Individualized patient care is ideal to treat and rehabilitate athletic illnesses and injuries. Exertional heat stroke (EHS) treatment best practice recommendations state all patients should undergo identical cold water immersion (CWI) treatment for ideal outcomes. It is unknown, however, if CWI can be optimized with individualized treatment plans, encouraging personalized medicine. To accomplish this task, clinicians and researchers need to better understand factors impacting CWI effectiveness. This short report will provide an update to the American College of Sports Medicine Roundtable on Exertional Heat Stroke, review recent research regarding EHS treatment, and identify knowledge gaps in EHS treatment.