title: Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion.
abstract: BACKGROUND
  The National Athletic Trainers' Association and the American College of Sports Medicine have recommended removing American football uniforms from athletes with exertional heat stroke before cold-water immersion (CWI) based on the assumption that the uniform impedes rectal temperature (T(rec)) cooling. Few experimental data exist to verify or disprove this assumption and the recommendations.
  
  
  OBJECTIVE
  To compare CWI durations, T(rec) cooling rates, thermal sensation, intensity of environmental symptoms, and onset of shivering when hyperthermic participants wore football uniforms during CWI or removed the uniforms immediately before CWI.
  
  
  METHODS
  Crossover study.
  
  
  METHODS
  Laboratory.
  
  
  METHODS
  Eighteen hydrated, physically active men (age = 22 ± 2 years, height = 182.5 ± 6.1 cm, mass = 85.4 ± 13.4 kg, body fat = 11% ± 5%, body surface area = 2.1 ± 0.2 m(2)) volunteered.
  
  
  METHODS
  On 2 days, participants exercised in the heat (approximately 40°C, approximately 40% relative humidity) while wearing a full American football uniform (shoes; crew socks; undergarments; shorts; game pants; undershirt; shoulder pads; jersey; helmet; and padding over the thighs, knees, hips, and tailbone [PADS]) until T(rec) reached 39.5°C. Next, participants immersed themselves in water that was approximately 10°C while wearing either undergarments, shorts, and crew socks (NOpads) or PADS without shoes until Trec reached 38°C.
  
  
  METHODS
  The CWI duration (minutes) and T(rec) cooling rates (°C/min).
  
  
  RESULTS
  Participants had similar exercise times (NOpads = 40.8 ± 4.9 minutes, PADS = 43.2 ± 4.1 minutes; t(17) = 2.0, P = .10), hypohydration levels (NOpads = 1.5% ± 0.3%, PADS = 1.6% ± 0.4%; t(17) = 1.3, P = .22), and thermal-sensation ratings (NOpads = 7.2 ± 0.3, PADS = 7.1 ± 0.5; P > .05) before CWI. The CWI duration (median [interquartile range]; NOpads = 6.0 [5.4] minutes, PADS = 7.3 [9.8] minutes; z = 2.3, P = .01) and T(rec) cooling rates (NOpads = 0.28°C/min ± 0.14°C/min, PADS = 0.21°C/min ± 0.11°C/min; t(17) = 2.2, P = .02) differed between uniform conditions.
  
  
  CONCLUSIONS
  Whereas participants cooled faster in NOpads, we still considered the PADS cooling rate to be acceptable (ie, >0.16°C/min). Therefore, if clinicians experience difficulty removing PADS or CWI treatment is delayed, they may immerse fully equipped hyperthermic football players in CWI and maintain acceptable T(rec) cooling rates. Otherwise, PADS should be removed preimmersion to ensure faster body core temperature cooling.
authors.affiliation: Schools of *Rehabilitation and Medical Sciences and † Health Sciences, Central Michigan University, Mount Pleasant.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Miller
authors.affiliation: Schools of *Rehabilitation and Medical Sciences and † Health Sciences, Central Michigan University, Mount Pleasant.
authors.forename: Blaine C
authors.initials: BC
authors.lastname: Long
authors.affiliation: Schools of *Rehabilitation and Medical Sciences and † Health Sciences, Central Michigan University, Mount Pleasant.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Edwards
mesh_terms: D000328:Adult; D001831:Body Temperature; D003020:Clothing; D003080:Cold Temperature; D018592:Cross-Over Studies; D015444:Exercise / Q000502:physiology; D005538:Football / Q000502:physiology*; D018882:Heat Stress Disorders / Q000628:therapy*; D006358:Hot Temperature; D006801:Humans; D007101:Immersion; D008297:Male; D014481:United States; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water
keywords: clothing; equipment; exertional heat stroke; rectal temperature