Promoting Best Practices regarding Exertional Heat Stroke: A Perspective from the Team Physician

Context: Knowing the team physician's perspective regarding the use of evidence-based practice (EBP) for treatment of exertional heat stroke (EHS) may help increase the number of athletic trainers (ATs) implementing best practices and avoiding the use of improper assessment tools and treatment methods. Objective: To ascertain team physicians' perspectives regarding the AT's use of rectal temperature (T[subscript re]) and cold-water immersion (CWI) for recognition and treatment of EHS. Design: Exploratory study using semi-structured focus groups and follow-up telephone interviews. Setting: American College of Sports Medicine Annual meeting. Patients or Other Participants: Thirteen family or internal medicine specialists who were currently serving as the team physician for a college/university or secondary school participated. The mean age was 44 plus or minus 4 with 10 plus or minus 8 years of sports medicine specific experience. Of these, 7 participated in a focus group and 5 completed a telephone interview. Data Collection and Analysis: Data analysis included open coding procedures by a 3-member research team. Credibility was established by member checks and multiple analyst triangulations. Results: Two major themes emerged regarding how ATs could be encouraged to use T[subscript re] assessment and CWI in clinical practice: 1) "pre-certification" and 2) "post-certification." Pre-certification included two lower level themes: a) "real-life experience" and b) "skill set mandate." The post-certification theme included one lower theme: "professional development." Conclusion: Physicians, in recognition of the dichotomy between best and actual practices, believe that ATs must receive both formal skill training in a structured learning environment and field experience using these methods, and remain current through annual professional development seminars and courses. (Contains 1 table and 1 figure.)