Szymanski Michael R, Scarneo-Miller Samantha E, Smith M Seth, Bruner Michelle L, Casa Douglas J
Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
Division of Athletic Training, School of Medicine, West Virginia University, Morgantown, WV 26506, USA.
Medicina (Kaunas). 2020 Sep 24;56(10):494. doi: 10.3390/medicina56100494.
Emergency Medical Service (EMS) protocols vary widely and may not implement best practices for exertional heat stroke (EHS). EHS is 100% survivable if best practices are implemented within 30 min. The purpose of this study is to compare EMS protocols to best practices for recognizing and treating EHS. Individuals ( = 1350) serving as EMS Medical or Physician Director were invited to complete a survey. The questions related to the EHS protocols for their EMS service. 145 individuals completed the survey (response rate = 10.74%). Chi-Squared Tests of Associations (χ) with 95% confidence intervals (CI) were calculated. Prevalence ratios (PR) with 95% CI were calculated to determine the prevalence of implementing best practices based on location, working with an athletic trainer, number of EHS cases, and years of directing. All PRs whose 95% CIs excluded 1.00 were considered statistically significant; Chi-Squared values with values < 0.05 were considered statistically significant. A majority of the respondents reported not using rectal thermometry for the diagnosis of EHS ( = 102, 77.93%) and not using cold water immersion for the treatment of EHS ( = 102, 70.34%). If working with an athletic trainer, EMS is more likely to implement best-practice treatment (i.e., cold-water immersion and cool-first transport-second) (69.6% vs. 36.9%, χ = 8.480, < 0.004, PR = 3.15, 95% CI = 1.38, 7.18). These findings demonstrate a lack of implementation of best-practice standards for EHS by EMS. Working with an athletic trainer appears to increase the likelihood of following best practices. Efforts should be made to improve EMS providers' implementation of best-practice standards for the diagnosis and management of EHS to optimize patient outcomes.
紧急医疗服务（EMS）协议差异很大，可能未实施运动性中暑（EHS）的最佳实践。如果在30分钟内实施最佳实践，EHS的生存率可达100%。本研究的目的是将EMS协议与识别和治疗EHS的最佳实践进行比较。邀请担任EMS医疗主任或医师主任的个人（n = 1350）完成一项调查。问题涉及他们所在EMS服务机构的EHS协议。145人完成了调查（回复率 = 10.74%）。计算了95%置信区间（CI）的关联卡方检验（χ²）。计算了95%CI的患病率比（PR），以确定基于地点、与运动训练师合作、EHS病例数和指导年限实施最佳实践的患病率。所有95%CI排除1.00的PR被认为具有统计学意义；χ²值p < 0.05被认为具有统计学意义。大多数受访者报告在诊断EHS时未使用直肠测温法（n = 102，77.93%），在治疗EHS时未使用冷水浸泡法（n = 102，70.34%）。如果与运动训练师合作，EMS更有可能实施最佳实践治疗（即冷水浸泡和先降温后转运）（69.6%对36.9%，χ² = 8.480，p < 0.004，PR = 3.15，95%CI = 1.38，7.18）。这些发现表明EMS缺乏对EHS最佳实践标准的实施。与运动训练师合作似乎增加了遵循最佳实践的可能性。应努力改善EMS提供者对EHS诊断和管理最佳实践标准的实施，以优化患者预后。
