Development of a Heat-Illness Screening Instrument Using the Delphi Panel Technique (Original Research) (Clinical Report‪)‬

Exertional heat stroke is the third leading cause of death in the United States among high school athletes, (1) and, with effort to reduce risk factors, many heat illnesses can be prevented. (2-4) Screening athletes during preparticipation physical examinations (PPEs) can help health care professionals identify predisposing factors of exertional heat illnesses (EHIs). Using the PPE to identify patients at risk for EHI can provide the athletic trainer (AT) with information about predisposing conditions that might not otherwise be disclosed. (5,6) Subsequent action to reduce these risks is an essential component of the prevention process. Typically, the PPE includes an evaluation of general medical considerations and orthopaedic injuries; however, ATs would be better equipped to prevent injury and illness with more information about any previous history of cardiovascular, respiratory, and heat illnesses. (5-7) The recognition of inherent risk factors can help practitioners make sound clinical decisions when extrinsic risk factors can inhibit safe participation. Extrinsic risk factors include exercising in warm or hot, humid environmental conditions; wearing protective equipment; having inappropriate work-to-rest ratios; or having insufficient access to water and shade. (2) The intrinsic risk factors for EHI include history of EHI; poor cardiovascular and physical fitness (and accompanying obesity); inadequate heat acclimatization; dehydration or electrolyte imbalance; recent febrile illness; sleep deprivation; a "never give up" or "warrior" mentality; a high level of motivation or zealousness; and use of questionable drugs, herbs, or supplements. (3,4) These intrinsic risk factors of EHI can be identified during the PPE, but most examinations are inadequate to obtain enough information to identify individuals at risk. Current research supports extending the length of the PPE to include more indicators for cardiovascular, respiratory, and general medical conditions, including EHI. (5-11) Expanding the PPE would allow practitioners to identify at-risk athletes and likely would prevent undue injury or illness. Using a preparticipation screening instrument to identify intrinsic risks for EHI would allow ATs to determine which individuals might be susceptible to heat illnesses. (8) Therefore, the purpose of our investigation was to determine content validity of a heat-illness screening instrument, the Heat Illness Index Score (HIIS), designed to be used by the AT as part of the PPE.