'Cool first, transport second' - Mantra while treating athlete of heat stroke

Turns out, the best course of action while treating an athlete for heat stroke is 'cool first, transport second'.

According to a study conducted by experts at Loyola University Health System, athletes who suffer life-threatening heat stroke should be cooled on site before they are taken to the hospital.

The principle of "cool first, transport second" differs from the usual practice of calling 911 and getting to the hospital as soon as possible.

"In the case of heat stroke, the definitive care is cooling, which may best be performed immediately onsite before transport," said Jolie C. Holschen, co-author of the expert panel's consensus statement.

First author of the statement is Luke Beval of the Korey Stringer Institute at the University of Connecticut.

Exertional heat stroke is one of the most common causes of death in athletes. Although it can happen in cooler temperatures, it typically occurs in warm weather during events such as marathons and preseason football practices.

The athlete shows central nervous system disturbances such as confusion, irritability or irrational behavior, which may culminate in a collapse or loss of consciousness.

There is a common misconception that the athlete will have stopped sweating, have hot skin or be unconscious, but none of these symptoms are required for heat stroke.

The Korey Stringer Institute organized a meeting of national experts in emergency medicine and sports medicine to identify best practices for treating exertional heat stroke in pre-hospital settings.

The panel recommended rapidly cooling the body to less than 104.5 degrees F (the threshold for critical cell damage) within 30 minutes of the time of collapse. Cooling should end once the body temperature drops to about 101.5 degrees F.

The best cooling method is to immerse the athlete in a tub of cold water. If a tub isn't available, a tarp, shaped like a taco and filled with cold water, could be tried (Also known as tarp-assisted cooling).

Less effective cooling methods include cold-water dousing, cold showers, fans and icepacks.

"Transportation of an exertional heat stroke patient should occur only if it is impossible to cool adequately onsite or after adequate cooling has been verified by a body temperature assessment," the expert panel wrote.

If a patient cannot be cooled onsite, paramedics should try the most aggressive cooling methods possible in the ambulance, such as continuously applying cold wet towels.

The research is published in the journal Prehospital Emergency Care.