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Evidence-based practice and the recognition and treatment of exertional heat stroke, part I: a perspective from the athletic training educator.

CONTEXT
Athletic trainers (ATs) know to diagnose exertional heat stroke (EHS) via rectal thermometry (T(re)) and to treat EHS via cold-water immersion (CWI) but do not implement these recommendations in clinical practice.


OBJECTIVE
To gain an understanding of educational techniques used to deliver content regarding EHS.


DESIGN
Qualitative study.


SETTING
In-person focus groups at the National Athletic Trainers' Association (NATA) Annual Meeting in June 2009 and 2 follow-up telephone interviews to confirm emergent themes.


PATIENTS OR OTHER PARTICIPANTS
Thirteen AT educators (11 men, 2 women) from programs accredited by the Commission on Accreditation of Athletic Training Education, with an average of 22 ± 9 years of clinical experience and 16 ± 10 years of experience as educators. Five NATA districts were represented.


DATA COLLECTION AND ANALYSIS
Data were analyzed using inductive content analysis. Peer review and data source triangulation also were conducted to establish trustworthiness.


RESULTS
Four themes emerged from the analysis: educational techniques, educational competencies, previous educational training, and privacy/public opinion. Educational techniques highlighted the lack of hands-on training for T(re) and CWI. Educational competencies referred to the omission of T(re) and CWI as psychomotor skills. Previous educational training addressed educators not having the skills or comfort with the skills necessary to properly educate students. Privacy/public opinion comprised external inputs from various groups (parents and coaches), legal considerations, and social bias.


CONCLUSIONS
Educators supplied students with the appropriate didactic knowledge about EHS, but their lack of training and misgivings about T(re) prevented them from allowing students to gain competence with this skill. Until the NATA competencies state the need to teach T(re) and CWI and until educators are provided with their own learning opportunities, evidence-based practice regarding EHS will be lacking.