Attitude Toward Exertional Heat Stroke Prehospital Management Among Falmouth Road Race Volunteers

ASICS Falmouth Road Race (FRR) implements the gold-standard care of exertional heat stroke (EHS) prehospital management (e.g., rectal temperature [TREC] assessment, whole-body cold-water immersion [CWI]). Many medical volunteers (MV) seek opportunities to perform these skills at FRR. PURPOSE: To investigate the change in attitudes toward EHS prehospital management among MV of ASICS FRR 2024. METHODS: Two online anonymous questionnaires were sent before (PRE, August 16, 2024) and after (POST, September 1, 2024) the race in 2024. Participants’ responses were classified according to the precaution adoption process model (PAPM). Open-ended answers from POST about their reasons for the selected PAPM stage were coded and analyzed by researchers (FA, KK, YH). The agreement between PRE and POST PAPM stages was computed using weighted Cohen’s kappa. The correlation between the PRE PAPM stage and the number of MV experiences was calculated using Spearman's correlation coefficient. Statical significance was set at p < 0.05 a priori. RESULTS: Fifty-eight MV completed PRE, with a follow-up rate of 44.8% at POST (n = 26). The median number of MV experiences at FRR was three (range: 1, 28). Approximately half of the MV was in stage 7 for using TREC assessment (51.7%) and CWI (53.4%) at PRE. However, no association was observed between the PAPM stage and the number of MV experiences (TREC, r = 0.05, p = 0.73; CWI, r = 0.15, p = 0.28). The majority of MV maintained their attitudes and behaviors on TREC (65.4%) assessment and CWI (69.2%), while a few demonstrated improvements (TREC, 7.7%; CWI, 19.2%) and decrements (TREC, 26.9%; CWI, 11.5%) at POST. There was a moderate similarity in PAPM stages of both methods at PRE and POST (TREC, κ = 0.39, p = .001; CWI, κ = 0.55, p < .001;). Open-ended answers revealed that “evidence-based practice,” “accurate diagnosis/assessment,” “most effective cooling method,” and “following the (local) policy” promoted the selection of stage 7 in TREC and CWI. In contrast, “no equipment” and “no EHS encounter” were reported as common barriers to implementation. CONCLUSION: Over half of the FRR 2024 MV routinely used TREC and CWI for EHS prehospital care. As most MV in the current study were experienced, future research should examine how FRR experience affects EHS management in novice MV.