User:Jessmart24/Korey Stringer Institute

Korey Stringer Institute The Korey Stringer Institute (KSI) is a not-for-profit organization dedicated to the prevention of sudden death in sports, especially as it pertains to exertional heat stroke (EHS).

After Korey Stringers death in August of 2001 from EHS, Korey's widow, Kelci Stringer, settled her lawsuit against the NFL in January of 2009. KSI stems from this settlement with Kelci Stringer teaming up with EHS expert, Douglas Casa, PhD, ATC, FACSM, FNATA from the Neag School of Education at University of Connecticut, Department of Kinesiology. It is the goal of the institution to minimize preventable deaths in sports through awareness, education, and research in the ways to accurately prevent, recognize, and treat symptoms quickly by being a resource to the entire sports community.

KSI is currently staffed by:

• Founder, Kelci Stringer
• Chief Operating Officer, Douglas Casa, PhD, ATC, FACSM, FNATA
• Board of Advisors
• Medical Science Advisory Board
• Heat Stroke Consultants

Operations

One of the main purposes of KSI is to be a resource of accurate and reliable information for all levels of athletic organizations.

Consultations

Consultations are provided to any affiliated personnel both private and public of an athletic organization. This includes athletic trainers, team physicians, athletic directors, league supervisors, athletes, coaches, parents, ect. KSI offers assistance to creating, altering, and approving site-specific emergency action plans in order for the prevention of sudden death in sport.

Advocacy

Advocacy for the creation or improvement of policies as it relates to prevention of sudden death in sport, especially as it relates to EHS. KSI works with governing bodies of sport organizations and state medical boards in order to create or improve policies.

Education

KSI provides a comprehensive database of current literature and research as it pertains to the prevention, recognition, and treatment of EHS.

Prevention

In order to prevent EHS, individuals need to acclimatize to the weather conditions by exercising in the heat gradually over 10-14 days . During acclimatization you should progressively increase intensity of work and duration of work, incorporate rest breaks, minimize the amount of equipment worn during hot and humid weather, and encourage adequate fluid consumption .

Recognition

EHS can be characterized by central nervous system (CNS) dysfunction and a core body temperature that is > 40 °C (104 °F). The only accurate method to measure core body temperature in a hyperthermic individual is by a rectal temperature assessment unless they have a gastrointestinal temperature sensor in. Other temperature assessment tools such as tympanic, oral, skin, or axillary may give false readings and should not be considered accurate.

Additional signs and symptoms of EHS

• tachycardia
• hypotension
• sweating
• hyperventilation
• dizziness
• irrational behavior
• irritability
• headache
• inability to work
• loss of balance
• vomiting
• diarrhea
• collapse
• seizures
• coma .

Treatment

Rapid and aggressive whole-body cooling through cold water 15 °C (59 °F) immersion is essential to the survival of EHS.

Practical Guidelines for Cold Water Immersion

1. Initial Response

Once EHS is suspected, prepare to cool the patient and contact emergency medical services (EMS).

1. Prepare for ice water immersion

On the field or temporary medical tent, half-fill the tub or wading pool with water and ice (before an emergency happens, check to see how quickly your water source fills the immersion tub).

• Fill immersion tub with ice and water prior to event or have the tub half-filled with water and have three to four coolers of ice. This prevents having to keep the tub cold throughout the day.
• Ice should cover the surface of the water at all times.
• If the athlete collapses near an athletic training room, a whirlpool tub or cold shower may be used.

1. Determine vital signs

Just before immersing the heat-stroke patient, take vital signs.

• Assess core body temperature with a rectal thermistor (thermistor implies flexible thermometer that stays in during cooling and allows for continuous monitoring of temperature during immersion therapy).
• Check airway, breathing, pulse, and blood pressure.
• Assess the level of central nervous system dysfunction.

1. 4 Begin ice water immersion

Place the athlete in the ice water immersion tub. Medical staff, volunteers, and teammates may be needed to assist with a smooth and safe entry and exit.

1. 5 Total body coverage

Cover as much of the body as possible with ice water while cooling. *If full body coverage is not possible due to the container’s size, cover the torso as much as possible. *To keep the athlete’s head and neck above water, an assistant may hold the victim under the axillae – armpits – with a towel or sheet wrapped across the chest and under the arms. *Place an ice/wet towel over head and neck while body is being cooled in tub. *Use a water temperature under 15 °C (59 °F)

1. 6 Vigorously circulate water

During cooling, water should be continuously circulated or stirred to enhance the water-to-skin temperature gradient, which optimizes cooling. Have an assistant stir the water during cooling.

1. 7 Continue medical assessment

Vital signs should be monitored at regular intervals.   

*It may be helpful for an assistant to stand nearby in case the athlete becomes combative. *Other assistants may be needed to lift or roll the athlete if vomiting occurs.

1. 8 Fluid administration

If a qualified medical professional is available, an intravenous fluid line can be placed for hydration and support of cardiovascular function. Rest the arm to be used on the side of the water immersion tub.  

1. 9 Cooling duration Continue cooling until the patient’s rectal temperature lowers to 39 °C (102 °F)

*If rectal temperature cannot be measured and cold water immersion is indicated, cool for 10-15 minutes and then transport to a medical facility. *An approximate estimate of cooling via cold water immersion is 1ºC for every five minutes and 1ºF every 3 minutes (if the water is aggressively stirred). This means, the cooling rate will be slower initially, and increase the longer the person is in the tub. For example, if someone is in the tub for 15 minutes they would cool approximately 3 °C (37 °F) during that time.

1. 10 Patient transfer

Remove the patient from the immersion tub only after rectal temperature reaches 39ºC (102ºF) and then transfer to the nearest medical facility via EMS as quickly as possible.

1. 11 Cooling is the primary goal before transport

If appropriate medical staff is available on-site (team physician or athletic trainer); an aggressive cooling modality is readily available (i.e., Cold water immersion, ice/wet towel rotation, high flow cold water dousing); and no other emergency medical services are needed besides the rapid lowering of temperature, then always follow the “cool-first, transport second” doctrine.

1. 12 Advanced medical support

During transportation, maintain the rectal thermistor, which allows body temperature to be monitored continuously.

• Once the athlete has arrived at the hospital, tests and other treatments will address issues resulting from the hyperthermia.

These recommendations are adapted from Casa et al.

Presentations and web-based seminars are provided to specific settings. Also, the development of a web-based CEU program for multiple organizations and professions is currently underway.

Professional Organizations

The following professional organizations are within the umbrella of sports medicine and can be directly effected by KSI.

• American College of Sports Medicine (ACSM)[ http://www.acsm.org/]
• American Medical Athletic Association (AMAA)[ http://www.amaasportsmed.org/]
• American Medical Society for Sports Medicine (AMSSM)[ http://www.amssm.org/]
• American Physiological Society[1]
• Journal of Athletic Training[2]
• National Strength and Conditioning Association[3]

* National Athletic Trainers Association link (NATA)[ http://www.nata.org/]

• National Collegiate Athletic Association (NCAA)[ http://www.ncaa.org/]
• Professional Football Athletic Trainers’ Society Research &Education Foundation[4]

Research

KSI continues to build on the 20 years of research that is related to sudden death in sports and EHS. Research approaches are varied including quantitative and qualitative, and mixed methods to further the literature on these topics.

Mass-market Outreach

In order for the education of the public on the prevention of sudden death in sport, especially as it relates to EHS, KSI works through advertising, public service announcements, podcasts, CD ROMs, webinars, conferences, and working along reporters and talk shows at a regional and national level.

External Links

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