scholarly journals Cooling Rates of Hyperthermic Humans Wearing American Football Uniforms When Cold-Water Immersion Is Delayed

2018 ◽  
Vol 53 (12) ◽  
pp. 1200-1205 ◽  
Author(s):  
Kevin C. Miller ◽  
Timothy A. Di Mango ◽  
Grace E. Katt
Keyword(s):  
Rectal Temperature ◽  
Cold Water ◽  
Thermal Sensation ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
American Football ◽  
Exertional Heat Stroke ◽  
Cooling Rates ◽  
Treatment Delays

Context Treatment delays can be contributing factors in the deaths of American football athletes from exertional heat stroke. Ideally, clinicians begin cold-water immersion (CWI) to reduce rectal temperature (Trec) to <38.9°C within 30 minutes of collapse. If delays occur, experts recommend Trec cooling rates that exceed 0.15°C/min. Whether treatment delays affect CWI cooling rates or perceptual variables when football uniforms are worn is unknown. Objective To answer 3 questions: (1) Does wearing a football uniform and delaying CWI by 5 minutes or 30 minutes affect Trec cooling rates? (2) Do Trec cooling rates exceed 0.15°C/min when treatment delays have occurred and individuals wear football uniforms during CWI? (3) How do treatment delays affect thermal sensation and Environmental Symptoms Questionnaire responses? Design Crossover study. Setting Laboratory. Patients or Other Participants Ten physically active men (age = 22 ± 2 y, height = 183.0 ± 6.9 cm, mass = 78.9 ± 6.0 kg). Intervention(s) On 2 days, participants wore American football uniforms and exercised in the heat until Trec was 39.75°C. Then they sat in the heat, with equipment on, for either 5 or 30 minutes before undergoing CWI (10.6°C ± 0.1°C) until Trec reached 37.75°C. Main Outcome Measure(s) Rectal temperature and CWI duration were used to calculate cooling rates. Thermal sensation was measured pre-exercise, postexercise, postdelay, and post-CWI. Responses to the Environmental Symptoms Questionnaire were obtained pre-exercise, postdelay, and post-CWI. Results The Trec cooling rates exceeded recommendations and were unaffected by treatment delays (5-minute delay = 0.20°C/min ± 0.07°C/min, 30-minute delay = 0.19°C/min ± 0.05°C/min; P = .4). Thermal sensation differed between conditions only postdelay (5-minute delay = 6.5 ± 0.6, 30-minute delay = 5.5 ± 0.7; P < .05). Environmental Symptoms Questionnaire responses differed between conditions only postdelay (5-minute delay = 27 ± 15, 30-minute delay = 16 ± 12; P < .05). Conclusions Treatment delays and football equipment did not impair CWI's effectiveness. Because participants felt cooler and better after the 30-minute delay despite still having elevated Trec, clinicians should use objective measurements (eg, Trec) to guide their decision making for patients with possible exertional heat stroke.

scholarly journals Temperate-Water Immersion as a Treatment for Hyperthermic Humans Wearing American Football Uniforms

2017 ◽  
Vol 52 (8) ◽  
pp. 747-752 ◽  
Author(s):  
Kevin C. Miller ◽  
Tyler Truxton ◽  
Blaine Long
Keyword(s):  
Rectal Temperature ◽  
Cold Water ◽  
Thermal Sensation ◽  
Water Immersion ◽  
Cold Water Immersion ◽  
American Football ◽  
Body Core Temperature ◽  
Temperate Water ◽  
Cooling Rates ◽  
Before And After

