Mississippi High School Activities Association The place for high school sports in Mississippi Cold Water Immersion
In the event of potential Exertional Heat Stroke (EHS), each school participating in interscholastic sports must be properly prepared and equipped to initiate Cold Water Immersion (CWI) or equivalent whole body cooling techniques and EMS concurrently contacted. Exertional Heat Stroke prevention and treatment should be part of the Athletic Emergency Action Plan.
The best practices shall be carried out by a licensed athletic trainer, designated healthcare provider, or EMS provider.
When a health care provider is not available, the team’s school personnel shall provide Cold Water Immersion (CWI) or equivalent whole body cooling technique.
The cooling modality must be set up during the 1st 6 weeks of practice and when the WBGT is at 82 degrees or higher. It should also be readily available if the need arises.
The focus is to cool first and then transport via EMS. It is important to recognize Exertional Heat Stroke immediately and initiate emergency treatment.
How to Respond to Exertional Heat Stroke Emergency KSI https://ksi.uconn.edu/wp-content/uploads/sites/1222/2015/04/Appropriate-Response-to-EHS.pdf
The two main criteria for diagnosing exertional heat stroke (EHS) are rectal temperature >105°F (40.5°C) immediately post collapse and central nervous system (CNS) dysfunction (e.g. irrational behavior, irritability, emotional instability, altered consciousness, collapse, coma, dizziness, etc.)
When observing athletes, look for other signs and symptoms that may indicate they are suffering from EHS:
- Rectal temperature greater than 105°F (40.5°C).
- Irrational behavior, irritability, emotional instability
- Altered consciousness, coma
- Disorientation or dizziness
- Headache
- Confusion or just look “out of it”
- Nausea or vomiting
- Diarrhea
- Muscle cramps, loss of muscle function/balance, inability to walk
- Collapse, staggering or sluggish feeling
- Profuse sweating
- Decreasing performance or weakness
- Dehydration, dry mouth, thirst
- Rapid pulse, low blood pressure, quick breathing
- Other outside factors may include:
- They are out of shape or obese
- It is a hot and humid day
- Practice is near the start of the season, and near the end of practice
- It is the first day in full pads and equipment
If an athlete collapses during or immediately after exercise, consider EHS as a differential diagnosis. However, collapse is not required to consider EHS. Many athletes may display CNS dysfunction without collapse and healthcare professionals should still consider EHS as a differential diagnosis.
Follow these steps to initiate emergency treatment:
- Remove all equipment and excess clothing.
- Cool the athlete as quickly as possible within 30 minutes viawhole body ice water immersion (place them in a tub/stock tank with ice and water approximately 35–58°F); stir water and add ice throughout cooling process.
- If immersion is not possible (no tub or no water supply), take athlete to a shaded, cool area and use rotating cold, wet towels to cover as much of the body surface as possible.
- Maintain airway, breathing and circulation.
- After cooling has been initiated, activate emergency medical system by calling 911.
- Monitor vital signs such as rectal temperature, heart rate, respiratory rate, blood pressure, monitor central nervous system status.
- If rectal temperature is not available, DONOT USE AN ALTERNATE METHOD (oral, tympanic, axillary, forehead sticker, etc.). These devices are not accurate and should never be used to assess an athlete exercising in the heat.
- Cease cooling when rectal temperature reaches 101–102°F (38.3–9°C).
Exertional heat stroke has had a 100% survival rate when immediate cooling (via cold water immersion or aggressive whole body cold water dousing) was initiated within 10 minutes of collapse.
Reviewed and updated August 2026
