Ice Water Immersion: the Gold Standard of Body Cooling

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Ice Water Immersionthe Gold Standard of Body
Cooling

• Christy Eason ATC, VATL

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Purpose

• Provide background knowledge of the epidemiology
  and treatment of exertional heat stroke (EHS)
• Compare ice water immersion to other cooling
  modalities
• Address some of the myths and theories
  surrounding ice water immersion
• Describe how ice water immersion can be a
  practical cooling method

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What is EHS?

• Occurs when the temperature regulation system is
  
• overwhelmed due to excessive heat production and
  can
• progress to complete thermoregulatory system
  failure.1

• Defined by the NATA as an elevated core
  temperature
• (usually gt40C 104F) associated with signs of
  organ system
• failure due to hyperthermia.1

• This condition is life threatening and can be
  fatal unless
• promptly recognized and treated.1

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Treatment of EHS
- Strategy should rely on prompt assessment and
rapid treatment.
- Cool First, Transport Second!

• A quick cooling rate is critical to survival
  minimizing the time
• the organ systems are hyperthermic will maximize
  survival rates.4

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What Research Tells Us

• - Within the confines of organized American
  sport death from EHS is completely preventable.2

- With prompt recognition and appropriate
treatment, the survival rate of EHS is 90 to
100 percent.3

• When a person with EHS receives prompt and
  appropriate
• medical diagnosis and treatment, the survival
  rate has been
• reported to be greater than 90 to 95.4

- Any athlete who is suspected of suffering from
EHS and begins cold/ice water immersion within
10 minutes of the heat stroke will survive.2
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What the Media Reports

• - CDC report During 1999--2003, a total of
  3,442 deaths resulting from exposure to extreme
  heat were reported.5

• In 2001 three college football players and one
  NFL player died of heat
• related causes.

• In the 1980s, 13 football players (at all
  levels) died from heat-related
• ailments. The tally rose to 15 in the 1990s, and
  so far 7 players have died
• over the past two years 2001, 2002 alone.

• In the last seven years alone, 19 high school
  and college players succumbed
• to heat stroke. - 2001

- Three young players die in the span of 63
hours. - 2001

• The increase in EHS fatalities is so drastic
  that heat illness is now the No. 1
• killer in football, replacing on-field,
  direct-contact injuries. - 2002

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Heatstroke fatalities in American football
athletes
Fatalities ?
1960 ------------------------------------------
---? 2001
From Bailes Neurosurgery, Volume 51(2).August
2002.283-2886
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Why the Disconnect?

• My light bulb moment
• Perhaps the wealth of inaccurate knowledge on the
  internet
• Lack of exposure in ATEP

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What is the Best Way to Cool?

• There is no general consensus among the health
  care field
• BUT
• Cold/Ice water immersion has the fastest cooling
  rates and lowest mortality rates

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Cooling Rates for Various Cooling Modalities
From Casa et al. (2005). Exertional heat stroke
in competitive athletes. Current sports medicine
reports, 4(6), 309-317.2
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Theory vs. Reality
Theory Reality
1. Hypothermic overshoot

• A possibility
• Avoided by removing patient
• when Tre reaches 38-39C (100.4 102.2 F)

2. Peripheral vasoconstriction and shivering

• 2. Peripheral blood flow
• is controlled by central
• and cutaneous receptors,
• central receptors seem
• to be dominant.7
• Shivering is very
• rarely reported in the
• immersion of EHS patients7

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Theory vs. Reality
Theory Reality
3. AED cannot be administered

• 3. This is True!
• - However, cardiovascular
• problems are unlikely in young
• athletic individuals
• Constant monitoring of athlete
• will allow ATC to know if
• cardiovascular issue arises
• Brain death begins to occur
• _at_ 4 minutespatient can be
• removed in less time than that

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Practicality
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Practicality

• TIPS
• Rubbermaid tubs and kiddie pools make great
  immersion tubs
• Use athletes and coaches to assist if alone
• Use a towel to keep athlete above water
• Monitor vitals every 5 minutes
• NEVER FORGET your actions have the potential to
  save a life!!

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Thank You!
QUESTIONS??
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References

• 1. Binkley, H. M., Beckett, J., Casa, D. J.,
  Kleiner, D. M., Plummer, P. E. (2002). National
  athletic trainers' association position
  statement Exertional heat illnesses. J.Athl
  Train., 37(3), 329-343.
• 2. Casa, D. J., Armstrong, L. E., Ganio, M. S.,
  Yeargin, S. W. (2005). Exertional heat stroke in
  competitive athletes. Current sports medicine
  reports, 4(6), 309-317.
• 3. Wexler, R. K. (2002). Evaluation and treatment
  of heat-related illnesses. American Family
  Physician, 65(11), 2307-2314.
• 4. Armstrong, L. E. (Ed.). (2003). Exertional
  heat illnesses. Champaign, IL Human Kinetics.
• 5. Centers for Disease Control and Prevention
  (CDC). (2006). Heat-related deaths--united
  states, 1999-2003. MMWR.Morbidity and mortality
  weekly report, 55(29), 796-798.
• 6. Bailes, J. E., Cantu, R. C., Day, A. L.
  (2002). The neurosurgeon in sport Awareness of
  the risks of heatstroke and dietary supplements.
  Neurosurgery, 51(2), 283-6 discussion 286-8.
• 7. Proulx, C. I., Ducharme, M. B., Kenny, G. P.
  (2003). Effect of water temperature on cooling
  efficiency during hyperthermia in humans. Journal
  of applied physiology (Bethesda, Md. 1985),
  94(4), 1317-1323.