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Wilderness Environ Med. 2015 Jun;26(2):173-9. doi: 10.1016/j.wem.2014.11.006. Epub 2015 Mar 12.

Novel application of chemical cold packs for treatment of exercise-induced hyperthermia: a randomized controlled trial.

Author information

Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Drs Lissoway, Lipman, and Weiss).
Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Drs Lissoway, Lipman, and Weiss). Electronic address:
Department of Biology, Stanford University, Stanford, CA (Drs Grahn and Heller; Mr Cao).
Stanford-Kaiser Emergency Medicine Residency, Stanford, CA (Dr Shaheen).
Department of Engineering, Stanford University, Stanford, CA (Dr Phan).



Heat-related illness is a common disease with significant morbidity and mortality. Despite no proven efficacy, application of chemical cold packs (CCP) to the skin overlying the large vessels of the neck, groin, and axillae is a traditional recommended cooling modality. The study objective was to compare the cooling rates of CCP applied to these traditional areas vs the glabrous skin surfaces of the cheeks, palms, and soles in exercise-induced hyperthermia.


Ten healthy adult male volunteers walked on a treadmill in a heated room (40°±0.5°C) while wearing insulated military overgarments until their esophageal temperatures (Tes) reached 39.2°C. Each participant had three heat stress trials on separate days: no treatment followed by randomly ordered traditional (neck, groin, and axillae) cooling and glabrous skin cooling.


With no treatment, Tes remained stable after the first 5 minutes of the heat trial (ΔTes=0.12°±0.07°C/10 min). Traditional cooling followed a linear decline (ΔTes=0.17°±0.04°C/10 min; P<.001). Glabrous cooling enhanced the treatment effect by a steeper decline (ΔTes=0.30°±0.06°C/10 min; P<.001), significantly different from traditional cooling by 2-way analysis of variance (P<.001).


Application of CCP to glabrous skin surfaces was more effective for treating exercise-induced heat stress than the traditional CCP cooling intervention. This novel cooling technique may be beneficial as an adjunctive treatment for heat-related illness in the prehospital environment.


chemical cold packs; cooling; exercise; glabrous; heat-related illness; hyperthermia

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