Context:  Cold-water immersion (CWI; 10°C) can effectively reduce body core temperature even if a hyperthermic human is wearing a full American football uniform (PADS) during treatment. Temperate-water immersion (TWI; 21°C) may be an effective alternative to CWI if resources for the latter (eg, ice) are unavailable. Objective:  To measure rectal temperature (Trec) cooling rates, thermal sensation, and Environmental Symptoms Questionnaire (ESQ) scores of participants wearing PADS or shorts, undergarments, and socks (NOpads) before, during, and after TWI. Design:  Crossover study. Setting:  Laboratory. Patients or Other Participants:  Thirteen physically active, unacclimatized men (age = 22 ± 2 years, height = 182.3 ± 5.2 cm, mass = 82.5 ± 13.4 kg, body fat = 10% ± 4%, body surface area = 2.04 ± 0.16 m2). Intervention(s):  Participants exercised in the heat (40°C, 50% relative humidity) on 2 days while wearing PADS until Trec reached 39.5°C. Participants then underwent TWI while wearing either NOpads or PADS until Trec reached 38°C. Thermal sensation and ESQ responses were collected at various times before and after exercise. Main Outcome Measure(s):  Temperate-water immersion duration (minutes), Trec cooling rates (°C/min), thermal sensation, and ESQ scores. Results:  Participants had similar exercise times (NOpads = 38.1 ± 8.1 minutes, PADS = 38.1 ± 8.5 minutes), hypohydration levels (NOpads = 1.1% ± 0.2%, PADS = 1.2% ± 0.2%), and thermal sensation ratings (NOpads = 7.1 ± 0.4, PADS = 7.3 ± 0.4) before TWI. Rectal temperature cooling rates were similar between conditions (NOpads = 0.12°C/min ± 0.05°C/min, PADS = 0.13°C/min ± 0.05°C/min; t12 = 0.82, P = .79). Thermal sensation and ESQ scores were unremarkable between conditions over time. Conclusions:  Temperate-water immersion produced acceptable (ie, >0.08°C/min), though not ideal, cooling rates regardless of whether PADS or NOpads were worn. If a football uniform is difficult to remove or the patient is noncompliant, clinicians should begin water-immersion treatment with the athlete fully equipped. Clinicians should strive to use CWI to treat severe hyperthermia, but when CWI is not feasible, TWI should be the next treatment option because its cooling rate was higher than the rates of other common modalities (eg, ice packs, fanning).

scholarly journals Necessity of Removing American Football Uniforms From Humans With Hyperthermia Before Cold-Water Immersion

2015 ◽  
Vol 50 (12) ◽  
pp. 1240-1246 ◽  
Author(s):  
Kevin C. Miller ◽  
Blaine C. Long ◽  
Jeffrey Edwards
Keyword(s):  
Sports Medicine ◽  
Cold Water ◽  
Thermal Sensation ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
American Football ◽  
Body Core Temperature ◽  
Cooling Rates ◽  
National Athletic Trainers Association

Context  The National Athletic Trainers' Association and the American College of Sports Medicine have recommended removing American football uniforms from athletes with exertional heat stroke before cold-water immersion (CWI) based on the assumption that the uniform impedes rectal temperature (Trec) cooling. Few experimental data exist to verify or disprove this assumption and the recommendations. Objectives  To compare CWI durations, Trec cooling rates, thermal sensation, intensity of environmental symptoms, and onset of shivering when hyperthermic participants wore football uniforms during CWI or removed the uniforms immediately before CWI. Design  Crossover study. Setting  Laboratory. Patients or Other Participants  Eighteen hydrated, physically active men (age = 22 ± 2 years, height = 182.5 ± 6.1 cm, mass = 85.4 ± 13.4 kg, body fat = 11% ± 5%, body surface area = 2.1 ± 0.2 m2) volunteered. Intervention(s)  On 2 days, participants exercised in the heat (approximately 40°C, approximately 40% relative humidity) while wearing a full American football uniform (shoes; crew socks; undergarments; shorts; game pants; undershirt; shoulder pads; jersey; helmet; and padding over the thighs, knees, hips, and tailbone [PADS]) until Trec reached 39.5°C. Next, participants immersed themselves in water that was approximately 10°C while wearing either undergarments, shorts, and crew socks (NOpads) or PADS without shoes until Trec reached 38°C. Main Outcome Measure(s)  The CWI duration (minutes) and Trec cooling rates (°C/min). Results  Participants had similar exercise times (NOpads = 40.8 ± 4.9 minutes, PADS = 43.2 ± 4.1 minutes; t17 = 2.0, P = .10), hypohydration levels (NOpads = 1.5% ± 0.3%, PADS = 1.6% ± 0.4%; t17 = 1.3, P = .22), and thermal-sensation ratings (NOpads = 7.2 ± 0.3, PADS = 7.1 ± 0.5; P > .05) before CWI. The CWI duration (median [interquartile range]; NOpads = 6.0 [5.4] minutes, PADS = 7.3 [9.8] minutes; z = 2.3, P = .01) and Trec cooling rates (NOpads = 0.28°C/min ± 0.14°C/min, PADS = 0.21°C/min ± 0.11°C/min; t17 = 2.2, P = .02) differed between uniform conditions. Conclusions  Whereas participants cooled faster in NOpads, we still considered the PADS cooling rate to be acceptable (ie, >0.16°C/min). Therefore, if clinicians experience difficulty removing PADS or CWI treatment is delayed, they may immerse fully equipped hyperthermic football players in CWI and maintain acceptable Trec cooling rates. Otherwise, PADS should be removed preimmersion to ensure faster body core temperature cooling.

