The first thing you notice about Doug Casa, PhD, ATC is how energetic he is.

Seeing him up on the podium at the Great Lakes Athletic Trainers' Association's annual meeting earlier this month, I immediately thought to myself, "This guy is wired." And after listening to him for a few minutes, I realized there are times when he would like you to be, but he would prefer that time would never come.

His problem -- the reason he is so passionate -- is that when that time does come, too many medical professionals are either too ignorant or reluctant to do the wiring.

"About using an AED for a heart attack?" you may ask.

No. All medical professionals are in agreement regarding the necessity of early defibrillation in cases of cardiac arrest.

Instead, Casa's crusade concerns the proper diagnosis and treatment of exertional heat stroke (EHS), which can be every bit as deadly but allows a little more time to respond.

Mixing humor with pathos, Casa made the case for the standard of care endorsed by the NATA and, among others, the American College of Sports Medicine, the American Academy of Pediatrics, and the American College of Emergency Physicians.

"Heat stroke can never be completely prevented," said Casa, "but death (from it) can be."

The first step in treatment, according to the director of athletic training education at the University of Connecticut, is proper triage.

That means being watchful for early signs of heat illness, which may be as dramatic as sudden loss of consciousness or as subtle as dizziness and irritability. Knowing what to next is key and Casa refers to a "golden hour" in which to get it done. Unfortunately, medical textbooks are not up-to-date in that regard.

"EMTs and ER docs are getting bad information," Casa asserted.

Last year, in the Journal of Strength and Conditioning Research, Casa wrote, "A temperature greater than 105 deg. F indicates possible EHS. The ability to perform -- the assessment is critical because an athlete may have a brief (10-15 minutes) lucid interval -- but likely feel out-of-sorts, and a coach or athletic trainer who knows the athlete well may recognize that something is amiss. The temperature must be obtained rectally. Recent research has clearly shown other methods do not accurately reflect core temperature."

If that advice isn't controversial enough, Casa advocates cooling first and transporting second. To that end, he recommends immersing the victim in cold water "kept between 45 deg. F and 58 deg. F" until body temperature reaches 102 deg. F. To best monitor the temperature of one who is immersed, a medical professional should insert a thermistor rectally, rather than a thermometer.

The thermistor is then attached by wire to a thermometer outside the water.

"Save a life, annoy your patient," Casa concluded.

John Doherty is a certified athletic trainer and licensed physical therapist.

This column reflects solely his opinion. Reach him at ptatcsport@sbcglobal.net.