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Military standard operating procedures translated into civilian best practice: delivery of cold water immersion to treat exertional heat stroke at Brighton marathon 2023
  1. Todd Leckie1,2,
  2. M J Stacey3,4,
  3. D Woods3,4,
  4. R Greenhalgh5,6,
  5. R Galloway2,5,
  6. C Kipps7 and
  7. R Hemingway8,9
  1. 1School of Sport and Health Sciences, University of Brighton - Eastbourne Campus, Eastbourne, UK
  2. 2Brighton and Sussex Medical School, Brighton, UK
  3. 3Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  4. 4Carnegie School of Sport, Leeds Beckett University, Leeds, UK
  5. 5Emergency Medicine Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  6. 6Institute of Pre-Hospital Care, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
  7. 7Institute of Sport, Exercise and Health, Faculty of Medical Sciences, University College London, London, UK
  8. 8Medical Centre, Commando Training Centre Royal Marines, Exmouth, UK
  9. 9Department of Sport and Health Sciences, University of Exeter, Exeter, UK
  1. Correspondence to LtCol M J Stacey, Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham B15 2SQ, UK; M.stacey13{at}

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Exertional heat stroke (EHS) poses a threat to UK Service Personnel and is a Research & Clinical Innovation (R&CI) priority in the Defence Medical Services (DMS). Initiated promptly, body cooling may rapidly and completely reverse brain dysfunction and mitigate the risk of multiple organ failure.1 2 Cold water immersion (CWI) is the preferred cooling modality in EHS guidelines1 3 and the optimal method applicable to UK Service Personnel.

Despite adoption of CWI at the Commando Training Centre Royal Marines (CTCRM),2 its uptake in wider UK military and civilian race medicine remains limited. Potential barriers to implementation include lack of awareness; unfamiliarity with the methods and systems available; and potential safety concerns for immersed casualties. These have been overcome at CTCRM,2 with over 50 casualties treated.

In early 2023, a collaboration was established between Brighton Marathon Medical Team (BMMT), CTCRM Medical Team and R&CI, in …

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  • Twitter @todd_leckie, @GreenhalghRob, @RossHemingway

  • Contributors MJS, TL and RH devised the study; MJS and DW secured material funding for the study; MJS, TL and R Galloway executed the study in the field; MS drafted the manuscript; all authors critically revised and approved the final draft and take responsibility for its contents.

  • Funding Research & Clinical Innovation (Royal Centre for Defence Medicine) funded the cooling pod acquisition. University of Brighton provided funding to peripheral/ancillary materiele (eg, warming blankets).

  • Competing interests RH is a Director of Nereus Medical Ltd, a sports medicine consultancy which specialises in the prevention, management and rehabilitation of heat illness.

  • Provenance and peer review Not commissioned; externally peer reviewed.