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Exertional Heat Stroke Symptoms & Treatment (EHS)

What is exertional heat stroke( EHS)?

  • Life-threatening medical emergency
  • Body's temperature is too high
  • Left untreated, exertional heat stroke results in death due to organ damage across all body systems (liver, kidney, brain, etc.)
  • Until medical help arrives, the key is to immediately lower elevated body temperature
  • EHS is different from classic heat stroke, which usually effects children and the elderly during prolonged hot weather.

Exertional heat stroke symptoms

  • Excessively high rectal temperature (over 105 degrees)(oral, axillary, tympanic, and temporal measurements are innacurate and cannot be trusted)
And any or all of the following:
  • Erratic pulse (strong and rapid or weak and rapid)
  • Lack of coordination
  • Collapse
  • Low blood pressure
  • Vomiting
  • Headache
  • Loss of consciousness and/or seizure 
  • Shock
  • Irritability, confusion, disorientation
  • Sweaty skin that may be red/flushed or pale

Risk factors

Exertional heat stroke: treatment

Rapid and aggressive whole-body cooling is the key to survival of EHS.  The goal is to lower core body temperature to less than 102.5 degrees farenheit within 30 minutes of collapse. 

  • Call 911
  • Remove excessive clothing  
  • Ice-water or cold-water immersion up to the neck (because removing excess clothing and equipment can be time consuming,cold water immersion should begin immediately, with clothing and equipment removed while the patient is in the tub, or while temperature is being assessed or the tub is being prepared)
  • When not feasible, immediate and continual dousing with water (either from a hose, multiple water containers or shower) combined with fanning and continually rotating cold, wet towels on head and neck until immersive cooling can occur.
  • If a physician is onsite to manage the patient's medical care, then transportation to a medical facility for monitoring of possible organ damage may not be necessary and immersion can continue uninterupted.  If a physician is not present, aggressive cooling should continue until the patient's temperature is 102.5 degrees F before EMS transport. When medical staff is present, the rule is cool first, transport second.

Return to play

  • Medical clearance advised
  • Avoid exercise for minimum of one (1) week after release from medical care
  • Gradual increase in exercise level under supervision of qualified health care professional (doctor, ATC)


Revised  August 8, 2011; reviewed and updated April 23, 2017


For the National Athletic Trainers' Position Statement: Exertional Heat Illnesses, click here.