Heatstroke on the Rise: A Guide to Implementing Tarp-Assisted Cooling With Oscillation (TACO) in the Emergency Department

Heat-related illnesses, namely, heatstroke is on the rise and is a public health concern nationally and internationally. Heatstroke is generally considered to be a core body temperature greater than 40 °C (104 °F) with dry, hot skin, and central nervous system manifestations. Heatstroke is characterized by a systemic inflammatory response that leads to multiple-organ dysfunction and ultimately death if not treated in a timely manner. Rapid recognition and cooling are imperative, as mortality is high, especially in the elderly. There are many cooling methods that have been studied that include cold-water immersion, tarp-assisted cooling with oscillation (TACO), evaporative cooling (misting/fanning), commercial ice packs, cooling vests and jackets, cold showers, and ice sheets. Although cold-water immersion is the fastest method for cooling, it is not usually feasible in an emergency department (ED). TACO is the most feasible and effective cooling method for EDs. It is vital that EDs have a specific plan in place before implementing TACO, as it requires 30-40 gallons of ice water, a tarp or waterproof sheet, core temperature monitoring, and an ample number of ED staff members to oscillate the water over the patient. Further research is needed to study TACO in the ED setting. As the incidence of heatstroke is expected to increase in the coming years, EDs must have a plan in place to rapidly recognize and treat patients with heatstroke so that patients will have improved outcomes and reduced mortality.