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. 2019 Feb 18;10:108. doi: 10.3389/fphys.2019.00108

FIGURE 2.

FIGURE 2

Comparison of exertional heat stroke (EHS) triage flow charts between the accepted gold-standard by the current scientific literature (A, left; Belval et al., 2018) and the current Japanese medical standard allowed by domestic medical regulations (B, right; Japanese Association for Acute Medicine, 2015). (A-1), EHS is diagnosed with rectal thermometry; (A-2), primary method of cooling is whole-body cold-water immersion; and (A-3), rectal temperature is monitored continuously to determine the end point for the treatment. (B-1), EHS is diagnosed by clinical sign (i.e., alertness) and (B-2), on-site cooling is optional and the methods are partial-body cooling.