A Sequential Application of Qualitative Methods to Develop a Population Based Tool for Identifying and Managing Exertional Heat Illness

Abstract

Problem: United States (U.S.) National Guard (NG) units train annually to respond to natural and human-caused disasters. Given seasonal weather and climate extremes, no specific EHI risk assessment tool exists for medical personnel to assess EHI risk both before, during and after each day of training or response. With personnel wearing impermeable personal protective equipment (all hazard suits and respirators), these personnel are at increased risk for EHI. Purpose: EHI risk factors were identified, and clinical management guidelines were developed using qualitative methods involving focus groups, content experts and a Delphi panel. Methods: A 4-phase approached was utilized: focus groups, content panel experts to estimate content validity of the revised SF-600 and a Delphi panel to estimate the content validity of the field and clinical management care guidelines to be used in conjunction with the SF-600R. The fourth phase was piloting the SF600R to compare with the current SF600. Results: Focus group data revealed human, environmental, and workplace/social factors as indicators associated with EHI. Content expert consensus was reached for sleep, fitness, acclimatization, sickle cell trait, medications, and hyper-motivation factors. Delphi panel results were used to confirm evidence-based field/pre-transport guidelines for managing EHI in CERF-P/HRF operations. A revised SF 600 was developed and piloted during a limited 2-day training exercise. Readability, time to completion by service members and medical teams, and capture of additional evidence-based risk factors were evaluated with a sub-set of 250 NG personnel (n=38). Conclusion: Screening and assessment of NG personnel before disaster deployment and post-screening evaluations must utilize current evidence on prevention and identification of EHI risk. Medical group leadership need to engage in more strategic planning and discussion to utilize the SF600 Pre and Post Event Screening form as a risk-based safety tool to reduce EHI incidence during training exercises and real-world response deployments. Keywords: Haddon’s Matrix, Exertional Heat Illness, Focus groups, Qualitative Research, Military