The appropriate procedure for using an ice water bath with a student experiencing a serious heat reaction (exertional heat stroke) involves rapid and effective cooling to reduce core body temperature safely and quickly. The key steps are:
- Immediate assessment and removal of excess clothing and equipment: Remove the student’s shirt and any equipment to expose the skin for cooling, but keep the head above water to maintain airway safety
- Prepare an ice water bath: Use a tub, stock tank, or kiddie pool filled with water and ice, cooled to between 35°F and 59°F (about 1.5°C to 15°C), with an optimal target around 50°F (10°C)
- Immersion: Carefully immerse the student up to the neck in the ice water bath, ensuring the head and neck remain above water. Support the student if needed by holding under the armpits and wrapping a towel across the chest to keep them stable
- Additional cooling measures: Place an ice or wet towel over the head and neck while the body cools. Stir the water continuously to maintain temperature and maximize cooling efficiency
- Monitoring: Continuously monitor vital signs and core body temperature, ideally with a rectal thermometer. Cooling should continue until the core temperature drops to about 102°F (39°C) or until shivering begins, which indicates the risk of overcooling
- End cooling and seek further care: Remove the student from the bath once the target temperature is reached. Promptly transport the student to medical care for further evaluation and treatment
- If a cold water bath is not available: Move the student to a shaded or cool area and apply ice water-soaked towels or ice packs to the neck, armpits, and groin, rotating them frequently to maintain cooling
This method, known as cold water immersion, is recognized as the gold standard for rapid cooling in exertional heat stroke and can reduce core temperature effectively within 15 to 20 minutes, significantly improving survival and outcomes
. In summary, the procedure is:
- Remove clothing and equipment.
- Immerse the student up to the neck in an ice water bath at 35-59°F.
- Keep the head above water and place ice/wet towels on head and neck.
- Stir water continuously.
- Monitor core temperature and vitals.
- Stop cooling at about 102°F or if shivering occurs.
- Transport for medical care immediately after cooling.
This rapid cooling approach is critical to prevent serious complications or death from heat stroke
