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NATA's New Exertional Heat Illnesses Position Statement

I just read this article about NATA guidelines:

"Rectal temperature is the only method of obtaining an immediate and accurate measurement of core body temperature in an exercising individual."

As an AT we are bound by the standard of care which comes primarily from NATA but SERIOUSLY how many SSATs use rectal temperatures?

It is not in our school protocol. Aren't you scared of lawsuit? Don't you guys use or even prefer other methods of measurement (oral, tympanic for instance)?


  • edited October 2015
    I think the updated guidelines are great, the update was definitely needed. Where I do not currently work with high school aged athletes, when I did, I did not hesitate to use rectal temperature measurement.

    Other methods of temperature measurement are not accurate at extreme temps involved with exertion heat stroke. So rectal temperature is the only way to accurately assess a heat illness.

    For example if you arrive on the scene and an athlete has collapsed and may unconscious or have altered consciousness how do you know if it is heat illness and should be cooled prior to transport? Or something else that requires a different plan of care? Simply take a rectal temp and quickly let you know what to do to save their life.

    If you do not take a rectal temp and miss the diagnosis of heat stroke and your athlete dies, you have a way bigger lawsuit on your hands.

    An athletic trainer is an Allied Health Care practitioner. There is no way we should not provide the most accurate and correct assessment and care.

    Here are all the research articles about temperature assessment with heat illness: (From

    Brennan FH, O’Connor FG. Emergency triage of collapsed endurance athletes: a stepwise approach to on-site treatment. Phys Sportsmed. 2005;33:28–35.

    Byrne C, Lim CL. The ingestible telemetric body core temperature sensor: a review of validity and exercise applications. Br J Sports Med. 2007;41:126–133.

    Casa DJ, Armstrong LE, Ganio MS, Yeargin SW. Exertional heat stroke in competitive athletes. Curr Sports Med Rep. 2005;4:309–317.

    Casa DJ, Becker SM, Ganio MS, Brown CM, Yeargin SW, Roti MW, Siegler J, Blowers JA, Glaviano NR, Huggins RA, Armstrong LE, Maresh CM. Validity of devices that assess body temperature during outdoor exercise in the heat. J Athl Train. 2007;42:333–342.

    Coso JD, Aguado-Jimenez R, Mora-Rodriguez R. Infrared tympanic thermometry in a hot environment. Int J Sports Med. 2008;29:713–718.

    Ganio MS, Brown CM, Casa DJ, Becker SM, Yeargin SW, McDermott BP, Boots LM, Boyd PW, Armstrong LE, Maresh CM. Validity and reliability of devices that assess body temperature during indoor exercise in the heat. J Athl Train. 2009;44(2):124–135.

    Goodman DA, Kenefick RW, Cadarette BS, Cheuvront SN. Influence of sensor ingestion timing on consistency of temperature measures. Med Sci Sports Exerc. 2009;41:597–602.

    Gunga HC, Werner A, Stahn A, Steinach M, Schlabs T, Koralewski E, Kunz D, Belavý DL, Felsenberg D, Sattler F, Koch J. The double sensor-A non-invasive device to continuously monitor core temperature in humans on earth and in space. Respir Physiol Neurobiol. 2009;169 Suppl 1:S63–8.

    Heat Stress Control and Heat Casualty Management. Army/Air Force Bulletin (USARIEM). TB Med 507/AFPAM 48-152 (I). 2003..pdf

    Kistemaker JA, Den Hartog EA, Daanen HA. Reliability of an infrared forehead skin thermometer for core temperature measurements. J Med Eng Technol. 2006;30:252–261.

    Pryor RR, Seitz JR, Morley J, Suyama J, Guyette FX, Reis SE, Hostler D. Estimating core temperature with external devices after exertional heat stress in thermal protective clothing. Prehosp Emerg Care. 2012;16(1):136-141.

    Ronneberg K, Roberts WO, McBean AD, Center BA. Temporal artery temperature measurements do not detect hyperthermic marathon runners. Med Sci Sports Exerc. 2008;40:1373–1375.

    Shapiro Y, Seidman DS. Field and clinical observations of exertional heat stroke patients. Med Sci Sports Exerc. 1990;22:6–14.
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
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