Hyperthermia

Field Management of Exertional Heat Stroke (EHS) in Remote, Occupational and Sport Environments

Core body temperature monitoring during Exertional Heat Stroke

Standard of Care: Cold Water Immersion (CWI)

“Cool First – Transport Second”

✔ In athletic events, military operations, industrial settings, and remote environments, the gold-standard treatment for Exertional Heat Stroke (EHS) is:

Immediate whole-body cold water immersion (CWI).

✔ This approach is endorsed by:

American College of Sports Medicine (ACSM)
National Athletic Trainers’ Association (NATA)
Wilderness Medical Society (WMS)
International sport medicine consensus statements

✔ The principle is unequivocal:

Cool First – Transport Second.

Delayed cooling significantly increases:

Mortality risk
Risk of multi-organ failure
Long-term neurological sequelae

What is Cold Water Immersion?

Effective EHS management requires:

Immediate recognition (core temperature ≥ 40.5°C with CNS dysfunction)
On-site cold water immersion (1–15°C water)
Continuous cooling until core temperature reaches ~38.5–39°C
Avoidance of premature transport before adequate cooling

✔ Cooling rates with CWI:

~0.15–0.20°C per minute
Survival approaches 100% when cooling begins within 30 minutes of collapse

Operational Limitation in Current Practice

During cold water immersion:

✔ Core temperature monitoring is often delayed or intermittent

✔ Peripheral thermometers are unreliable

✔ Continuous monitoring during immersion is technically difficult

✔ In some cases, transport is initiated prematurely due to uncertainty about core temperature

This creates a gap between:

Evidence-based rapid cooling protocols and
Real-time core temperature monitoring capability

Added Value of Coretraqer in EHS Management

The Coretraqer system is designed to integrate directly within this workflow.

✔ Device remains in place during immersion

✔ Continuous real-time core temperature monitoring

✔ Remote visualization on portable device (tablet/smartphone)

✔ Accurate endpoint determination (avoid overcooling or undercooling)

✔ Documentation of temperature curve for medico-legal protection

This enables:

Objective decision-making in mass participation events
Continuous monitoring during cooling and stabilization
Safer transition to transport phase
Better communication with receiving emergency departments

Clinical and Operational Impact

In EHS, every minute matters.

Survival and outcomes depend on:

✔ Time to initiation of cooling

✔ Rate of temperature reduction

✔ Avoidance of delayed cooling due to transport

Continuous core temperature data:

✔ Confirms diagnosis rapidly

✔ Validates cooling effectiveness

✔ Identifies plateau or insufficient cooling

✔ Provides documented evidence of guideline adherence

In mass endurance events, military drills, and industrial heat exposure, this supports:

Reduced mortality risk
Reduced ICU admissions
Reduced liability exposure
Improved operational readiness

References

Casa DJ et al. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses.
American College of Sports Medicine Consensus on Exertional Heat Stroke.
Wilderness Medical Society Practice Guidelines for the Treatment of Heat Illness.
Demartini JK et al. Cooling rates in cold water immersion for exertional heat stroke.

Hypothermia

Field Management of Hypothermia in Remote and Mountain Environments

Standard of Care: “Burrito Wrapping” (Hypothermia Wrap)

✔ In remote, alpine, wilderness and search-and-rescue environments, the recommended pre-hospital management of moderate to severe hypothermia is the “Hypothermia Wrap” technique, commonly referred to as the Burrito Wrapping method.

✔ This technique is recommended in:

Wilderness Medical Society Practice Guidelines
Mountain Rescue protocols (European and North American)
Pre-hospital trauma and alpine emergency care frameworks

What is Burrito Wrapping?

The hypothermia wrap consists of:

Removal from cold exposure
Insulation from the ground (foam pad or stretcher insulation)
Vapor barrier (plastic sheet or bivy bag)
High-efficiency thermal insulation (blankets, sleeping bags)
Windproof outer layer
Gentle handling (to prevent arrhythmias)
The patient is completely wrapped to minimize further heat loss and prevent afterdrop.

Operational Limitation in Current Practice

Once wrapped:

✔ Core temperature monitoring becomes difficult

✔ Peripheral measurements are unreliable

✔ Unwrapping to assess temperature increases heat loss

✔ Continuous monitoring during prolonged evacuation (e.g., helicopter or long stretcher transport) is limited

This creates a gap between:

Guideline-based insulation strategyandReal-time physiological monitoring capability

Added Value of Coretraqer in Hypothermia Management

The Coretraqer system is designed to integrate directly within this workflow.

✔ The device can remain inside the hypothermia wrap without disturbing insulation

✔ Continuous core temperature monitoring during transport

✔ Remote data visualization via portable device (tablet/smartphone)

✔ No need to unwrap the patient for reassessment

✔ Reduced risk of additional heat loss

✔ Improved decision-making during prolonged evacuation

This enables:

Safer triage in mountain rescue
Continuous monitoring during helicopter transport
Better documentation for medico-legal protection
Objective temperature trend analysis

Clinical and Operational Impact

In remote environments, evacuation time can exceed 60–120 minutes.

Continuous temperature data:

✔ Supports appropriate rewarming strategy

✔ Helps identify deterioration (e.g., drop toward severe hypothermia <28°C)

✔ Reduces unnecessary manipulation

✔ Improves communication between rescue teams and receiving hospitals

References

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Hypothermia (McIntosh et al., Wilderness Environ Med. 2019)
European Resuscitation Council Guidelines – Special Circumstances: Hypothermia
Brugger H. et al. Accidental Hypothermia in Mountain Rescue – Pathophysiology and Field Management.