title: Evidence-based medicine and the recognition and treatment of exertional heat stroke, part II: a perspective from the clinical athletic trainer.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  In-person focus groups consisting of 3 to 6 collegiate or high school ATs.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Kinesiology, Neag School of Education, University of Connecticut, 2095 Hillside Road, U-1110, Storrs, CT 06269-1110, USA. stephanie.mazerolle@uconn.edu
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Mazerolle
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Pinkus
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Casa
authors.forename: Brendon P
authors.initials: BP
authors.lastname: McDermott
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Pagnotta
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Ruiz
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Armstrong
authors.forename: Carl M
authors.initials: CM
authors.lastname: Maresh
mesh_terms: D000328:Adult; D056352:Athletes; D003625:Data Collection; D019317:Evidence-Based Medicine; D005260:Female; D018883:Heat Stroke / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D005082:Physical Exertion; D011361:Professional Competence; D012574:Schools; D013177:Sports / Q000193:education; D014495:Universities