title: Cold-water dousing with ice massage to treat exertional heat stroke: a case series.
abstract: BACKGROUND
  We sought to determine the rate of cooling via a novel water ice therapy (WIT) as an alternative to cold-water immersion for the acute treatment of exertional heat stroke (EHS).
  
  
  METHODS
  Observations were made at the 2004-2008 Marine Corps Marathons (mean +/- SD: 16.3 +/- 4.9 degrees C dry bulb, 32 +/- 6% RH). Nine (seven men, two women) EHS patients (33 +/- 6 yr of age; 268 +/- 54 min average race time for six who finished) were observed during on-site treatment. Patients were treated while lying supine on a porous stretcher resting on a tub filled with cold water (approximately 10-12 degrees C). Medical personnel monitored T(re), doused the patient with water and massaged major muscle groups with ice bags until T(re) decreased to 38.9 degrees C. Patients were not immersed in water. Serial T(re) and time were used to calculate cooling rates.
  
  
  RESULTS
  Final T(re) (39.12 +/- 0.63 degrees C) was significantly lower than initial T(re) (41.43 +/- 0.71 degrees C, P < 0.05). Cooling rates were 0.13 +/- 0.04 degrees C min(-1). The decrease in T(re) for the initial 6 min of WIT (0.38 +/- 0.13 degrees C) was significantly less than for the subsequent 6-min time period (1.31 +/- 0.34 degrees C, P < 0.001). Cooling rates for these time periods were significantly different (0.06 +/- 0.02 degrees C x min(-1) and 0.22 +/- 0.06 degrees C x min(-1), respectively, P < 0.05). Initial T(re) was not correlated with overall cooling rate (r = 0.434, P = 0.244), or total cooling time required (17 +/- 4 min; r = 0.207, P = 0.593). Survival rate was 100%.
  
  
  CONCLUSIONS
  WIT provided cooling rates that were 70% as effective as those published for cold-water immersion with 8 degrees C water (0.19 degrees C x min(-1)) and resulted in 100% patient survival.
authors: Department of Kinesiology, University of Connecticut, Storrs, CT, USA. brendonpmcdermott7@gmail.com
authors: Brendon P
authors: BP
authors: McDermott
authors: Douglas J
authors: DJ
authors: Casa
authors: Francis G
authors: FG
authors: O'Connor
authors: William B
authors: WB
authors: Adams
authors: Lawrence E
authors: LE
authors: Armstrong
authors: Alfred H
authors: AH
authors: Brennan
authors: Rebecca M
authors: RM
authors: Lopez
authors: Rebecca L
authors: RL
authors: Stearns
authors: Christopher
authors: C
authors: Troyanos
authors: Susan W
authors: SW
authors: Yeargin
mesh_terms: D000328:Adult; D003080:Cold Temperature; D005260:Female; D018883:Heat Stroke / Q000628:therapy*; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D007101:Immersion; D008297:Male; D008405:Massage / Q000379:methods