Investigation of Emergency Medical Technicians Practice and Beliefs Regarding the Recognition and Treatment of Exertional Heat Stroke

Context: Current Evidence Based Practice (EBP) supports the use of rectal thermometry (Tre) for an accurate diagnosis and cold water-immersion (CWI) for the treatment of Exertional Heat Stroke (EHS) for an optimal outcome. Emergency Medical Services (EMS) play a critical role for the diagnosis and treatment of EHS as they may be the first to arrive on scene, however there is limited data regarding their implementation of EBP. Objective: Investigate current practice regarding EHS by EMS professionals and explore the relationship that exists between EMS and Athletic Trainers (ATs). Design: A basic qualitative design using in-person focus groups. Setting: Regionally biased EMS companies. Participants: A total of 17 (3 females and 14 males) EMS professionals including Emergency Medical Technicians (EMTs) (n=11) and Paramedics (n=6), age 28+8 years participated in the study. EMS professionals averaged 6.3+5.3years of experience. Data Collection and Analysis: Interviews were transcribed verbatim and data was analyzed using open coding procedures. Peer review and multiple analyst data triangulation were conducted to establish trustworthiness. Results: Educational preparation emerged as the predominate explanation for the lack of EBP regarding EHS. Three sub-themes help illustrate educational preparation including temperature assessment (educational training and knowledge), rapid cooling (educational training, knowledge, and logistics), and the role of the AT/Healthcare professional. Educational training and knowledge provided for the EMS professional, regarding temperature assessment was limited, in some cases inaccurate as compared to the most current EBP, and highlighted a disparity in the EMS professional’s ability to accurately diagnosis EHS. Because the education EMS professionals receive is limited partly due to scope of practice, the knowledge they bring to clinical practice reflects this disconnect. Rapid cooling educational training and knowledge illustrates the use of and belief in alternative methods other than CWI such as ice bags, air conditioning, and shaded areas. Logistics played a limiting role for the use of CWI as immediate transport is considered more important than immediate rapid cooling as well as impossible in an ambulance. The true role of the AT/Health care professional was unknown to many EMS professionals, which created confusion between two separate medical professionals. Conclusion: Findings from this research are consistent with previous literature regarding EBP among medical professionals; a failure to utilize best practices. Unlike the AT, cool first transport second is not considered standard practice for EMS, due to protocol procedures, therefore alternative, but effective methods must be investigated. Proper education consistent with the most current literature regarding EHS must be taught within EMS certification preparation to ensure the most efficient recognition and treatment of EHS. A relationship among EMS professionals and ATs should be formed to create familiarity among the professions and establish emergency treatment protocols ensuring consistent EBP and optimal care. Word Count: 44