in this category. Well done Brad and his research team!

Dr. Rebecca Stearns presented research during the session “When Exercise Gets Hot.” Her study focused on “Repeated Exertional Heat Stroke Incidence in a Warm-Weather Road Race.” Following Dr. Stearns presentation, two KSI members; Kelly Coleman and Alicia Pike spoke during the Diversity and Inclusion Considerations in Athletic Training session. Kelly Coleman presented data about the “Perceptions of Race and Ethnic Diversity on Athletic Training Clinical Practice” while Alicia Pike spoke about “Providing Medical Care to Male Sports Teams: Attractors to Employment for Female Athletic Trainers.

To finish the day, Dr. Robert Huggins provided an update on “An Overview of Secondary Schools ATLAS Project: Where Are We Now?” demonstrating the progress in mapping secondary schools across the nation.

The second day started off strong with three KSI members presenting. First, Sarah Attanasio provided insightful information about the ATLAS project. In a well-attended session, Dr. Douglas Casa discussed “Catastrophic Heat and Exertional-Related Condition Among Athletes.” Lastly, Samantha Scarneo presented data about “Implementation of Emergency Action Plan Policies in Secondary School Athletics.” Her study focused on the importance of every high school having an athletic trainer prepare an emergency care plan.

On the final day of presentations KSI members Kelsey Rynkiewicz, Dr. Robert Huggins, Dr. Yuri Hosokawa, Dr. William Adams and Alicia Pike all had an opportunity to present their data. Kelsey Rynkiewicz presented data on the “Implementation of Concussion Policies in Secondary School Athletics.” Dr. Robert Huggins presented on three different topics on Thursday. The first presentation looked at the “Presence of Athletic Trainers, Emergency Action Plans, and Emergency Training at the Time of Sudden Death in Secondary Athletics.” His second presentation provided data to support why all athletic trainers should be staffed and the importance of an athletic trainer in the ability to reduce risk and save lives. His last presentation was titled “State High School Athletic Policy Change Successes and Barriers: Results from Collaborative Solutions for Safety in Sports Meeting.” Dr. Yuri Hosokawa presented information on “Optimizing the Direction of Care: A Secondary Insurance Claim Analysis.” Dr. William Adams presented information on the “Current Status of Evidence-Based Best Practice Recommendations in Secondary School Athletics.”  Lastly, Alicia Pike looked at “Examining Sport Safety Policies in Secondary Schools: An Analysis of States’ Progress Toward and Barriers to Policy Implementation.”

It was a privilege for so many KSI members to have the opportunity to provide much needed information about subject matters such as the prevention and care of exertional heat illnesses to athletic trainers who are heading to summer sport training camps or planning for preseason training for fall sports. When not presenting, KSI staff members took advantage of the tremendous opportunity to learn from colleagues from other institutions. The annual conference, which will be moving to New Orleans, LA next year, is well worth the investment to attend!

American Society for Safety Engineers Heat Stress Panel Discussion

Gabrielle Giersch, MS

Associate Director of Education & Assistant Director of Athlete Performance and Safety

On Tuesday June 20th, I had the pleasure of representing KSI and sitting on a panel for the American Society of Safety Engineers entitled “An athletic approach to heat stress – beyond water, rest, and shade.” On this panel, we discussed the importance of keeping laborers safe, and using the knowledge we’ve garnered on athletes to do so. We discussed the causes of heat related illnesses, contributing factors, and how to best prevent heat illnesses from occurring in a working population. This panel could definitely be considered a conversation with a very active audience who was very interested in the topic and asked a lot of great questions! While the panel was only an hour long, some great information was put forth and hopefully with collaborations and putting the knowledge that we all have together, we can reduce the amount of heat related illnesses and deaths among laborers!

Wet Bulb Globe Temperature or Heat Index?

Yuri Hosokawa, PhD, ATC, Vice President of Education, Vice President of Communication

 

On February 27th, KSI’s Vice President of Education and Communication, Yuri Hosokawa, PhD, ATC was invited to give a presentation on wet bulb globe temperature (WBGT) based activity modification guidelines at the Athletic Trainers’ Society of New Jersey.

