Body bag integrity in simulated prehospital cold water immersion: A comparison study

Heat stroke is a life-threatening condition defined as core body temperature > 40 °C plus end organ damage, most notably CNS dysfunction. Standard of care has long included the use of evaporative and convective cooling techniques; however, Cold Water Immersion (CWI) has emerged as a potential new standard of care. Thermal Emergency Management Patient (TEMP) bags (ie. body bags) allow for cooling rates that meet or exceed ideal rates of 0.2 °C/min. We investigated several commercially available bags to assess which characteristics would make up the ideal TEMP bag for CWI cooling. We conducted an observational study to test the characteristics of different bags that optimize cooling for CWI by obtaining seven commercially available body bags. Each bag was put through the same real-life simulation of patient cooling, both on the ground and with movement to patient stretcher utilizing 38 L of ice water. We evaluated water depth and residual volume, as well as the integrity and strength of each bag. On average, bags lost 14.49 L of water during testing, with a median amount of water loss of 10.7 L Bags with center zippers and those with handles lost the least amount of water. Five out of the seven bags experienced some sort of structural failure. The characteristics found to be most beneficial include thicker bag material, double sewn or fused seams, and center zippers. Further research into which characteristics or specific bag would be optimal for CWI needs to be conducted to ensure patient safety and efficacy of treatment.