High Schools' Adoption of Evidence-Based Practices for the Management of Exertional Heat Stroke

Samantha E. Scarneo-Miller, Rebecca M. Lopez, Kevin C. Miller, William M. Adams, Zachary Y. Kerr, Douglas J. Casa

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Context: Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. Objective: To investigate high schools' adoption of policies and procedures for recognizing and treating patients with EHS and the factors influencing the adoption of a comprehensive policy. Design: Cross-sectional study. Setting: Online questionnaire. Patients or Other Participants: Athletic trainers (ATs) practicing in the high school (HS) setting. Main Outcome Measure(s): Using the National Athletic Trainers' Association position statement on exertional heat illness, we developed an online questionnaire and distributed it to ATs to ascertain their schools' current written policies for using rectal temperature and cold-water immersion. The precaution adoption process model allowed for responses to be presented across the various health behavior stages (unaware if have the policy, unaware of the need for the policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining). Additional questions addressed perceptions of facilitators and barriers. Data are presented as proportions. Results: A total of 531 ATs completed the questionnaire. Overall, 16.9% (n = 62) reported adoption of all components for the proper recognition and treatment of EHS. The component with the highest adoption level was ''cool first, transport second''; 74.1% (n = 110) of ATs described acting on or maintaining the policy. The most variability in the precaution adoption process model responses was for a rectal temperature policy; 28.7% (n = 103) of ATs stated they decided not to act and 20.1% (n = 72) stated they maintained the policy. The most frequently cited facilitator of and barrier to obtaining rectal temperature were a mandate from the state HS athletics association (n = 274, 51.5%) and resistance to or apprehension of parents or legal guardians (n = 311, 58.5%), respectively. Conclusions: Athletic trainers in the HS setting appeared to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing as the biggest challenge. Tailored strategies based on health behavior, facilitators, and barriers may aid in changing this paradigm.

Original languageEnglish
Pages (from-to)1142-1153
Number of pages12
JournalJournal of Athletic Training
Issue number10
StatePublished - Oct 2021


  • adoption
  • health behavior
  • policies and procedures
  • tailored interventions


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