Proper Recognition and Management of Exertional Heat Stroke in a High School Cross-Country Runner: A Validation Clinical Case Report

J Athl Train. 2022 Jun 1;57(6):586-591. doi: 10.4085/1062-6050-0462.21.


A 14-year-old female high school cross- country runner (height = 154 cm, mass = 48.1 kg) with no history of exertional heat stroke (EHS) collapsed at the end of a race. An athletic trainer assessed the patient, who presented with difficulty breathing and then other signs of EHS (eg, confusion and agitation). The patient was taken to the medical area and draped with a towel, and a rectal temperature (Tre) of 106.9°F (41.6°C) was obtained. The emergency action plan was activated, and emergency medical services was called. The patient was submerged in a cold-water immersion tub until emergency medical services arrived (∼15 minutes; Tre = 100.1°F; cooling rate: 0.41°F.min-1[0.25°C.min-1]). At the hospital, the patient received intravenous fluids, and urine and blood tests were normal. She was not admitted and returned to running without sequelae. Following best practices, secondary school athletic trainers can prevent deaths from EHS by properly recognizing the condition and providing rapid cooling before transport.

Keywords: cold-water immersion; cool first and transport second.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Cold Temperature
  • Female
  • Heat Stroke* / diagnosis
  • Heat Stroke* / etiology
  • Heat Stroke* / therapy
  • Humans
  • Running*
  • Schools
  • Water


  • Water