Exertional heat stroke, defined as a body temperature greater than 40(degrees)C to 40.5(degrees)C (104(degrees)F to 105(degrees)F) with associated central nervous system (CNS) dysfunction, is a medical emergency, and can lead to long-term complications or death without prompt recognition and proper care. Evidence shows that reducing body temperature below the critical threshold for cell damage (40.83(degrees)C) within 30 minutes of collapse ensures 100% survival without long-term sequelae.1–4 Evidence-based best practices clearly dictate that prompt assessment of body temperature using rectal thermometry and immediate, "cool first, transport second," whole body cooling with cold water immersion is the standard of care for exertional heat stroke.5–7 However, what are clinicians to do if the gold-standard method of treatment, cold water immersion, is not feasible at the location where an exertional heat stroke occurs? The aim of this commentary is to provide clinicians with an alternative option for the treatment of exertional heat stroke in the event of cold water immersion not being available or feasible at a location where exertional heat stroke occurs.
