Summer 2022 is already setting record temperatures across the world. With high temperatures and unpredictable weather, it’s always important to be prepared for exertional heat stroke. Construction, transportation, and warehousing are among the occupations with the highest heat-related mortality rates according to OSHA statistics1. Heat-related illness is also vastly underreported and is shown to lead to significantly increased work-related injury risk, lost wages, and lost productivity1.

A Quick Overview

Heat stroke is a life-threatening condition which occurs when the body’s core temperature rises above 40˚C (104˚F). This can occur when the body cannot cool itself adequately through sweating and evaporative cooling. This may be due to humidity, heavy clothing or, heavy equipment. As body temperatures continue to rise, it causes heat-related injury to the organs and can result in death if quick action is not taken.

How to Deal With Heat Stroke

In athletic settings, cold water immersion (CWI) is the gold standard for treatment of heat stroke and is now the recommendation of OSHA as well. The goal is to cool as aggressively as possible to reduce body temperature to less than 38.9˚C (102˚F) within 30 minutes of collapse. If CWI is achieved within 10 minutes of collapse, heat stroke has a 100% survival rate2. In the industrial setting this is not a common practice but can easily be implemented with the following considerations!


•  A core temperature of >40˚C (104˚F) is a sign of heat stroke.

◦ Rectal temperature is the best gauge for assessment of core temperature and no other temperature method should be utilized instead3.

• If no rectal thermometer is available, but heat stroke is suspected due to clinical presentation, CWI is still indicated3.

Why Cool 1st – Transport 2nd?

• TIME! The longer the body spends at high core temperatures, the less likely survivability will be3.

Immediate onsite cooling avoids delays in cooling when every minute counts.

• Aggressive cooling rates (>0.15˚C/min) are needed to reduce body temperature to 38.9˚C before transport.

• This is often in disagreement with EMS protocols so discussions with local EMS prior to implementation are encouraged.

Best Cooling Options

• A 50-100 gallon plastic tub is an ideal cooling vessel to submerge the torso and limbs.

◦  A water temperature of 10˚C (50˚F) is ideal2,4.

• A body bag or tarp can also be used if no tub is available5,6.

• CWI is the gold standard, but if the above options are not available, a cold shower cooling is recommended while awaiting EMS transport.

Miranda Zamora-Williams received a B.S. in Athletic Training from the University of New Mexico and a M.S. in Kinesiology and Health from the University of Wyoming and is currently pursuing her doctorate in Athletic Training at A.T. Still University. Her professional interests include heat illness, rehab, and wildland firefighter health.

Be sure to check out our other blogs for further injury prevention education and tips from Work Right NW!

  1. Occupational Safety and Health Administration. Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings. Vol 86.; 2021:59309-59326.
  2. Filep EM, Murata Y, Endres BD, Kim G, Stearns RL, Casa DJ. Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review. Medicina . 2020;56(11). doi:10.3390/medicina56110589
  3. Casa DJ, DeMartini JK, Bergeron MF, et al. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. J Athl Train. 2015;50(9):986-1000.
  4. Zhang Y, Davis JK, Casa DJ, Bishop PA. Optimizing Cold Water Immersion for Exercise-Induced Hyperthermia: A Meta-analysis. Med Sci Sports Exerc. 2015;47(11):2464-2472.
  5. Kim DA, Lindquist BD, Shen SH, Wagner AM, Lipman GS. A body bag can save your life: a novel method of cold water immersion for heat stroke treatment. J Am Coll Emerg Physicians Open. 2020;1(1):49-52.
  6. Parker KC, Shelton RR, Lopez RM. Do Alternative Cooling Methods Have Effective Cooling Rates for Hyperthermia Compared With Previously Established CWI Cooling Rates? J Sport Rehabil. 2020;29(3):367-372.