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Evidence-based medicine and the recognition and treatment of exertional heat stroke, part II: a perspective from the clinical athletic trainer.

CONTEXT: Exertional heat stroke (EHS) is one of the leading causes of death in athletes. Certified athletic trainers (ATs) demonstrate strong knowledge of recommended practices with EHS but are apprehensive in implementing 2 basic procedures: rectal temperature assessment and cold water immersion. This apprehension might lead to deaths from EHS that could have been prevented.

OBJECTIVE: To investigate why collegiate and high school ATs do not implement best practices for the recognition and treatment of EHS.

DESIGN: Qualitative study.

SETTING: In-person focus groups consisting of 3 to 6 collegiate or high school ATs.

PATIENTS OR OTHER PARTICIPANTS: A total of 19 ATs (9 men, 10 women; age = 36 ± 10 years, length of certification = 12 ± 9 years) employed at either the collegiate (n = 10) or high school (n = 9) level participated in the study.

DATA COLLECTION AND ANALYSIS: Interviews were transcribed verbatim, and data were analyzed using deductive data analysis. Peer review and multiple-analyst data triangulation were conducted to establish trustworthiness of the data.

RESULTS: Five emergent themes explained the lack of evidence-based practice (EBP) regarding recognition and treatment of EHS. Three themes (lack of knowledge, comfort level, lack of initiative) were common in both the collegiate and high school settings, and 2 separate themes (liability concerns, lack of resources) were present in the high school setting.

CONCLUSIONS: Our findings are consistent with those in the literature on EBP and EHS. Regardless of clinical setting, ATs have basic information on recognition and treatment of EHS, but 5 themes act as barriers to implementing proper management in the clinical setting. Workshops or hands-on training sessions need to be made available to improve students' comfort levels so ATs will implement EBP into everyday settings.

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