scholarly journals Precooling, Hyperthermia, and Postexercise Cooling Rates in Humans Wearing American Football Uniforms

2019 ◽  
Vol 54 (7) ◽  
pp. 758-764 ◽  
Author(s):  
Jeremy Taylor ◽  
Kevin C. Miller
Keyword(s):  
Heart Rate ◽  
Rectal Temperature ◽  
Cold Water ◽  
Thermal Sensation ◽  
Water Immersion ◽  
Cold Water Immersion ◽  
Rating Of Perceived Exertion ◽  
American Football ◽  
Whole Body ◽  
Cooling Rates

Context Exertional heatstroke is one of the leading causes of death in American football players. Precooling (PC) with whole-body cold-water immersion (CWI) may prevent severe hyperthermia and, possibly, exertional heatstroke. However, it is unknown how much PC delays severe hyperthermia when participants wear American football uniforms during exercise in the heat. Does PC alter the effectiveness of CWI once participants become hyperthermic or affect perceptual variables during exercise? Objectives We asked 3 questions: (1) Does PC affect how quickly participants become hyperthermic during exercise in the heat? (2) Does PC before exercise affect rectal temperature (Trec) cooling rates once participants become hyperthermic? (3) Does PC affect perceptual variables such as rating of perceived exertion (RPE), thermal sensation, and environmental symptoms questionnaire (ESQ) responses? Design Crossover study. Setting Laboratory. Patients or Other Participants Twelve physically active males (age = 24 ± 4 years, height = 181.8 ± 8.4 cm, mass = 79.9 ± 10.3 kg). Intervention(s) On PC days, participants completed 15 minutes of CWI (9.98°C ± 0.04°C). They donned American football uniforms and exercised in the heat (temperature = 39.1°C ± 0.3°C, relative humidity = 36% ± 2%) until Trec was 39.5°C. While wearing equipment, they then underwent CWI until Trec was 38°C. Control-day procedures were the same except for the PC intervention. Main Outcome Measure(s) Rectal temperature, heart rate, thermal sensation, RPE, and ESQ responses were measured throughout testing. The duration of cold-water immersion was used in conjunction with Trec to calculate cooling rates. Results Precooling allowed participants to exercise 17.6 ± 3.6 minutes longer before reaching 39.5°C (t11 = 17.0, P < .001). Precooling did not affect postexercise CWI Trec cooling rates (PC = 0.18°C/min ± 0.06°C/min, control = 0.20°C/min ± 0.09°C/min; t11 = 0.9, P = .17); ESQ responses (F2,24 = 1.3, P = .3); or RPE (F2,22 = 2.9, P = .07). Precooling temporarily lowered thermal sensation (F3,26 = 21.7, P < .001) and heart rate (F3,29 = 21.0, P < .001) during exercise. Conclusions Because PC delayed hyperthermia without negatively affecting perceptual variables or CWI effectiveness, clinicians may consider implementing PC along with other proven strategies for preventing heat illness (eg, acclimatization).

scholarly journals Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

2016 ◽  
Vol 51 (3) ◽  
pp. 252-257 ◽  
Author(s):  
Cory L. Butts ◽  
Brendon P. McDermott ◽  
Brian J. Buening ◽  
Jeffrey A. Bonacci ◽  
Matthew S. Ganio ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cooling Rate ◽  
Rectal Temperature ◽  
Muscle Pain ◽  
Cold Water ◽  
Thermal Sensation ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Exercise Induced

