Heat Stroke Cooling Devices for Prehospital Use: A Systematic Review

Heat stroke and heat exhaustion (HS/HE) are life-threatening conditions requiring immediate intervention. Cooling devices play a critical role in emergency and prehospital care, yet their effectiveness and field readiness are inconsistently reported. This systematic review evaluates commercially available cooling devices for the treatment of HS/HE with an emphasis on device feasibility, performance, and suitability for prehospital and remote deployment.

A comprehensive literature search was conducted in August/October 2025 across academic databases (PubMed, Scopus, Cochrane Library, Compendex, Engineering Village, and IEEE Xplore) and gray literature via Google Advanced Search. Academic records were screened using Rayyan, while gray literature was organized in Excel with the aid of a custom HTML scraper. Devices were included if they met the United States Food and Drug Administration (FDA) definition of a medical device, were designed for adult human use, and specifically addressed HS/HE. Parameters extracted included working principle, cooling rate, weight, dimensions, volume, power requirements, external resource demands, and reusability. Cooling performance was benchmarked using thresholds reported by McDermott, et al, and portability was assessed using the MIL-STD-1472H single-person carriage limit of ≤16kg.

A total of 18 devices were identified and evaluated. Only three met the ideal cooling rate threshold (≥0.155°C/minute), and two others achieved acceptable performance (0.078-0.154°C/minute). Approximately 61% of devices did not report cooling rate data. Five devices met field portability criteria (≤16kg), though most were limited by reliance on water, power, or disposable components. Only one device demonstrated feasibility for remote use; this device, however, lacked full reusability.

No device meets the combined criteria of effectiveness, portability, field readiness, and reusability for HS/HE treatment. Current FDA pathways do not require reporting of key performance metrics, highlighting a regulatory gap. There is a need for development of field-appropriate solutions and revised evaluation standards that prioritize cooling performance, resource independence, and usability in austere environments.