Mechanistic Mapping Of Fatal And Nonfatal Exertional Heat Stroke Events In High Schools

PURPOSE: Exertional heat stroke (EHS) occurs at all levels of athletics. Previous case series describe fatal and nonfatal EHS events in military and recreational sport, but none have investigated the mechanisms of EHS events in the HS sport setting. The purpose of this study was to analyze factors impacting EHS events and create a Rasmussen’s Accident Map (AcciMap) to identify relationships between these factors and the outcomes. METHODS: EHS cases (n = 30) from the National Center for Catastrophic Sport Injury Research were linked by high school and year to: 1) data from the Athletic Training Locations and Services Project, which is a database identifying athletic training (AT) employment at secondary schools; and 2) publicly available Social Deprivation Index (SDI) score. An AcciMap was created to organize and tabulate the frequency of factors related to EHS cases into levels: external, organizational, actor events, conditions, and outcomes. RESULTS: The AcciMap shows fatal and nonfatal EHS events most commonly occurred in male, football linemen; notably, nonfatal EHS events occurred in female cross-country athletes. Schools with lower SDI scores had more ATs employed per school, EAP practiced, and access to cold water immersion tubs, favoring more nonfatal outcomes in EHS events. Schools with fatal EHS events were more socially disadvantaged as measured through a higher SDI score and did not have an AT employed. Athletes not cooled or cooled only using water dousing in fatal EHS events. Much remains unknown about the interactions that lead to EHS events in high schools. CONCLUSIONS: Disadvantaged schools had more fatalities than advantaged schools. Athletes may see increased risk in fatal EHS events in these schools; however, that risk can be mitigated through access to ATs, proper recognition and treatment, and access to appropriate cooling. Research should target the gaps in unknowns to further investigate the impact they may have on the outcomes of EHS events.