Exercise conducted in hot, humid environments increases the risk for exertional heat stroke (EHS). The current recommended treatment of EHS is cold-water immersion; however, limitations may require the use of alternative resources such as a cold shower (CS) or dousing with a hose to cool EHS patients.Context: To investigate the cooling effectiveness of a CS after exercise-induced hyperthermia.Objective: Randomized, crossover controlled study.Design: Environmental chamber (temperature = 33.4°C ± 2.1°C; relative humidity = 27.1% ± 1.4%).Setting: Seventeen participants (10 male, 7 female; height = 1.75 ± 0.07 m, body mass = 70.4 ± 8.7 kg, body surface area = 1.85 ± 0.13 m2, age range = 19–35 years) volunteered.Patients or Other Participants: On 2 occasions, participants completed matched-intensity volitional exercise on an ergometer or treadmill to elevate rectal temperature to ≥39°C or until participant fatigue prevented continuation (reaching at least 38.5°C). They were then either treated with a CS (20.8°C ± 0.80°C) or seated in the chamber (control [CON] condition) for 15 minutes.Intervention(s): Rectal temperature, calculated cooling rate, heart rate, and perceptual measures (thermal sensation and perceived muscle pain).Main Outcome Measure(s): The rectal temperature (P = .98), heart rate (P = .85), thermal sensation (P = .69), and muscle pain (P = .31) were not different during exercise for the CS and CON trials (P > .05). Overall, the cooling rate was faster during CS (0.07°C/min ± 0.03°C/min) than during CON (0.04°C/min ± 0.03°C/min; t16 = 2.77, P = .01). Heart-rate changes were greater during CS (45 ± 20 beats per minute) compared with CON (27 ± 10 beats per minute; t16 = 3.32, P = .004). Thermal sensation was reduced to a greater extent with CS than with CON (F3,45 = 41.12, P < .001).Results: Although the CS facilitated cooling rates faster than no treatment, clinicians should continue to advocate for accepted cooling modalities and use CS only if no other validated means of cooling are available.Conclusions:

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

2015 ◽  
Vol 47 (2) ◽  
pp. 240-245 ◽  
Author(s):  
JULIE K. DEMARTINI ◽  
DOUGLAS J. CASA ◽  
REBECCA STEARNS ◽  
LUKE BELVAL ◽  
ARTHUR CRAGO ◽  
...  
Keyword(s):  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Exertional Heat Stroke ◽  
Road Race

scholarly journals Cooling Effectiveness of a Modified Cold-Water Immersion Method After Exercise-Induced Hyperthermia

2016 ◽  
Vol 51 (11) ◽  
pp. 946-951 ◽  
Author(s):  
Katherine E. Luhring ◽  
Cory L. Butts ◽  
Cody R. Smith ◽  
Jeffrey A. Bonacci ◽  
Ramon C. Ylanan ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Effect Size ◽  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Whole Body ◽  
Exertional Heat Stroke

Context: Recommended treatment for exertional heat stroke includes whole-body cold-water immersion (CWI). However, remote locations or monetary or spatial restrictions can challenge the feasibility of CWI. Thus, the development of a modified, portable CWI method would allow for optimal treatment of exertional heat stroke in the presence of these challenges. Objective: To determine the cooling rate of modified CWI (tarp-assisted cooling with oscillation [TACO]) after exertional hyperthermia. Design: Randomized, crossover controlled trial. Setting: Environmental chamber (temperature = 33.4°C ± 0.8°C, relative humidity = 55.7% ± 1.9%). Patients or Other Participants: Sixteen volunteers (9 men, 7 women; age = 26 ± 4.7 years, height = 1.76 ± 0.09 m, mass = 72.5 ± 9.0 kg, body fat = 20.7% ± 7.1%) with no history of compromised thermoregulation. Intervention(s): Participants completed volitional exercise (cycling or treadmill) until they demonstrated a rectal temperature (Tre) ≥39.0°C. After exercise, participants transitioned to a semirecumbent position on a tarp until either Tre reached 38.1°C or 15 minutes had elapsed during the control (no immersion [CON]) or TACO (immersion in 151 L of 2.1°C ± 0.8°C water) treatment. Main Outcome Measure(s): The Tre, heart rate, and blood pressure (reported as mean arterial pressure) were assessed precooling and postcooling. Statistical analyses included repeated-measures analysis of variance with appropriate post hoc t tests and Bonferroni correction. Results: Before cooling, the Tre was not different between conditions (CON: 39.27°C ± 0.26°C, TACO: 39.30°C ± 0.39°C; P = .62; effect size = −0.09; 95% confidence interval [CI] = −0.2, 0.1). At postcooling, the Tre was decreased in the TACO (38.10°C ± 0.16°C) compared with the CON condition (38.74°C ± 0.38°C; P < .001; effect size = 2.27; 95% CI = 0.4, 0.9). The rate of cooling was greater during the TACO (0.14 ± 0.06°C/min) than the CON treatment (0.04°C/min ± 0.02°C/min; t15 = −8.84; P < .001; effect size = 2.21; 95% CI = −0.13, −0.08). These differences occurred despite an insignificant increase in fluid consumption during exercise preceding CON (0.26 ± 0.29 L) versus TACO (0.19 ± 0.26 L; t12 = 1.73; P = .11; effect size = 0.48; 95% CI = −0.02, 0.14) treatment. Decreases in heart rate did not differ between the TACO and CON conditions (t15 = −1.81; P = .09; effect size = 0.45; 95% CI = −22, 2). Mean arterial pressure was greater at postcooling with TACO (84.2 ± 6.6 mm Hg) than with CON (67.0 ± 9.0 mm Hg; P < .001; effect size = 2.25; 95% CI = 13, 21). Conclusions: The TACO treatment provided faster cooling than did the CON treatment. When location, monetary, or spatial restrictions are present, TACO represents an effective alternative to traditional CWI in the emergency treatment of patients with exertional hyperthermia.

