As athletic trainers, it always seems like we are pushing for more. More respect. More recognition. More money. The list goes on. We are pushing for these things for good reasons. We are highly trained, highly skilled healthcare professionals equipped to handle a myriad of conditions. 

But something has been bothering me, and I want to talk about it.

We tout evidence based medicine. We are highly aware of best practice documents and utilize them to create policy and procedure manuals as well as emergency action plans. The problem that I have is that there are times when we ignore parts of these documents because they make us uncomfortable, we don’t feel adequately prepared, or believe it is outside of our scope.

Do you think I’m off base? Then why are so many of us averse to utilizing a rectal thermometer when presented with a patient exhibiting signs/symptoms of exertional heat illness?

It is the gold standard. 

It is our educational standard.


So again, why are we not utilizing a rectal thermometer when heat stroke is a possibility? I have heard many excuses (none of them good) and one of the most common is “I’m confident I can recognize the signs and symptoms and treat appropriately without a rectal temperature.” Here’s the problem . . . no you can’t. We all know the signs and symptoms of heat illness, but here is a refresher just in case:

Rectal temperature greater than 104°F
Irrational behavior, irritability, emotional instability
Altered consciousness, coma
Confusion/Appear “out of it”
Nausea or vomiting
Muscle cramps/loss of function
Profuse sweating
Decreasing performance or weakness
Dehydration/dry mouth/thirst
Rapid pulse, low blood pressure, quick breathing

Now, ignore the rectal temperature and work through your list of differential diagnoses. Heat exhaustion? Exertional hyponatremia? Cardiac arrest? Concussion? Those are just a few things it could be. The ONLY way to know for sure is to get a rectal temperature and to continue to monitor it. If it is above 104°F, the most effective way to treat the patient is to immerse them in cold water (35-58°F) and monitor vital signs, including rectal temperature, until their core body temperature has decreased to 102.5°F. 

According to the Korey Stringer Institute, if this process is followed within 10 minutes of patient collapse, heat stroke is survivable 100% of the time. 

Nobody should die from a condition that is 100% survivable when recognized early and treated correctly. 

If you do not feel adequately prepared to diagnose and treat heat stroke I urge you to review the best practice documents. Have difficult conversations with your administration. Present the evidence. Update your EAPs/Policies and Procedures. Equip yourself with the tools necessary to save a life. 

Because you never know.

– AT Community Manager, Josh Beard, MA, ATC

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