Department of Physical Education and Sports, University of Prishtina "Hasan Prishtina", Prishtina, Kosovo.
Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, Connecticut.
J Emerg Med. 2024 Oct;67(4):e327-e337. doi: 10.1016/j.jemermed.2024.04.005. Epub 2024 May 3.
Exertional heat illnesses (EHIs), specifically exertional heat stroke (EHS), are a top cause of nonaccidental death among U.S. laborers. EHS management requires coordination between Emergency Medical Services (EMS) and workplace officials to implement cold water immersion (CWI) and cool first, transport second (CFTS).
The purpose of this article was to quantify and identify existing statewide EMS guidelines, determine whether statewide EHS guidelines improved outcomes for EHIs in laborers, and examine the odds of laborer EHS fatalities when best practices are present in EMS statewide guidelines.
The Paramedic Protocol Provider database and official EMS websites were examined to determine which U.S. states had statewide EMS guidelines and, for those with statewide guidelines, a two-way χ analysis with associated odds ratios examined EHI outcomes. Statewide EMS guidelines underwent content analysis by three independent reviewers regarding EHS best practices. Significance was set a priori at p < 0.05.
Among 50 states, the District of Columbia, and Puerto Rico, 57.7% (n = 30) had statewide EMS guidelines and 42.3% (n = 22) did not. There was a significant association for EHI outcome for states recommending CWI as a cooling method vs. those that did not (χ = 3.336; p = 0.049). The odds of EHS deaths for laborers were 3.0 times higher if CWI was not included in the EMS guidelines. There was a significant association in EHI outcomes for states without CFTS (χ = 5.051; p = 0.017). The odds of laborers dying from EHS were 3.7 times higher in states without CFTS.
Laborers are 3.0 and 3.7 times less likely to die from EHS when statewide EMS guidelines include CWI and CFTS, respectively.
运动性热病（EHIs），特别是运动性热射病（EHS），是美国劳动者非意外死亡的首要原因。EHS 的管理需要紧急医疗服务（EMS）和工作场所官员之间的协调，以实施冷水浸泡（CWI）和先冷却、后运输（CFTS）。
本文的目的是量化和识别现有的全州 EMS 指南，确定全州 EHS 指南是否改善了劳动者 EHIs 的结局，并在全州 EMS 指南存在最佳实践的情况下，检查劳动者 EHS 死亡的几率。
检查了护理人员协议提供者数据库和官方 EMS 网站，以确定哪些美国州有全州 EMS 指南，对于那些有全州指南的州，使用双向 χ 分析和相关优势比检查 EHI 结局。全州 EMS 指南由三名独立审查员进行了 EHS 最佳实践的内容分析。显著性预先设定为 p < 0.05。
在 50 个州、哥伦比亚特区和波多黎各，57.7%（n = 30）有全州 EMS 指南，42.3%（n = 22）没有。建议 CWI 作为冷却方法的州与不建议 CWI 的州之间的 EHI 结局有显著关联（χ = 3.336；p = 0.049）。如果 EMS 指南中不包括 CWI，劳动者发生 EHS 死亡的几率将增加 3 倍。对于没有 CFTS 的州，EHIs 结局也有显著关联（χ = 5.051；p = 0.017）。在没有 CFTS 的州，劳动者因 EHS 死亡的几率增加 3.7 倍。
当全州 EMS 指南分别包含 CWI 和 CFTS 时，劳动者因 EHS 死亡的几率分别降低 3.0 和 3.7 倍。
