Abstract
Introduction
The recommended treatment for exertional heat stroke is immediate, whole-body immersion in < 10 °C water until rectal temperature (Tre) reaches ≤ 38.6 °C. However, real-time Tre assessment is not always feasible or available in field settings or emergency situations. We defined and validated immersion durations for water temperatures of 2–26 °C for treating exertional heat stroke.
Methods
We compiled data for 54 men and 18 women from 7 previous laboratory studies and derived immersion durations for reaching 38.6 °C Tre. The resulting immersion durations were validated against the durations of cold-water immersion used to treat 162 (98 men; 64 women) exertional heat stroke cases at the Falmouth Road Race between 1984 and 2011.
Results
Age, height, weight, body surface area, body fat, fat mass, lean body mass, and peak oxygen uptake were weakly associated with the cooling time to a safe Tre of 38.6 °C during immersions to 2–26 °C water (R2 range: 0.00–0.16). Using a specificity criterion of 0.9, receiver operating characteristics curve analysis showed that exertional heat stroke patients must be immersed for 11–12 min when water temperature is ≤ 9 °C, and for 18–19 min when water temperature is 10–26 °C (Cohen’s Kappa: 0.32–0.75, p < 0.001; diagnostic odds ratio: 8.63–103.27).
Conclusion
The reported immersion durations are effective for > 90% of exertional heat stroke patients with pre-immersion Tre of 39.5–42.8 °C. When available, real-time Tre monitoring is the standard of care to accurately diagnose and treat exertional heat stroke, avoiding adverse health outcomes associated with under- or over-cooling, and for implementing cool-first transport second exertional heat stroke policies.
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Data availability
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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Acknowledgements
We would like to thank all the participants who volunteered in the laboratory-based studies. We would also like to thank all members of the Human and Environmental Physiology Research Unit who contributed to the original laboratory data collection as well as a special thanks to Dr. Daniel Gagnon, Dr. Tiago Sotto Mayor, and Mr. Brian J. Friesen for their contributions to this project.
Funding
The work was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC; Discovery Grant no. RGPIN-2020–03891, held by Dr. G. Kenny). S.R.N. was supported by the Human and Environmental Physiology Research Unit.
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ADF and GPK contributed to the conception and design of the work. ADF and GPK contributed to the acquisition, analysis, and interpretation of the data. ADF prepared the first draft. All the authors revised the paper critically for important intellectual content. All the authors approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All persons designated as authors qualify for authorship, and all those who qualify for authorship are listed.
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Flouris, A.D., Notley, S.R., Stearns, R.L. et al. Recommended water immersion duration for the field treatment of exertional heat stroke when rectal temperature is unavailable. Eur J Appl Physiol 124, 479–490 (2024). https://doi.org/10.1007/s00421-023-05290-5
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DOI: https://doi.org/10.1007/s00421-023-05290-5