Exertional heat stroke (EHS) is prevalent across the entire United States but more commonly occurs in the Southern part of the country. Recent studies have identified a low adoption rate of athletic trainers (ATs) using best practices in managing EHS. This study aimed to identify AT’s use of rectal thermometry and cold-water immersion. We surveyed 116 ATs in Heat Safety Category Region 3 practicing in: secondary schools, universities/colleges, youth sports, professional sports, performing arts, or military/government. We identified a statistically significant difference between ATs’ actual and planned use of rectal thermometry and cold-water immersion. Athletic trainers who used EHS best practices felt confident in differentiating EHS from other conditions.