Belval et al. 2018, Exertional heat stroke care consensus

Best-practice review of exertional heat stroke recognition and treatment. Diagnosis rests on rectal core temperature above ~40.5 °C plus central nervous system dysfunction; peripheral thermometers are unreliable in exercising people. Cold water immersion is the gold-standard treatment, and the principle is ‘cool first, transport second’, aiming to get core temperature down within 30 minutes. Consensus / expert review. Moderate to strong on the cooling priority.