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Effectiveness of Cold Water Immersion in the Treatment of Exertional Heat Stroke at the Falmouth Road Race


Medicine & Science in Sports & Exercise: February 2015 - Volume 47 - Issue 2 - p 240–245
doi: 10.1249/MSS.0000000000000409
Clinical Sciences

Purpose: This study aimed to investigate the effectiveness (speed of cooling and survival rates) of cold water immersion (CWI) in the treatment of patients with exertional heat stroke (EHS). Secondly, this study aimed to compare cooling rates on the basis of gender, age, and initial rectal temperature (T r).

Methods: Eighteen years of finish line medical tent patient records were obtained from the exertional heat illness treatment area at the Falmouth Road Race. Study participants included patients with EHS who were treated with CWI in the medical tent. The number of EHS cases was recorded for each year, and incidence was established on the basis of the number of finishers. Overall cooling rate and differences between initial T r, age, and sex were evaluated.

Results: A total of 274 cases of EHS was observed over the 18 yr of collected data. A mean of 15.2 ± 13.0 EHS cases per year was recorded, with an overall incidence of 2.13 ± 1.62 EHS cases per 1000 finishers. The average initial T r was 41.44°C ± 0.63°C, and the average cooling rate for patients with EHS was 0.22°C·min-1 ± 0.11°C·min-1. CWI resulted in a 100% survival rate for all patients with EHS. No significant interactions between cooling rate and initial T r (P = 0.778), sex (P = 0.89), or age (P = 0.70) were observed.

Conclusions: CWI was found to effectively treat all cases of EHS observed in this study. CWI provided similar treatment outcomes in all patients, with no significant differences noted on the basis of initial T r, age, or sex. On the basis of the 100% survival rate from EHS in this large cohort, it is recommended that immediate (on site) CWI be implemented for the treatment of EHS.

1 Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT; and

2 Falmouth Hospital, Falmouth, MA

Address for correspondence: Julie K. DeMartini, Ph.D., A.T.C., L.A.T., Korey Stringer Institute, University of Connecticut, 2095 Hillside Road, Storrs, CT 06269; Email:

Submitted for publication December 2013.

Accepted for publication May 2014.

© 2015 American College of Sports Medicine