Pilot Implementation of a Heat Illness Prevention Program in the Southeastern US

Objective: To evaluate the ease of application of a heat illness prevention program (HIPP). Design: A mixed-method research design was used: questionnaire and semi-structured interview. Setting: Eleven South Florida high schools in August (mean ambient temperature=84.0°F, mean relative humidity=69.5%) participated in the HIPP. Participants: Certified Athletic Trainers (AT) (n=11; age=22.2+1.2yr; 63.6% female, 36.4% male; 63.6%) implemented the HIPP with their football athletes which included a pre-screening tool, the Heat Illness Index Score- Risk Assessment. Data Collection and Analysis: Participants completed a 17-item questionnaire, 4 of which provided space for open-ended responses. Additionally, semi-structured interviews were voice recorded, and separately transcribed. Results: Three participants (27.7%) were unable to implement the HIPP with any of their athletes. Of the 7 participants (63.6%) who implemented the HIPP to greater than 50% of their athletes, a majority reported that the HIPP was difficult (54.5%) or exceedingly difficult (18.2%) to implement. Lack of appropriate instrumentation (81.8%, n=9/11), lack of coaching staff/administrative support (54.5%, n=6/11), insufficient support staff (54.5%, n=6/11), too many athletes (45.5%, n=5/11), and financial restrictions (36.4%, n=4/11) deterred complete implementation of the HIPP. Conclusions: Because AT in the high school setting often lack the resources, time, and coaches’ support to identify risk factors, predisposing athletes to exertional heat Illnesses (EHI) researchers should develop and validate a suitable screening tool. Further, ATs charged with the health care of high school athletes should seek out prevention programs and screening tools to identify high-risk athletes and monitor athletes throughout exercise in extreme environments.

Comparison of Common Field/Clinical Measures to Standard Laboratory Measures of Hydration Status

Context: Accurately determining hydration status is a preventative measure for exertional heat illnesses (EHI). Objective: To determine the validity of various field measures of urine specific gravity (Usg) compared to laboratory instruments. Design: Observational research design to compare measures of hydration status: urine reagent strips (URS) and a urine color (Ucol) chart to a refractometer. Setting: We utilized the athletic training room of a Division I-A collegiate American football team. Participants: Trial 1 involved urine samples of 69 veteran football players (age=20.1+1.2yr; body mass=229.7+44.4lb; height=72.2+2.1in). Trial 2 involved samples from 5 football players (age=20.4+0.5yr; body mass=261.4+39.2lb; height=72.3+2.3in). Interventions: We administered the Heat Illness Index Score (HIIS) Risk Assessment, to identify athletes at-risk for EHI (Trial 1). For individuals “at-risk” (Trial 2), we collected urine samples before and after 15 days of pre-season “two-a-day” practices in a hot, humid environment(mean on-field WBGT=28.84+2.36oC). Main Outcome Measures: Urine samples were immediately analyzed for Usg using a refractometer, Diascreen 7® (URS1), Multistix® (URS2), and Chemstrip10® (URS3). Ucol was measured using Ucol chart. We calculated descriptive statistics for all main measures; Pearson correlations to assess relationships between the refractometer, each URS, and Ucol, and transformed Ucol data to Z-scores for comparison to the refractometer. Results: In Trial 1, we found a moderate relationship (r=0.491, p<.01) between URS1 (1.020+0.006μg) and the refractometer (1.026+0.010μg). In Trial 2, we found marked relationships for Ucol (5.6+1.6shades, r=0.619, p<0.01), URS2 (1.019+0.008μg, r=0.712, p<0.01), and URS3 (1.022+0.007μg, r=0.689, p<0.01) compared to the refractometer (1.028+0.008μg). Conclusions: Our findings suggest that URS were inconsistent between manufacturers, suggesting practitioners use the clinical refractometer to accurately determine Usg and monitor hydration status.