scholarly journals Cold-Water Immersion for Hyperthermic Humans Wearing American Football Uniforms

2015 ◽  
Vol 50 (8) ◽  
pp. 792-799 ◽  
Author(s):  
Kevin C. Miller ◽  
Erik E. Swartz ◽  
Blaine C. Long
Keyword(s):  
Effect Size ◽  
Cold Water ◽  
Water Immersion ◽  
Cold Water Immersion ◽  
Current Treatment ◽  
The Body ◽  
American Football ◽  
Cooling Rates ◽  
Physically Active ◽  
Core Cooling

Context Current treatment recommendations for American football players with exertional heatstroke are to remove clothing and equipment and immerse the body in cold water. It is unknown if wearing a full American football uniform during cold-water immersion (CWI) impairs rectal temperature (Trec) cooling or exacerbates hypothermic afterdrop. Objective To determine the time to cool Trec from 39.5°C to 38.0°C while participants wore a full American football uniform or control uniform during CWI and to determine the uniform's effect on Trec recovery postimmersion. Design Crossover study. Setting Laboratory. Patients or Other Participants A total of 18 hydrated, physically active, unacclimated men (age = 22 ± 3 years, height = 178.8 ± 6.8 cm, mass = 82.3 ± 12.6 kg, body fat = 13% ± 4%, body surface area = 2.0 ± 0.2 m2). Intervention(s) Participants wore the control uniform (undergarments, shorts, crew socks, tennis shoes) or full uniform (control plus T-shirt; tennis shoes; jersey; game pants; padding over knees, thighs, and tailbone; helmet; and shoulder pads). They exercised (temperature approximately 40°C, relative humidity approximately 35%) until Trec reached 39.5°C. They removed their T-shirts and shoes and were then immersed in water (approximately 10°C) while wearing each uniform configuration; time to cool Trec to 38.0°C (in minutes) was recorded. We measured Trec (°C) every 5 minutes for 30 minutes after immersion. Main Outcome Measure(s) Time to cool from 39.5°C to 38.0°C and Trec. Results The Trec cooled to 38.0°C in 6.19 ± 2.02 minutes in full uniform and 8.49 ± 4.78 minutes in control uniform (t17 = −2.1, P = .03; effect size = 0.48) corresponding to cooling rates of 0.28°C·min−1 ± 0.12°C·min−1 in full uniform and 0.23°C·min−1 ± 0.11°C·min−1 in control uniform (t17 = 1.6, P = .07, effect size = 0.44). The Trec postimmersion recovery did not differ between conditions over time (F1,17 = 0.6, P = .59). Conclusions We speculate that higher skin temperatures before CWI, less shivering, and greater conductive cooling explained the faster cooling in full uniform. Cooling rates were considered ideal when the full uniform was worn during CWI, and wearing the full uniform did not cause a greater postimmersion hypothermic afterdrop. Clinicians may immerse football athletes with hyperthermia wearing a full uniform without concern for negatively affecting body-core cooling.

