This is the page you read while it is happening. The full background is at heat-and-hydration. The protocol below is the next 20 minutes.

Heatstroke kills kids in youth football, marching band, summer camps, and preseason cross country. The protocol that saves them is specific and counterintuitive. Cool the kid before transporting. Not after.

Recognize. Heatstroke is heat illness with neurologic involvement. The signs that distinguish heatstroke from heat exhaustion:

  • Confusion or altered mental state. The kid is not making sense.
  • Slurred speech.
  • Stopped sweating despite heat (or, sometimes, heavy sweating with collapse).
  • Vomiting.
  • Loss of coordination, stumbling, falling.
  • Body temperature above 104°F (40°C). A rectal thermometer is the only accurate measure under heat conditions; oral, axillary, and tympanic readings can underestimate by several degrees.
  • Collapse or loss of consciousness.

Any combination of those, in a kid practicing in heat, treat as heatstroke until proven otherwise.

Call 911. This is step one alongside step three.

Move to shade or AC. Out of the sun. Off the field. Into the building, the trainer’s room, the shaded tent.

Cold-water immersion. This is the treatment. Not adjunct. Not nice-to-have. Treatment.

The Korey Stringer Institute and NATA both publish the same protocol. A tub, a livestock stock tank, a kiddie pool, a large cooler, anything that can hold a kid submerged to the neck. Cold water, not just cool. Ice if available. Submerge the kid to the neck, keep the head up. Continue for 15 to 20 minutes or until temperature drops below 102°F.

If no immersion is available. Continuous ice-towel rotation over the entire body. Towels soaked in ice water, rotated every 30 to 60 seconds. Ice packs at the neck, armpits, groin, and behind the knees, where major blood vessels are close to the surface. Soak the kid with cold water from a hose if that is what is available.

The cool-first-transport-second protocol. This is the part most ambulance services and emergency departments now follow under NATA and KSI guidance. The published recovery rate when cooling begins on-site and continues in transit approaches 100 percent. The recovery rate when transport happens before cooling drops sharply because brain damage from sustained hyperthermia is rapid.

The order of operations is: recognize, call 911, cool, then transport with cooling continuing.

Programs that have a cooling tub on site. Football programs in heat-belt states should have a tub or stock tank set up before practice during the August window. Any program in any sport that practices in heat over 90°F WBGT should have a cooling-immersion plan. The American Academy of Pediatrics, KSI, and NATA all endorse this as the standard of care.

For the parent. Stay out of the way of the trainer if there is one. If there is no trainer, you may be the adult applying the towels. Keep cooling until EMS arrives and tells you to stop.

For the coach. Heatstroke recovery is measured in minutes. Every minute the kid’s core temperature is above 104°F is a minute of brain and organ insult. The cooler is not a comfort measure. It is the treatment.

Prevention is what makes this rare. The full prevention protocol is at heat-and-hydration. Heat acclimatization, WBGT-based practice modification, hydration, breaks, weigh-in / weigh-out for the first week. Programs that follow it see heatstroke as the rarest of events.

The honest part: even with prevention, heatstroke happens. The kid who recovers fully is the kid whose program had a tub ready, a trainer or coach who recognized it fast, and the discipline to cool first and transport second.