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The following is a summary of “Exertional Heat Stroke: Are We Cool Enough? Retrospective Observational Study of Patients of Running Events,” published in the April 2025 issue of Journal of Emergency Medicine by Dollée et al. 

Early recognition and immediate cooling were paramount in the treatment for exertional heat stroke (EHS), with cold water immersion being the most effective method, although its use in the prehospital setting might have been limited by practicalities, making rotating ice water–soaked towels a quicker, less personnel-intensive alternative that allowed easier patient monitoring.  

Researchers conducted a retrospective study to examine the effectiveness of rotating ice water–soaked towels in reducing tympanic temperature to below 104^°  F (40^°  C) within 30 minutes in individuals with EHS.  

They enrolled participants aged 18 years and older who received medical care for EHS during running events held from 2016 to 2019, covering distances between 2.6 miles (4.2 km) and 26.2 miles (42.195 km, i.e., a full marathon) and assessed the primary outcome as the proportion of individuals whose tympanic temperature dropped below 104^°  F (40^°  C) within 30 minutes using the rotating ice water–soaked towel cooling method.  

The results showed that 3,74,534 runners participated, with 879 requiring medical care. Among them, 48 had a tympanic temperature ≥ 104^°  F (40^°  C), and 36 were diagnosed with EHS based on neurologic symptoms. The median age of patients was 32.5 years, and 69% were male. All patients who received cooling achieved a temperature below 104^°  F (40^°  C) within 30 minutes. The average cooling rate was 0.22^°  F/min (95% CI 0.16–0.27; 0.12^° C/min [95% CI 0.09–0.15]). No EHS patients died.  

Investigators concluded that all patients with EHS reached a temperature below 104^°  F (40^°  C) within 30 minutes. 

Source: jem-journal.com/article/S0736-4679(24)00354-8/fulltext