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Cool First, Transport Second

Cool First, Transport Second

Cool first, transport second is the core rule of National Stay Cool Day (NSCD). When an athlete shows signs of exertional heat stroke, cooling starts on site, right away. Transport comes after.

Call 911 right away, while cooling starts. One person calls. Everyone else starts cooling.

The steps

  1. Spot the signs: confusion, odd behavior, staggering or collapse during hard activity in the heat.
  2. Call 911 right away, while cooling starts.
  3. Remove equipment and extra clothing.
  4. Whole-body cold-water immersion, right where the athlete is. Stir the water and keep adding ice.
  5. No tub? Use a tarp with ice and water, or rotate ice-water towels.
  6. Start cooling within 10 minutes. Reach 102°F within 30.
  7. Hand off to EMS once cooling is done or EMS takes over.

Plan it before practice

Write down who calls 911, who cools, where the tub is and who meets the ambulance. Build yours with the free Emergency Action Plan Builder and print the Heat Rules Card.

Quick answers

What does cool first, transport second mean?

Cool an athlete with suspected exertional heat stroke on site, with whole-body cold-water immersion, before moving them. Hand off to EMS after cooling.

When do we call 911?

Call 911 right away, while cooling starts. One person calls while everyone else starts cooling the athlete on site.

How fast should cooling start?

Start cooling within 10 minutes. Reach 102°F within 30.

What if there is no tub?

Use a tarp with ice and water, or rotate ice-water towels over as much of the body as possible, and keep cooling until EMS takes over.

Is exertional heat stroke survivable?

Exertional heat stroke is 100% survivable when the athlete is cooled fast, on site.

For education and preparedness only. Not a substitute for professional medical advice. In an emergency, call 911.

What should I do if my child collapses at practice in the heat?

Treat it as exertional heat stroke until proven otherwise: call 911, begin cold-water immersion on site, and keep cooling while you wait for EMS. Cool first, transport second.

How many athletes have died from exertional heat stroke?

There are at least 175 documented exertional heat stroke deaths. Approximately 9,000 high-school athletes are treated for heat-related illnesses every year in the United States.