Version June 2024
| Contact emergency medical services (EMS) immediately. |
| Assess airway, breathing, circulation, and mental status; measure vital signs before immersing the patient. |
| If appropriate medical staff is present on-site (eg, team physician), equipment for aggressive cooling is readily available (eg, cold water immersion, ice/wet towel rotation, high-flow cold water dousing), and no other emergency medical treatment is needed other than rapid lowering of the body temperature, follow the "cool-first, transport second" guideline. |
| For patients to be treated with ice water immersion, prepare as follows: |
| Get help. |
| Move patient to a shaded area. |
| Half fill a tub or wading pool with water and ice. Ice should cover the surface of the water at all times. |
| A whirlpool tub filled with ice water may be used if the athlete collapses near an athletic training room. |
| During ice water immersion treatment, assess the patient's core body temperature with a rectal thermistor continuously (a thermistor is a flexible thermometer that remains in place throughout the cooling and treatment process). |
| Obtain necessary assistance and cool the patient as follows: |
| Place the athlete in the ice water immersion tub. |
| Cover as much of the body as possible with ice water. If complete coverage is not possible, cover the torso as much as possible. |
| Keep the athlete's head and neck above water. An assistant or two can do so by holding the victim under the axillae with a towel or sheet wrapped across the chest and under the arms. |
| Place a towel soaked in ice water over the head and neck while the body is being cooled. |
| Keep water temperature under 15°C (60°F). |
| Vigorously circulate water throughout the cooling process. |
| Monitor vital signs approximately every 10 minutes and mental status continually during cooling. |
| Have several additional assistants immediately nearby in case the athlete becomes combative or must be lifted or rolled because of vomiting. |
| Continue cooling until the patient's rectal temperature reaches 39°C (102°F). If the rectal temperature cannot be measured and on-site ice water immersion is indicated, cool for 10 to 15 minutes and then transport to the emergency department. Cooling via ice water immersion occurs at a rate of approximately 1°C for every five minutes (or 1°F every three minutes), if the water is aggressively stirred. |
| Remove the patient from the immersion tub and transfer to the nearest emergency department or hospital after the rectal temperature reaches 39°C (102°F). |
| If ice water immersion is not feasible given the constraints of the environment, and on-site cooling is appropriate, then cool the patient using the best available means. These may include any of the following three methods: |
| Fill a cooler with ice, water, and 12 towels. Place six icy wet towels all over the patient's body. Leave them in place for two to three minutes, then place those back in cooler and replace them with the six others. Continue this rotation every two to three minutes. |
| Douse the patient continuously with cold water using a shower or hose. |
| If ice is available but no tub, place the patient in a tarp or sheet, cover the patient with a large amount of ice, and then wrap the tarp or sheet around them. Replenish the ice as soon as a moderate degree of melting occurs. |
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