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A national protocol can be lifesaving for patients with heat illness. Only 11 states require it.
During football practice in Fort Myers, Florida, 17-year-old Zach Martin collapsed. His body temperature hit 107 degrees, and when the ambulance arrived on the scene, he was unresponsive and moaning, according to his mother Laurie Giordano.
“I just remember the panic that was setting in in that moment,” Giordano said. “They were just assessing him and then loading him up.”
But what Giordano didn’t know is that when a patient is overheated, the national recommendation is not to load the patient and rush them to the hospital. It’s a technique called “Cool First, Transport Second.” In that process, a patient’s body temperature is brought back down before they are transported to the hospital. It can be lifesaving. However, just 11 states require ambulance services to follow that protocol.
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Zach died from organ failure 11 days after his collapse. Giordano believes that her “gentle and kind and funny” son could have survived if “Cool First, Transport Second” had been followed.
“As a mother, that first heartbeat is really important to hear on the sonogram,” Giordano said. “I heard his last heartbeat too.”
What is “Cool First, Treat Second?”
Matt Willens is a paramedic who practices “Cool First, Transport Second” when treating a patient who is experiencing extreme heat illness.
The process starts with ice. Then, the patient is loaded into a bag. Ice and water are poured in, and the bag is zipped, with one arm hanging out so Willens can monitor the patient’s blood pressure. This impromptu ice bath allows the patient to cool down rapidly, reducing the impacts of heat illness.
“Now we’re treating them in the field and making that difference and that could save their life,” Willens explained. “That is going to save their life.”
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The National Association of EMS Officials recommends this protocol when a patient’s core temperature is above 104 degrees Fahrenheit. The patient should remain in the ice bath until their body temperature falls to 102.2 degrees. Then, they can be transported to the hospital.
Preparing for heat illness in a warming world
“Cool First, Transport Second” is more critical than ever as climate change makes summers hotter and hotter. Multiple dangerous heat waves struck the United States in 2024, and excessive heat is the No. 1 cause of weather-related deaths in the United States. Around the world, rising temperatures have caused hundreds of deaths this year.
Heat illness is likely to become more common. A study from the National Institutes of Health found that cardiovascular deaths due to extreme heat are projected to increase in the U.S. between 2036 and 2065, CBS News previously reported, with older and Black adults likely to be disproportionately affected.
Children are also more vulnerable to extreme heat. More than 9,000 high school athletes like Zach are treated for heat-related illnesses every year.
After years of advocacy, Giordano worked with the Florida legislature to pass a law requiring an on-site ice bath at all outdoor high school athletic events. The law, known as the “Zachary Martin Act,” also requires schools to learn about how to treat excessive heat, modify athletic activities based on temperature, and require coaches to complete annual training about how to identify and treat heat illness.
“If you can, if we can get the first response to be cool, then then that’s gonna be where where the lives are saved,” Giordano said.
Giordano said she’s not stopping with high schools. She wants all of the nation’s ambulances to cool heat victims on the spot.
“Everybody has heat waves in this country,” Willens said. “And this is the future of how these heat emergencies should be treated.”
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California Gov. Gavin Newsom vetoed a bill Saturday that would have required new cars to beep at drivers if they exceed the speed limit in an effort to reduce traffic deaths.
California would have become the first to require such systems for all new cars, trucks and buses sold in the state starting in 2030. The bill would have mandated that vehicles beep at drivers when they exceed the speed limit by at least 10 mph.
The European Union has passed similar legislation to encourage drivers to slow down. California’s proposal would have provided exceptions for emergency vehicles, motorcycles and motorized scooters.
In explaining his veto, Newsom said federal law already dictates vehicle safety standards and adding California-specific requirements would create a patchwork of regulations.
The National Highway Traffic Safety “is also actively evaluating intelligent speed assistance systems, and imposing state-level mandates at this time risks disrupting these ongoing federal assessments,” the Democratic governor said.
Opponents, including automotive groups and the state Chamber of Commerce, said such regulations should be decided by the federal government, which earlier this year established new requirements for automatic emergency braking to curb traffic deaths. Republican lawmakers also said the proposal could make cars more expensive and distract drivers.
The legislation would have likely impacted all new car sales in the U.S., since the California market is so large that car manufacturers would likely just make all of their vehicles comply.
California often throws that weight around to influence national and even international policy. The state has set its own emission standards for cars for decades, rules that more than a dozen other states have also adopted. And when California announced it would eventually ban the sale of new gas-powered cars, major automakers soon followed with their own announcement to phase out fossil-fuel vehicles.
Democratic state Sen. Scott Wiener, who sponsored the bill, called the veto disappointing and a setback for street safety.
“California should have led on this crisis as Wisconsin did in passing the first seatbelt mandate in 1961,” Wiener said in a statement. “Instead, this veto resigns Californians to a completely unnecessary risk of fatality.”
The speeding alert technology, known as intelligent speed assistance, uses GPS to compare a vehicle’s pace with a dataset of posted limits. If the car is at least 10 mph over, the system emits a single, brief, visual and audio alert.
The proposal would have required the state to maintain a list of posted speed limits, and it’s likely that those would not include local roads or recent changes in speed limits, resulting in conflicts.
The technology has been used in the U.S. and Europe for years. Starting in July, the European Union will require all new cars to have the technology, although drivers would be able to turn it off. At least 18 manufacturers including Ford, BMW, Mercedes-Benz and Nissan, have already offered some form of speed limiters on some models sold in America, according to the National Transportation Safety Board.
The National Highway and Traffic Safety Administration estimates that 10% of all car crashes reported to police in 2021 were related to speeding. This was especially a problem in California, where 35% of traffic fatalities were speeding-related — the second highest in the country, according to a legislative analysis of the proposal.
Last year the NTSB recommended federal regulators require all new cars to alert drivers when they speed. Their recommendation came after a crash in January 2022, when a man with a history of speeding violations ran a red light at more than 100 mph and struck a minivan, killing himself and eight other people.
