Exertional Heat Stroke (EHS) is one of the leading causes of death for athletes. (1) EHS is also currently the top cause of exertion (non-accident) related deaths in the laborer population. (2) While athletes may have the benefit of school or organization-specific medical professionals like athletic trainers, laborers will likely rely on EMS for the diagnosis and treatment of EHIs.

Best practices for the care of EHS is to provide cold water immersion (CWI) to the patient, with the cooling preferably taking place before transport to the hospital; the cool first, transport second standard. (3) CWI has been used for the treatment of EHS at the Falmouth Road Race, as well as other athletic venues. When this method is used, survival rates have been as high as 100% for EHS victims. (4) This presentation will review the successes of CWI at the Falmouth Road Race and the incorporation of this standard into EMS protocols. EHS is a time-sensitive diagnosis that requires assessment and treatment within 30 minutes. (1) The presentation will provide a new paradigm for EMS to minimize the risk of morbidity and mortality associated with EHS: the cool first, transport second method for the pre-hospital treatment of EHS.
Learning Objectives:

define the spectrum of exertional heat illnesses, including the diagnostic criteria for exertional heat stroke.
describe the methods for the treatment of exertional heat stroke and the successes of cold-water immersion.
discuss the role of EMS in the rapid assessment and treatment of exertional heat stoke using the "cool first, transport second" standard.