Dr. Douglas Casa, CEO of the Korey Stringer Institute at the University of Connecticut, has spent nearly four decades studying exertional heat stroke. His research has tracked over 3,000 cases. His conclusion is precise: exertional heat stroke has been 100% survivable in every tracked case where the patient's temperature was reduced below 104°F within 30 minutes. And yet, people still die from it every summer. Understanding why is the most important thing any field medical team can do before the season starts.
A researcher who lived the research
Dr. Casa's path to becoming the world's leading authority on EHS began on August 8, 1985. He was 16 years old, competing in the New York 10K Championship in Buffalo when he collapsed from exertional heat stroke during a heat wave. He survived because of the quality of his on-site treatment.
As he told UConn Today: "The benefit of having a near-death experience as a 16-year-old is I never had to worry about what my job or my career was going to be. I knew literally within a couple days of that taking place that I wanted to pursue this area of study."
Since then, Casa has accumulated more than 200 peer-reviewed publications on heat-related illness and has treated hundreds of EHS patients personally — with zero fatalities.
The core finding: 100% survival is achievable
In a SciLine media briefing in November 2025, Dr. Casa stated: "It has been 100% survival in over 3,000 cases we have tracked if the person's body temperature gets under 104 [°F] within 30 minutes of the presentation of the condition."
This is not a theoretical aspiration. It is a documented outcome from 3,000+ real cases across athletic, occupational, and military environments. The inverse is equally important. As Casa told CBS News: "Any time you hear of a death you'll know from this moment forward that person was not cooled aggressively."
Every preventable EHS death is a system failure, not a medical inevitability.
Why deaths still happen: the three failure modes
1. Rushing to transport before cooling
The reflex to load a patient and drive to the hospital is deeply embedded in emergency response culture. In EHS, it is the wrong priority. The patient who arrives already cooled has a fundamentally different prognosis from the one who arrives at 108°F after a 20-minute transport. The protocol: cool first, transport second. The ambulance call happens in parallel with immersion — not instead of it.
2. Using inadequate cooling methods
Wet towels, ice packs, and misting fans are widely available. They are also insufficient as primary EHS treatment. Cold water immersion cools at 0.35 to 0.40°F per minute. Wet towels and fanning cool at 0.05 to 0.10°F per minute — approximately 6 times slower. In a 30-minute window, that gap is the difference between full recovery and permanent neurological damage.
3. Missing or unavailable cooling equipment
This is the most common operational failure. The protocol is known. The training has happened. But when the athlete collapses, the tub is not there. As Casa has noted repeatedly, this is increasingly a logistical problem, not a medical knowledge problem.
What the Korey Stringer Institute has changed
Since 2010, the Korey Stringer Institute has influenced more than 466 state-level policies and laws covering heat stroke, cardiac arrest, and head injury protocols in US sports. For EHS specifically, 15 states now require cold water immersion tubs during high-risk athletic training sessions.
Casa describes the protocol shift as equivalent to AED deployment for cardiac arrest: "Cool first, transport second is just like using an AED for a cardiac event." The equipment must be present, the responders trained, and the protocol automatic.
Pre-season operational checklist
Based on KSI's recommendations:
- Cold water immersion capability on site — not in a vehicle, not in a depot, but at the point of potential need
- Rectal thermometers in every medical kit — ear and forehead devices are not adequate for EHS diagnosis
- All first responders trained on "cool first, transport second" — not just the team physician
- Ice supply planned and confirmed for events and training sessions at risk
- Emergency action plan with EHS response, named roles, and time targets
Sources
- SciLine, Dr. Douglas Casa: Heat stroke care — Cool first, transport second, November 2025 — sciline.org
- UConn Today, One Collapse, Countless Saves, October 2025 — today.uconn.edu
- CBS News Minnesota, Korey Stringer Institute heat research — cbsnews.com
- Korey Stringer Institute, University of Connecticut — ksi.uconn.edu
Kollder is the emergency cooling tub that deploys in under 30 seconds, anywhere.
Kollder is the emergency cooling tub that deploys in under 2 minutes, anywhere.
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