McDermott BP, Casa DJ, O’Connor FG, Adams WB, Armstrong LE, Brennan AH, Lopez RM, Stearns RL, Troyanos C, Yeargin SW. Cold-water dousing with ice massage to treat exertional heat stroke: a case series. Aviat Space Environ Med 2009; 80:720–2. Introduction: We sought to determine the rate of cooling via a novel water ice therapy (WIT) as an alternative to cold-water immersion for the acute treatment of exertional heat stroke (EHS). Methods: Observations were made at the 2004-2008 Marine Corps Marathons (mean ± SD: 16.3 ± 4.9°C dry bulb, 32 ± 6% RH). Nine (seven men, two women) EHS patients (33 ± 6 yr of age; 268 ± 54 min average race time for six who finished) were observed during on-site treatment. Patients were treated while lying supine on a porous stretcher resting on a tub filled with cold water (~10-12°C). Medical personnel monitored T_re, doused the patient with water and massaged major muscle groups with ice bags until T_re decreased to 38.9°C. Patients were not immersed in water. Serial T_re and time were used to calculate cooling rates. Results: Final T_re (39.12 ± 0.63°C) was significantly lower than initial T_re (41.43 ± 0.71°C, P < 0.05). Cooling rates were 0.13 ± 0.04°C · min⁻¹. The decrease in T_re for the initial 6 min of WIT (0.38 ± 0.13°C) was significantly less than for the subsequent 6-min time period (1.31 ± 0.34°C, P < 0.001). Cooling rates for these time periods were significantly different (0.06 ± 0.02°C · min⁻¹ and 0.22 ± 0.06°C · min⁻¹, respectively, P < 0.05). Initial T_re was not correlated with overall cooling rate (r = 0.434, P = 0.244), or total cooling time required (17 ± 4 min; r = 0.207, P = 0.593). Survival rate was 100%. Conclusion: WIT provided cooling rates that were 70% as effective as those published for cold-water immersion with 8°C water (0.19°C · min⁻¹) and resulted in 100% patient survival.