A hot button topic in Athletic Training lately has been the use of rectal thermometers in the field. Recent discussions with colleagues has revealed a somewhat divided stance, so let me do my best to set the stage. WE are in the midst of a time where our profession is really pushing for the inclusion of evidence based practice, that is utilizing research to help dictate and guide our daily professional practice. This is common in health care professions in the U.S. Sometimes though, practitioners are resistant, for a variety of reasons, substantiated and unsubstantiated. Essentially, the NATA Position Statement on Heat Related Illness, found here recommends utilizing rectal temperature as an evaluative tool to help differentiate between heat exhaustion and heat stroke. It clearly states that oral, tympanic and axillary forms of temperature measurement are inaccurate pre and post exercise. Research has shown that rectal assessment is the most accurate form of measuring core body temperature. So why the resistance of ATC's to perform? To be honest, I'm not sure.
We are educated to recognize life threatening conditions and to evaluate and treat them accordingly, and this is no different. A rectal thermometer should be in every ATC's kit. It can be a valuable tool which provides valuable information.
Let me be clear on this; when an ATC decides to take a rectal temperature, it's because bad things are happening (think life threatening emergency). The athlete may be exhibiting cognitive difficulties, and systems are not functioning properly. Scenario: An athlete collapses on the field during pre-season, clearly struggling. The ATC makes the decision to call an ambulance for transport; the ambulance will take approximately 20 minutes to arrive. During that time, many things can be done; including assessment of rectal temperature and cold water immersion (another statistically supported treatment method that is quicker at reducing core temp. than packing with ice bags). Core temp is reduced (and you are monitoring it in real time) and again, literature has stated that heat stroke can be completely survivable if appropriate actions are taken immediately.
My point: Isn't that what we are here for? I don't know about you, but I'd rather know exact temperatures than "guess" or speculate.
Here is another recent take on the topic:
http://www.training-conditioning.com/2011/07/31/ahead_of_the_pack_2/index.php
Best Line: Would an ATC hesitate to use an AED on a female because her torso would be exposed?
For those interested, you can view an excellent "How To" of rectal temp here:
The bottom line: If we are to be viewed as health care professionals, we should act in accordance. Perhaps, if we acted as health care professionals (we teach our students to view the body objectively, don't we?), we might even be viewed as such!
We are educated to recognize life threatening conditions and to evaluate and treat them accordingly, and this is no different. A rectal thermometer should be in every ATC's kit. It can be a valuable tool which provides valuable information.
Let me be clear on this; when an ATC decides to take a rectal temperature, it's because bad things are happening (think life threatening emergency). The athlete may be exhibiting cognitive difficulties, and systems are not functioning properly. Scenario: An athlete collapses on the field during pre-season, clearly struggling. The ATC makes the decision to call an ambulance for transport; the ambulance will take approximately 20 minutes to arrive. During that time, many things can be done; including assessment of rectal temperature and cold water immersion (another statistically supported treatment method that is quicker at reducing core temp. than packing with ice bags). Core temp is reduced (and you are monitoring it in real time) and again, literature has stated that heat stroke can be completely survivable if appropriate actions are taken immediately.
My point: Isn't that what we are here for? I don't know about you, but I'd rather know exact temperatures than "guess" or speculate.
Here is another recent take on the topic:
http://www.training-conditioning.com/2011/07/31/ahead_of_the_pack_2/index.php
Best Line: Would an ATC hesitate to use an AED on a female because her torso would be exposed?
For those interested, you can view an excellent "How To" of rectal temp here:
The bottom line: If we are to be viewed as health care professionals, we should act in accordance. Perhaps, if we acted as health care professionals (we teach our students to view the body objectively, don't we?), we might even be viewed as such!
Good point Ben and research explains why Athletic Trainers do not recognize and treat properly the Exertional Heat Stroke.
ReplyDeleteThis is something I covered here:
http://www.athletictrainercenter.com/5-reasons-why-athletic-trainers-do-not-recognize-and-treat-properly-exertional-heat-stroke/