Brendon McDermott, associate professor of health, human performance and recreation at the University of Arkansas, recently received the Christine M. Bonci Award for Excellence in Athletic Training Scholarship.

Three students enrolled in graduate level Athletic Training programs at the U of A also recently won scholarships from the Southwest Athletic Trainer's Association: Katie Buria won the David Heidt Memorial Graduate Scholarship; Yuto Mori won the WB Carrell Clinic Memorial Dr. Robert Vandermeer Graduate Scholarship; and Yuka Ogata won the James Dodson, Ken Murray, and Brooks McIntyre Graduate Scholarship.

The Bonci award was developed by the Southwest Athletic Trainers' Association to recognize a member of District VI who has actively impacted athletic training practice, education, or scholarship based on the previous year's publications and presentations. 

Christine M. Bonci was an athletic trainer and assistant athletic director at the University of Texas- Austin and worked with athletes for 28 years. Under her direction, UT developed an interdisciplinary model for health care that focused on clinical, research and educational initiatives that have preventive, health-restoring and performance-enhancing potential.

McDermott's presentations have led to positive changes in clinical care related to preventing sudden death in sport and improved clinical management in terms of diagnosis and treatment of exertional heat stroke.

His publications -- eight in the past two years -- have set the standard for hydration recommendations for physically active individuals, improved heat illness treatment and explored renal health during exercise in the heat. 

McDermott offered more details about his research in this short Q&A:

What are some of the positive changes that have been made in clinical care and management based on your research into exertional heat stroke?

Athletic trainers and emergency physicians now have evidence for and against various whole-body cooling modalities for exertional heat stroke. We have shown that cold shower, ice sheeting (applying wet soaked bed sheets), and a commercially available cooling kit do not provide adequate cooling for a patient experiencing exertional heat stroke.

However, we have published evidence demonstrating that a tarp can be used to cool a patient. We call this method the tarp-assisted cooling with oscillations (TACO) method of cooling a patient. Clinicians now have evidence for establishing emergency action plans for exertional heat stroke. With TACO or cold-water immersion, and not using the other modalities tested, death from exertional heat stroke is 100% preventable. 

What are some of your recommendations that have been made standard practice regarding physically active people/athletes?

Hydration recommendations for the physically active need to be individualized. Every person has a unique sweat rate, and everyone should replace what we lose. Therefore, each person should evaluate their own sweat rate. This can be done using the equation below. If you replace the fluid that you lose, you should remain hydrated.

Adequate hydration improves exercise performance, helps prevent heat illness, and aids in maintaining a positive mood. 

Sweat rate = body weight before exercise (kg) - body weight after exercise (kg) / time (hr); No fluids should be consumed during exercise for this assessment;

Because 1 kg = 1 Liter, the sweat rate is measured in Liters/hr; normal measures for sweat rate are between 0.6 Liters/hr and 2.5 Liters/hr

Does caffeine cause dehydration?

It's a common myth in hydration is that caffeine causes excess urination and fluid loss. However, many studies have demonstrated that caffeine does not alter fluid balance and does not lead to dehydration. Drinks with caffeine should not be discouraged for athletic individuals because of a supposed dehydrating effect.   

What are some of your top recommendations for heat illness treatment?

In terms of prevention, the number 1 recommendation is heat acclimatization. This is facilitated via gradual exposure to heat stress and exercise intensity (and protective equipment, if necessary). This process takes 10-14 days and allows the body to get used to exercise in the heat. Heat acclimatization expands blood volume, enhances sweating, reduces body temperature, and makes exercise in the heat feel easier. Every person should be afforded the innate protection of facilitated heat acclimatization prior to intense exercise in the heat. 

Diagnosis is key. Without a proper diagnosis, effective treatment can be delayed. Healthcare professionals need to adequately assess vital signs (including rectal temperature) with patients suspected of exertional heat stroke. It should be expected by the patient (and parents) that healthcare professionals utilize rectal temperature assessment for anyone suspected of having exertional heat stroke. The reason for this is that effective treatment for exertional heat stroke should take place on site (where heat illness took place) prior to emergency transport. If body temperature is normal (below 104 degrees F), the patient should be transported and does not require cooling. Effective treatment for exertional heat stroke involves cold water immersion or TACO, which is not feasible in an ambulance and is often not facilitated in emergency rooms.

What sparked your interest in the hydration field of study?

I was an athlete in high school and was fairly competitive in road races throughout college, so I was always interested in my own performance and physiology. When I went back to school to get my PhD, I studied exercise physiology. Specifically, I studied thermoregulation. The most effective mechanism of heat loss for humans is sweat evaporation, which can lead to dehydration. Further, dehydration can compromise thermoregulation and sweating efficiency. Therefore, thermoregulation, heat illness, and hydration are commonly grouped as they are connected in physiology.  

What would you tell the parents of student athletes who might just be starting out in football, for example?

My suggestion would be to do three things:

1. Facilitate heat acclimatization at home: Have your kids gradually increase exposure, intensity and maybe even equipment with respect to the heat and exercise. The more an individual is accustomed to the exercise and heat stress, the easier it will be when the season begins. 

2. Assess sweat rate: Anyone can do this at home (my 10-year-old son did this last year for his science project). Have your son or daughter take a nude body weight (kg) before a workout. Take a nude body weight following the workout (kg). Have them keep track of how much they drink during the activity and time the activity (1/2 hour is best). Then, use the equation:

Sweat rate = [body weight before exercise (kg) - body weight after exercise (kg) + fluid consumed] / time (hr)

This gives them an idea of how much they sweat during exercise. They should attempt to consume about 2/3 of what they lose during activity to maintain hydration. 

3. Ask the medical staff - Parents should talk with their athletic trainer for two reasons. First, the athletic trainer is the best defense against potential injury or illness during exercise. So, they should be aware of risk factors and any potential complications pertaining to your child. The athletic trainer is responsible for establishing effective emergency action plans related to heat illness, cardiac events, lightning, asthma, diabetes, etc. Second, many athletic trainers have a small budget and are not set up against heat stress monitoring, treating potential cardiac events, or other basic needs. Ask them if they have all of the resources they need to help your child. If they don't, help them advocate for more resources so that your child, and everyone else at school, is afforded best practices. All too often schools purchase equipment following a major event. 

What does it mean to you to receive the Christine M. Bonci award?

In our district, Christine Bonci is a legend. She is a legend because she was a pioneer in advocating for equal rights in athletics, and setting up an organizational structure that supported student-athletes all while blending scholarship and clinical practice. For me to be recognized as having some of the qualities that she embodied makes me extremely proud. I attempt to emulate people like her, so it means a lot that I was recognized to represent someone who is attempting to make a positive difference.