Team Physicians’ Practice Beliefs Regarding the Recognition and Treatment of Exertional Heat Stroke

Recognition and Treatment of Exertional Heat Stroke: A Perspective from the Team Physician McDowell LH, Mazerolle SM, Casa DJ, Pagnotta KD, Armstrong LE: University of Connecticut, Storrs, CT Context: Rectal temperature assessment (Tre) and cold-water immersion (CWI) are the gold standards for the recognition and treatment of exertional heat stroke (EHS), but athletic trainers (ATs) are reluctant to implement them regularly into clinical practice. ATs work under the guidance of a physician, but little information is available regarding the perceptions of the aforementioned methods from the team physician’s perspective. Objective: To investigate team physicians’ practice beliefs regarding the recognition and immediate treatment of EHS and the ways to increase the use of best practices. Design: Exploratory study using semi-structured focus groups and follow-up phone interviews. Setting: College, university, and secondary school clinical setting. Patients or Other Participants: 13 team physicians using criterion, convenience, and snowball sampling technique were included in the study. The criteria included the title “team physician” for a college/university or secondary school, at least 3 years of full-time work experience beyond their residency and possession of a family medicine or internal medicine specialization. Seven were involved with the focus groups and 6 completed phone interviews. The mean age was 44.2 ± 3.8 with 10.2 ± 7.1 years of sports medicine specific experience. Participants represented 11 states. 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 triangulation. Results: Two main themes emerged to explain the viewpoint of the physician on best practices: 1) Supervisory role of the physician and 2) Core body temperature. Participants strongly agreed that the role of the physician does not include educating the AT on proper Tre implementation, but instead must enforce a protocol that includes evidence-based medicine. Two major themes materialized to explain how ATs can be encouraged to use Tre assessment and CWI in clinical practice: 1) Pre-certification and 2) Post-Certification. Pre-certification was supported by two lower level themes including: 1) Real-time experience, and 2) Skill set mandate, while the Post-certification theme was illustrated by one lower theme: Professional development. Conclusions: The sports medicine physician is in support of Tre and CWI and believe it should be performed by the AT. Physicians, in recognition of the dichotomy between best and actual practice, believe that to increase the use of best practices the AT must receive formal training with those skills in a structured learning environment as well as gain real life exposure to the implementation of the methods. Physicians also recognize the dynamic nature of medicine and development of best practices, therefore they recommended for the AT to maintain current through professional development. Future studies should investigate the practice beliefs of emergency room physicians as well as those physicians employed within the secondary school setting without a sports medicine specialization. Word Count: 447