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In the CAATE Athletic Training Education Competencies [5th Edition] under the Prevention and Health Promotion section, it is stated that athletic trainers should be able to “explain the principles of environmental illness prevention programs to include acclimation and conditioning, fluid and electrolyte replacement requirements, proper practice and competition attire, hydration status, and environmental assessment (e.g., sling psychrometer, wet bulb globe temperatures [WBGT], heat index guidelines).” That being said, we, as Athletic Trainers and clinicians have all been exposed to the utilization of a sling psychrometer, WBGT, and heat index to monitor and assess environmental heat risk. But do you know the differences in how they work? Without the proper understanding of these indices, you may not be capturing the heat strain appropriately. For example, WBGT of 82°F and heat index of 82°F represent very different environmental conditions because of how these numbers are derived.

To calculate WBGT, you will need: wet bulb temperature (Tw), globe temperature (Tg), and dry bulb temperature (Td). Wet bulb temperature is a measurement of humidity, globe temperature is a measurement for amount of solar radiation, and dry bulb temperature is a measurement for air temperature. In addition, wet bulb temperature and globe temperature are influenced by wind speed. WBGT equation (see bellow) weighs heavily on the Tw (70%) because the air saturation dictates the capacity for the body heat dissipation through sweat evaporation. Since evaporative heat loss accounts for the majority heat dissipation during exercise, an environment that hinders this process will pose an extreme heat strain.

 

WBGT= 0.7Tw + 0.2Tg + 0.1Td

 

On the other hand, heat index is a number that shows “how hot it feels” when relative humidity is factored into the air temperature. It also assumes that the environment is under shade (i.e., not full sunshine) and that the person is walking at 3-mph, which is does not depict the heat stress of someone performing intense exercise in the heat. Therefore, it is apparent that activity modification guidelines that rely on heat index is not appropriate in an athletics context. Lastly, the measurement taken from the sling psychrometer is reflective of the Tw and Td. Typically, a sling psychrometer unit comes with a conversion scale, which allows the clinicians to use the Tw and Td values to calculate the heat index.

Athletic trainers, who are interested in checking or improving current activity modification guidelines, are encouraged to review Table 5 from the NATA Position Statement on Exertional Heat illness, which shows an example from the Georgia High School Athletics Association’s activity modification policy using WBGT.

6th International Conference on the Physiology and Pharmacology of Temperature Regulation

By: William M. Adams, PhD, ATC, Vice President of Sport Safety

 

This past week (December 5-9th), I had the pleasure of representing KSI at the 6th International Conference on the Physiology and Pharmacology of Temperature Regulation. This conference is a biannual conference held in different locations around the world that brings together the world’s leading thermal physiologists to present on topics from a basic (cellular and molecular) level of thermal physiology to clinical and applied applications of that research. This year’s conference was held in Ljubljana, Slovenia, the patron city of Saint George, which is located in the central part of Slovenia.

 

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The meeting started with an in depth discussion on the association of climate change on health. A European-based project, HEAT-SHIELD, was introduced to the audience which is a group tasked with developing guidelines and policies to handle heat stress from various aspects associated with climate change. The development of a well-rounded set of guidelines is needed to address this issue, especially as Europe is seeing the effects of increasing environmental conditions and a large migration of persons from other areas in the world, which when coupled together may cause downstream detrimental effects on health as a whole.

The conference continued with various symposiums, oral presentations and poster presentations on topics related to inflammation and the thermal response, fever, metabolic influences on thermal physiology, and the influence of exercise on thermal physiology. I had the pleasure of presenting some data that I collected examining the influence of hydration on body temperature and heart rate responses during repeated bouts of exercise in the heat. The talk was well received and it prompted some great discussion amongst other physiologists.

 

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It was great being able to meet new friends, connect with others and to discuss future collaborative work with some excellent researchers. The opportunity to attend this conference and to see the beautiful city of Ljubljana was an extremely rewarding experience and I would encourage anyone that does research in this area to attend the 2018 Conference in Split, Croatia.

 

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Be Aware of Heat Stress

By Yuri Hosokawa, MAT, ATC, Director of Communication, Director of Education  

Here in New England, we are starting to see the hint of fall foliage. Fall sports are in the midst of competition and athletes are not afraid to show all the hard work they have put it in throughout the summer months. The weather has cooled down considerably around Storrs, CT during the course of the last few weeks. For example, the forecast for the next few days looks like this in our region.

storrs

Source: weatherwunderground.com Forecast for Storrs, CT. Accessed 10/02/2016.

During pre-season football, we had several days where the ambient temperature was greater than 90-degrees Fahrenheit. I know, I can hear the mind of fellow ATs from the southern states, “we still have days exceeding 90-degrees Fahrenheit and it’s October!

tampa

Source: weatherwunderground.com Forecast for Tampa, FL. Accessed 10/02/2016.

