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Exertional heat stroke (EHS) is among the leading causes of sudden death during sport and physical activity. However, previous research has shown that EHS is 100% survivable when rapidly recognized and appropriate treatment is provided. Establishing policies to address issues related to the prevention and treatment of EHS, including heat acclimatization, environment-based activity modification, body temperature assessment using rectal thermometry, and immediate, onsite treatment using cold-water immersion attenuates the risk of EHS mortality and morbidity. This article provides an overview of the current evidence regarding EHS prevention and management. The transfer of scientific knowledge to clinical practice has shown great success for saving EHS patients. Further efforts are needed to implement evidence-based policies to not only mitigate EHS fatality but also to reduce the overall incidence of EHS.