The TACO as a Convenient Cost-Effective Method of Treating Heat Illness

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August 28, 2018

By Claudia Curtis, MS, LAT, ATC

As sports are rapidly heading into pre-season practices, heat illness becomes a hot topic on everyone’s radar in the sports and medical communities. In light of a recent heat illness related death, the Florida High School Athletic Association has created a heat illness prevention video that is mandatory for all coaches and athletes to view and understand the signs and symptoms of heat illness, as well as the importance of an emergency action plan for heat illness. One district has publicized their purchase of Wet Bulb Globe Thermometers and cold-water immersion tubs preventatively to have on-site. There are other amazing tools to prevent heat emergencies, but what happens when the circumstances and finances do not allow for this?

Full body cold water immersion (CWI) has long been the gold standard of care for effectively treating heat illness.1 The guidelines for care have been clearly delineated; immediate on-site full body cooling needs to occur prior to transport. Full body CWI has been shown to provide the greatest body cooling rates.2 In the professional sports setting, an abundance of space and resources are available allowing for many of these tubs to be filled and ready daily if the need were to ever arise. However, what happens in a high school setting where there is no storage or money for a tub, no ice machine onsite, no water hook-up or even no Athletic Trainer present? While our immediate reaction may be that you don’t practice there, the reality is that these are some of the conditions present in high school athletics, particularly in urban school settings where teams may practice off-site without access to resources or authorization of entry to certain areas. How can we keep them safe?

Sections of recent heat illness research have focused on a different approach to cooling, especially in places where logistics get more challenging (mobile events, e.g. races, off-site events). Tarp Assisted Cooling Oscillation (TACO) is a method in which a combination of ice and cold water are added to an athlete once they have been placed on a tarp with the edges held up by clinicians to create a physical “taco” for the patient to be encased inside.3-4 Logistically, this eliminates the need for a patient to be lifted up into a tub to be cooled. From an execution perspective, a minimum of 3 people will be needed to assist with cooling the patient. At least 2 people will be needed to hold the tarp, 1 on each side. One person will need to assist by adding the water and ice at the foot end of the patient, making sure to keep the affected patient’s head and chest above water. This is most easily accomplished by dumping coolers of ice and water into the tarp, which can easily be filled and transported on-site at minimal cost. Once the patient is in the TACO, water can be oscillated by the 2 people holding the tarp by moving the sides up and down (think of a parachute like in elementary school Physical Education class). Emptying of the TACO once treatment has completed is simple; let go. The personnel involved require minimal training to be able to properly execute this emergency action plan.

The 2 research studies differed on how much ice or water they used to complete their research, but the results were the same. Both studies found TACO protocols appropriately cooled the body’s core temperature at a statistically appropriate rate when compared to the gold standard CWI, measured via rectal temperature. 3-4 For those with limited resources, the TACO technique may provide a simple cost effective alternative when traditional CWI treatment is not readily available to provide the best opportunity for favorable outcomes when heat illness presents.


1. Casa DJ, DeMartini JK, Bergeron MF, et al. National Athletic Trainers’ Association position statement: exertional heat illnesses. J Athl Train. 2015;50(9):986–1000.

2. Casa DJ, McDermott BP, Lee EC, Yeargin SW, Armstrong LE, Maresh CM. Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev. 2007;35(3):141–149.

3. Luhring KE, Butts CL, Smith CR, et. al. Cooling Effectiveness of a Modified Cold-Water Immersion Method After Exercise-Induced Hyperthermia. J Athl Train. 2016; 51(11): 946-951.

4. Hosokowa Y, Adams WM, Belval LN, et al. Tarp-Assisted Cooling as a Method of Whole-Body Cooling in Hyperthermic Individuals. Annals of Emergency Medicine. 2017; 69(3): 347-352.

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