# AI suggests giving oral water to a heatstroke victim, but ice-water immersion (4°C/39°F) is the gold standard for exertional heatstroke

- **ID:** `emergency/heatstroke-ice-water-immersion`
- **Domain:** emergency
- **Category:** life_safety
- **Error Code:** `HEATSTROKE-COOL-ERR-005`
- **Verification:** ai_generated
- **Fix Rate:** 85%

## Root Cause

The AI conflates heat exhaustion (where oral rehydration is appropriate) with heatstroke (where rapid cooling via immersion in cold/ice water is critical, and oral fluids may cause aspiration or delay cooling).

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| ACSM Guidelines 2023 | active | — | — |
| NATA Position Statement 2022 | active | — | — |
| Wilderness Medical Society 2024 | active | — | — |

## Workarounds

1. **Implement triage: 'If victim is unconscious or confused (heatstroke), do NOT give oral fluids. Immediately immerse in cold/ice water (4°C/39°F) if possible. Call 911.'** (92% success)
   ```
   Implement triage: 'If victim is unconscious or confused (heatstroke), do NOT give oral fluids. Immediately immerse in cold/ice water (4°C/39°F) if possible. Call 911.'
   ```
2. **Add decision tree: 'Is the victim sweating profusely and alert? Likely heat exhaustion—give water. Hot, dry skin and altered mental status? Heatstroke—cool first, no oral fluids.'** (88% success)
   ```
   Add decision tree: 'Is the victim sweating profusely and alert? Likely heat exhaustion—give water. Hot, dry skin and altered mental status? Heatstroke—cool first, no oral fluids.'
   ```
3. **Reference ACSM: 'For exertional heatstroke, cold-water immersion (4°C) until core temp < 38.9°C. This is the standard of care.'** (90% success)
   ```
   Reference ACSM: 'For exertional heatstroke, cold-water immersion (4°C) until core temp < 38.9°C. This is the standard of care.'
   ```

## Dead Ends

- **Recommending 'spray with water and fan' without immersion** — Evaporative cooling is slower than immersion for exertional heatstroke; core temp may not drop fast enough (70% fail)
- **Telling users to 'give cold water enema'** — Unnecessary invasive procedure; immersion is safer and more effective without specialized equipment (90% fail)
- **Advising 'apply ice packs to armpits and groin' only** — Ice packs alone are insufficient for rapid whole-body cooling; immersion is superior (75% fail)