Recap: CHAMP Exertional Collapse Associated with Sickle Cell Trait (ECAST) Summit

November 12, 2019

By: Tim Gribbin, MEd, ATC*

In October 2019, the Consortium for Health and Military Performance (CHAMP) hosted a summit to discuss DoD policies and procedures for preventing and managing exertional collapse associated with sickle cell trait (ECAST). Subject-matter experts from military and civilian organizations reviewed ECAST, service-specific policies, and National Collegiate Athletics Association (NCAA) policy. This topic is particularly important in the wake of several recent ECAST-related deaths in the military.

Day 1
After some brief presentations on ECAST and sickle cell trait (SCT), 2 panels explored ways to identify athletes and Military Service Members with SCT and educate others.

SCT screening
Navy, Army, and Air Force representatives presented service-specific policies about SCT screening and described how each Service complies with DODI 6465.01, establishing SCT screening programs. An NCAA representative presented civilian SCT screening policies used in the NCAA. 

Screening for SCT is controversial, even within DoD, because of privacy concerns, including what to do with the information. If you identify someone as “SCT+” (someone who has SCT) with an armband or other feature, will it create a negative stigma or take an opportunity from them? Screening and identifying someone with SCT alone won’t prevent ECAST. Likewise, being SCT+ doesn’t mean the individual will have an issue in training or operations, making the decision to screen for SCT a tough one. 

SCT education
While service-specific policies vary, they all require an education program for SCT-positive individuals and those who work with them. For example, an Army recruit’s battle buddy in basic training learns to recognize signs of ECAST and when to call for a medic.

Other concerns about SCT education include deciding who, how, and when to train people. Panelists discussed how Military Service Members are educated in the respective services and how the NCAA screens and educates student-athletes. Leaders proposed opportunities to improve current education strategies, and the event was seen as a way to deliver a standardized message across the Services.

Day 2
CHAMP was honored to have Clifford Melton, an ECAST survivor, share the story of his collapse. The video of his collapse and his retelling of the days and minutes leading up to the event painted a vivid picture of the severity of ECAST, how it presents to others, and its impact.

CHAMP also held discussions on universal precautions for SCT, management of ECAST, and return to duty following ECAST.

Universal precautions
Universal precautions are steps taken for the safety of all Military Service Members, not just those at risk. The panel discussed which precautions are taken for everyone to better protect SCT+ individuals. Currently, most universal precautions center around safe physical training practices, such as gradually improving fitness, avoiding extreme exercise programs, and limiting activities known to lead to ECAST (for example, serial sprinting and timed runs). 

Managing ECAST
Current best practices for managing ECAST include removing the person from activity, rapidly identifying the cause of collapse (ruling out other causes such as exertional heat stroke or a heart condition), giving the person oxygen, and immediately transporting them to the emergency room. Panelists discussed the importance of recognizing and identifying the cause of the collapse and activating emergency medical services. The best way to standardize a rapid recognition plan includes using algorithms (such as those used in the Marine Corps Marathon) to rule out conditions that could lead to death more quickly. Once ECAST has been identified, the scientific evidence for the best treatment is slim.

Return to duty or play
Panelists discussed what guides the decision to allow someone who experienced ECAST to return to duty or play. They agreed it depends on the person’s condition and were unable to make general recommendations. More research, review, and discussion are needed to set guidelines for resuming activities after ECAST.

Wrap-up
In the weeks ahead, attendees will report on summit discussions and identify best practices; gaps in current research and policy; and ways to prevent, identify, and treat ECAST in the future.

--- About the Author ---
Tim Gribbin, of the Henry M. Jackson Foundation, is a Senior Scientist for the Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences (USUHS).

Disclosures: The opinions and assertions expressed herein are those of the author and do not necessarily reflect the official policy or position of USUHS or DoD. The contents of this publication are the sole responsibility of the author and do not necessarily reflect the views, opinions, or policies of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The author has no financial interests or relationships to disclose.

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