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Body bags filled with ice are helping save lives as heatstroke cases increase in Phoenix

Capt. John Prato with the Phoenix Fire Department, kneels over a manikin on the sidewalk outside Valleywise Health Medical Center. In this demonstration, the manikin is playing the role of someone who has passed out amid scorching heat. The most important thing, Prato says, is to get the patient off the hot ground and to start cooling down their body as quickly as possible.

The fire department does that now with water-tight body bags.

“We’re going to place them in this bag," Prato says. "There’s a lot of things happening at this point, we’re starting multiple IVs to give them cold fluids, we’re assessing their vital signs, their heart rate, their blood pressure."

Prato has a cooler next to him filled with bags of ice — the same kind you can get at a grocery store. He rips them open and starts pouring ice cubes into the bag with the patient. He zips the bag up to chest height.  Then, were this a real patient, not a manikin, the patient would then be transported in the bag to the emergency room.

“If we can cut down 20 or 30 minutes, just cooling them during drive time to the hospital, that shows an increase in survivability,” Prato said.

Timing is critical

The Phoenix Fire Department started using this technique last summer as a pilot program, but this year, it’s the official department protocol for heatstroke. Every Phoenix fire station, fire truck and fire department ambulance now has the supplies to provide this rapid cooling.

Heat-related deaths in the Phoenix area have skyrocketed in the past decade. In 2013, the county reported 75 heat deaths. In 2023, the death toll was a record-shattering 645.

Here at the Valleywise Health emergency department, doctors say the increase in heat-related illnesses has been alarming. Amid last summer’s relentless heat they would sometimes have four or five heatstroke patients arriving in the space of an hour. On average, those patients showed up to the hospital with body temperatures around 107 degrees. Nearly 40% of those patients last year died, the hospital reports.

But treating heatstroke patients with these ice-filled bags in ambulances and emergency rooms is making a difference, said Valleywise emergency department chair, Dr. Jeffrey Stowell.

“Prior to the implementation of this protocol, where we predominantly were doing fans, spraying water on them, maybe putting ice packs in their groin or axilla, we were seeing over an hour to an hour and a half to get somebody down,” Stowell said.

It takes just 10 to 30 minutes to lower a patient’s temperature in cold-water immersion, Stowell said.

That difference in timing is critical.

“For lack of a better word, they’re cooking their brains during this time,” Stowell said.

Stowell said among this hospital’s heatstroke patients last year who survived, nearly 20% suffered neurological damage.

“The longer their temperature is high and the longer their brain is hot, the worse their outcome will be,” Stowell said.

Heat is a growing threat everywhere

Valleywise Health Medical Center started treating heatstroke patients with the cold water immersion bags a few years ago, based on methods used in sports medicine and in the military. Other Phoenix-area emergency departments, along with the Phoenix Fire Department, have adopted similar techniques. But it’s not a commonly used practice around the country yet. Research about this treatment method is sparse — so far.

But Stowell said he has seen how effective it can be.

“They’re pretty unresponsive at those temperatures, it is not uncommon though, as we’ll cool them and they get down to a normal temperature, that they will start to wake up and even at times will wake up and talk to us and kind of respond immediately as they cool off,” Stowell said.

Medical teams can still monitor vital signs while patients are immersed. And they can get the patients out of the bags quickly once their temperature starts to drop.

The bags are inexpensive and Valleywise ER staff said cleanup is easy. As this hospital has ramped up use of this method over the past few years, there have been a few logistical challenges, like just not having enough ice on hand to fill the bags.

But emergency physician, Dr. Geoffrey Comp said the hospital has streamlined the process ahead of this summer.

“We’ve been able to partner with our cafeteria and food service workers to have all of our ice ready for us in huge, huge tubs,” Comp said.

It’s important to be prepared. If trends continue the way they’ve been going, doctors in this ER expect to see more heatstroke patients this summer and in years to come.

But while Phoenix is one of the hottest places in the country, heat is a growing threat everywhere. More than two-thirds of Americans experienced heat alerts in 2023, according to the Centers for Disease Control and Prevention.

Comp said the ice-filled body bags could be beneficial for other emergency rooms and fire departments.

“I keep in contact with a lot of residents that have graduated from our program and they’re telling me, ‘Hey, I did it up in Idaho, I did it over in California,’” Comp said. “It’s really encouraging to see that work that we’re doing here in Phoenix is hopefully taking off in other parts of the country.”

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Katherine Davis-Young is a senior field correspondent reporting on a variety of issues, including public health and climate change.