In 2015, Dr. Andrew Grundstein, a professor from the University of Georgia, published a paper that captures this regional differences and proposed activity guideline that takes account of the local climate. In this model, Storrs, CT is classified in Category I, which has the lower threshold to begin activity modification & event cancellation. Tampa, FL is classified in Category III, whose activity guideline closely follow the one developed by the Georgia High School Association that developed the activity guideline based on the heat related injury epidemiology data collected in Georgia.

This regional variance is expected for obvious geographical differences. Therefore, it only makes sense to know and adjust the thermal strain by what’s expected in the region. In other words, what may not be considered a “cancellation level” in the southern states may still be oppressive enough to cancel activities in the northern states, and vice versa.      

Some of you may be wondering, “it is well past beyond pre-season practices and the likelihood of experiencing oppressive heat stress is minimal.” You may be right in that it is less likely. But suppose we experience one day with temperatures exceeding 80-degrees Fahrenheit and »60% humidity in Storrs, CT. This could potentially push the wet bulb globe temperature (WBGT) to rise over 82-degrees Fahrenheit, which warrants considerable activity modification (i.e., maximum practice time 2 hours with increased frequency of rest breaks) in Category I but not necessary in Category III.

(Note: WBGT values should not be used interchangeably with Heat Index or air temperature. View a video from here to learn how these measures are different.)

A well-known example of unexpected weather during the fall is the 2007 Chicago Marathon, where the race organizers made an executive decision to shut down the race after 3.5 hours due to inclement heat (ambient temperature at 88-degrees Fahrenheit).

The 2016 Chicago Marathon is scheduled in less than a week, and as of now, the weather will likely to be cooperating with the runners.

chicago

Source: weatherwunderground.com Forecast for Tampa, FL. Accessed 10/02/2016.

Now, imagine recording highs of 88-degrees Fahrenheit in Chicago, IL (more than 20-degrees higher than what is forecasted for this year’s race), which is a Category II in the 2015 paper. Although there is a limitation in estimating race day WBGT from just the air temperature, it is apparent that recording near 90-degrees Fahrenheit for air temperature, especially around this time of the year for Chicago, is beyond their regional norm. Needless to say, it would affect not only the local runners but other runners who are traveling from all over the world who did not expect the race day to be this oppressive.

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At the end of the day, environmental monitoring is only one of the many tools we have to ensure safety of athletes. Monitoring the wet bulb globe temperature by itself will not protect the athletes per se, but it will give you valuable information for making a better clinical judgment in deciding to modify activity. A great thing about weather conditions is that, at most times, the weather forecast will allow you to make appropriate actions and intervene proactively to remove potential hazards (i.e., moving the event time and/or date, modifying practice intensity and/or duration).

 

#KnowYourCondition

Back in Falmouth

By Yuri Hosokawa, MAT, ATC, Director of Communication and Education

IMG_8657Twenty-seven research and medical volunteers from the Korey Stringer Institute, EC Lee Lab and University of Connecticut joined the 44th New Balance Falmouth Road Race in Falmouth, MA on August 21st. This was the fourth consecutive year in which KSI conducted a field research study at the race in conjunction with working in the medical tent treating exertional heat stroke patients. In this year’s study, we aimed to (1) investigate runner’s knowledge on heat and hydration and behaviors on race day and (2) investigate the use of real time gastrointestinal temperature feedback in altering runner’s behavior during the race. We also assessed participants’ readiness to exercise in the heat by measuring their cardiovascular fitness and their response to heat stress in our environmental chamber.

 

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KSI’s Rebecca Stearns, PhD, ATC and Luke Belval, MS, ATC also spoke at the Medical Symposium hosted by the Falmouth Hospital, which was attended by many medical volunteers and local healthcare professionals. Dr. Stearns’ presentation, The Tale of Two Heat Strokes, introduced case studies of two runners who suffered from exertional heat stroke at the same race with distinctly different prognosis due to the different treatment they received. Belval’s presentation, The Fluid Needs for Today’s Athletes, provided evidence-based suggestions on hydration. At the Health & Fitness Expo, William Adams, PhD, ATC spoke on Optimizing Safety and Maximizing Performance During Running the Heat, which was attended by many runners who were going to be racing the following day.

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We would like to thank the Falmouth Road Race Board of Directors for their continued support and partnership with the Korey Stringer Institute in supporting our mission to educate runners and continue our research in ways to optimize their performance and safety during warm weather road races such as Falmouth Road Race.