Can Temperate-Water Immersion Effectively Reduce Rectal Temperature in Exertional Heat Stroke? A Critically Appraised Topic

2017 ◽  
Vol 26 (5) ◽  
pp. 447-451 ◽  
Author(s):  
Tyler T. Truxton ◽  
Kevin C. Miller
Keyword(s):  
Rectal Temperature ◽  
Water Immersion ◽  
Heat Stroke ◽  
Medical Emergency ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Temperate Water ◽  
Bottom Line ◽  
Exertional Heat Stroke ◽  
Cooling Rates

Clinical Scenario:Exertional heat stroke (EHS) is a medical emergency which, if left untreated, can result in death. The standard of care for EHS patients includes confirmation of hyperthermia via rectal temperature (Trec) and then immediate cold-water immersion (CWI). While CWI is the fastest way to reduce Trec, it may be difficult to lower and maintain water bath temperature in the recommended ranges (1.7°C–15°C [35°F–59°F]) because of limited access to ice and/or the bath being exposed to high ambient temperatures for long periods of time. Determining if Trec cooling rates are acceptable (ie, >0.08°C/min) when significantly hyperthermic humans are immersed in temperate water (ie, ≥20°C [68°F]) has applications for how EHS patients are treated in the field.Clinical Question:Are Trec cooling rates acceptable (≥0.08°C/min) when significantly hyperthermic humans are immersed in temperate water?Summary of Findings:Trec cooling rates of hyperthermic humans immersed in temperate water (≥20°C [68°F]) ranged from 0.06°C/min to 0.19°C/min. The average Trec cooling rate for all examined studies was 0.11±0.06°C/min.Clinical Bottom Line:Temperature water immersion (TWI) provides acceptable (ie, >0.08°C/min) Trec cooling rates for hyperthermic humans post-exercise. However, CWI cooling rates are higher and should be used if feasible (eg, access to ice, shaded treatment areas).Strength of Recommendation:The majority of evidence (eg, Level 2 studies with PEDro scores ≥5) suggests TWI provides acceptable, though not ideal, Trec cooling. If possible, CWI should be used instead of TWI in EHS scenarios.

Should Cooling Vests Be Used to Treat Exertional Heatstroke? A Critically Appraised Topic

2017 ◽  
Vol 26 (3) ◽  
pp. 286-289
Author(s):  
Megan L. Keen ◽  
Kevin C. Miller
Keyword(s):  
Cold Water ◽  
Core Body Temperature ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Cooling Rates ◽  
Central Nervous System Dysfunction

Clinical Scenario:Exercise performed in hot and humid environments increases core body temperature (TC). If TC exceeds 40.5°C for prolonged periods of time, exertional heat stroke (EHS) may occur. EHS is a leading cause of sudden death in athletes. Mortality and morbidity increase the longer the patient’s TC remains above 40.5°C; thus, it is imperative to initiate cooling as quickly as possible. Acceptable cooling rates in EHS situations are 0.08–0.15°C/min, while ideal cooling rates are above 0.16°C/min. Cooling vests are popular alternatives for cooling hyperthermic adults. Most vests cover the anterior and posterior torso and have varying numbers of pouches for phase-change materials (eg, gel packs); some vests only use circulating water to cool. While cooling vests offer several advantages (eg, portability), studies demonstrating their effectiveness at rapidly reducing TC in EHS scenarios are limited.Clinical Question:Are TC cooling rates acceptable (ie, >0.08°C/min) when hyperthermic humans are treated with cooling vests postexercise?Summary of Findings:No significant differences in TC cooling rates occurred between cooling vests and no cooling vests. Cooling rates across all studies were ≤0.053°C/min.Clinical Bottom Line:Cooling vests do not provide acceptable cooling rates of hyperthermic humans postexercise and should not be used to treat EHS. Instead, EHS patients should be treated with cold-water immersion within 30 min of collapse to avoid central nervous system dysfunction and organ failure.Strength of Recommendation:Strong evidence (eg, level 2 studies with PEDro scores ≥5) suggests that cooling vests do not reduce TC quickly and thus should not be used in EHS scenarios.

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