Douglas J. Casa, PhD, ATC, FACSM, FNATA

1
ACSM/DOD Roundtable EHS- Return to Play/Duty
Issues Recognition and Treatment Session
3-DiscussantAthletics Perspective

• Douglas J. Casa, PhD, ATC, FACSM, FNATA
• Director, Athletic Training Education
• Associate Professor, Department of Kinesiology
• Research Associate, Human Performance Laboratory
• University of Connecticut

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5 Key Points to Emphasize The Recovery Story
Begins Here

• 1) Valid Temperature Assessment
• 2) Rapid Cooling Techniques
• Multiple viable options
• 3) On-site cooling
• 4) Cool-First/Transport Second
• 5) Benefits of Cold Water Immersion

3
High School/College ATC Study 2008
Mazerolle, Scruggs, Casa, et al. Perceptions and
behavior regarding exertional heat stroke among
athletic trainers. Journal of Athletic Training,
2009.
4
High School/College ATC Study 2008
Mazerolle, Scruggs, Casa, et al. Perceptions and
behavior regarding exertional heat stroke among
athletic trainers. Journal of Athletic Training,
2009.
5
Overall High Responders
Casa, Becker, Ganio, Brown, et al. Validity of
devices that assess body temperature during
outdoor exercise in the heat. Journal of
Athletic Training. 200742(3)333-342.
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Options for Assessing Core Temperature

• Axillary- NOT VALID
• Oral- NOT VALID
• Tympanic- NOT VALID
• Temporal- NOT VALID
• Forehead Sticker- NOT VALID FOR EHS
• Ingestible Thermistor- A LITTLE TOO LATE
• Esophageal- NOT PRACTICAL
• Rectal- YOUR ONLY OPTION

Casa, Armstrong, Ganio, Yeargin. Exertional
heat stroke in competitive athletes. Current
Sports Medicine Reports. 2005, 4309-317.
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The key determinant for an exertional heat
stroke outcome is the time above a critical
temperature, not the maximum temperature
obtained.(key temperature 105.5-106oF)
Pope L. Mosley, MD, FACSM University of New
Mexico School of Medicine Quote from May 29,
2003, ACSM Annual Meeting in San Francisco, CA
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From The Inter-Association Task-Force on
Exertional Heat Illnesses Consensus Statement,
2003

• Provided that adequate emergency medical care
• is available on-site (i.e. ATC, EMT, or
  physician),
• it is recommended to cool first via cold water
  immersion, then transport second.

9
High School/College ATC Study 2008
Mazerolle, Scruggs, Casa, et al. Perceptions and
behavior regarding exertional heat stroke among
athletic trainers. Journal of Athletic Training,
2009.
10
High School/College ATC Study 2008
Mazerolle, Scruggs, Casa, et al. Perceptions and
behavior regarding exertional heat stroke among
athletic trainers. Journal of Athletic Training,
2009.
11
THE CURRIE RESPONSE- 1798
Casa, McDermott, et al. Cold-water immersion
the gold standard for exertional heat stroke
treatment. Exercise Sport Sciences Reviews,
2007,35(3)141-149
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9.5min
108oF to 102oF
17min
83min
Casa, Armstrong, Ganio, Yeargin. Exertional
heat stroke in competitive athletes. Current
Sports Medicine Reports. 2005, 4309-317.
13
Casa, McDermott, et al. Cold-water immersion
the gold standard for exertional heat stroke
treatment. Exercise Sport Sciences Reviews,
2007,35(3)141-149
14
Survival Trumps Convenience

• Costrini et al, ACSM 1989, Med Sci 1990
• 100 (252/252) Survival rate of marines who
  suffered exertional heat stroke while doing basic
  training at Paris Island, South Carolina
• Brodeur et al, J. Emergency Nursing, 1989 (2008
  new data)
• 100 Survival rate of runners who suffer
  exertional heat stroke at Falmouth Road Race,
  average 10-12 per year, over 350 cases being
  treated this way in last 30 years