It’s that time of year again, and in California we are experiencing heat waves and wild fires. With high humidity and temperatures over 100°F many people are at risk for a heat illness, especially our firefighters. Communities have opened up cooling centers for heat illness prevention and to prevent emergencies and deaths related to the high temperatures.
→ The CDC reports that about 618 people die each year in the United States from a heat related illness.
Los Angeles County is helping citizens by turning Senior centers, Libraries and Recreation Centers into cooling centers during business hours.
Heat Related Illness and the EMT
So what can you do as a first responder to help patients with a heat related illness?
As an EMT it’s important to be able to identify and treat the different heat related emergencies and know when the patient’s life is at risk. This guide also covers heat stroke prevention for friends and family outside of the work environment.
Specific protocols for heat exhaustion treatment and heat stroke treatment can vary by state and county. This post has general guidelines for EMTs and first responders for responding to a heat related illness.
If you want a refresher from your EMT book, most books will have this topic listed in the chapters about environmental emergencies.
There are two heat related illnesses that you are likely to encounter as an EMT, especially if you spend time working or volunteering at special events. These are heat exhaustion and heat stroke.
What is Heat Exhaustion
A heat exhaustion definition according to Merriam Webster:
A condition marked by nausea, dizziness, weakness and profuse sweating that results from physical exertion in a hot environment.
The combination of power outages, high humidity and extreme temperatures, reaching 118° in cities like Riverside and Chino, California in July, 2018 means physical exertion is not a requirement for heat exhaustion. Individuals could be at risk for it while in their own home.
Whether it is exercise or an environment with extreme temperatures that brought on the heat exhaustion, you will see a patient with volume depletion from sweating.
Signs and Symptoms of Heat Exhaustion
Core Body Temperature (CBT) will be normal or slightly elevated, but will always be below 104°F in heat exhaustion.
- Profuse sweating
- Orthostatic hypotension
- Pale, clammy skin
The patient will usually appear wet, pale and weak. They will often feel dizzy and need to sit or lay down. Patients may be too weak and fatigued to help cool themselves. For this reason, friends or family need to help the person cool down while waiting for EMS to arrive.
The patient may present with eyes closed, but patient should be able to answer your questions appropriately and won’t have neurological deficits.
Heat exhaustion is the less serious heat illness, but it can progress to heat stroke rapidly if cooling measures aren’t taken.
Heat exhaustion recovery time will depend on how quickly the patient can be removed from the heat source and whether they respond well to your cooling measures.
How to Treat Heat Exhaustion
The goal with heat exhaustion treatment is to decrease sweating, restore fluid volume and bring the body back to homeostasis.
As an EMT you will perform your normal assessments, making sure to first take the patient out of the sun and into a shady or air conditioned spot.
EMT Heat Exhaustion Treatment
- Remove patient from heat and keep rested. Take to air conditioned or shady place.
- Remove or loosen excess and restrictive clothing.
- Put in supine position with legs elevated. (Dizzy patients.)
- Rehydrate with fluids. Oral fluids ok for hydration if patient isn’t vomiting or nauseated.
- If patient isn’t improving with heat exhaustion treatment or if they have an increased temperature, beginning using evaporation for cooling measures.
- Get water and drip, gently wipe, or spray it on the patient and then fan the skin. Do not cause shivering.
Heat exhaustion recovery time is usually fast once the patient is at rest in a cool environment and fluids are replenished.
→ It can take around 20 to 30 minutes for heat exhaustion recovery time once the patient has been removed from heat and given fluids.
However, watch for signs and symptoms of heat stroke because heat exhaustion can quickly become heat stroke.
Advanced EMTs and paramedics can also consider establishing an IV to infuse a fluid bolus as part of heat exhaustion treatment.
Heat Stroke vs Heat Exhaustion Infographic
What is Heat Stroke
A heat stroke definition according to Merriam Webster is:
A life-threatening condition marked especially by cessation of sweating, extremely high body temperature, and collapse that results from prolonged exposure to high temperature.
Heat stroke is a true medical emergency that requires immediate, aggressive treatments. It involves a body temperature of 104° F (40° C) or higher and can lead to multi-system organ failure, coagulopathy and even death.
→ Unlike heat exhaustion, heat stroke may require prolonged hospitalization.
Heat stroke can be classified as either classic or exertional heat stroke.
Exertional Heat Stroke
Exertional heat stroke typically happens in people who are exercising when it’s hot out or during high humidity. Healthy individuals running marathons, college athletes, soldiers and even manual laborers can find themselves overcome with heatstroke under the right conditions.
Weather temperatures don’t have to be severe for exertional heat stroke. However, it commonly happens in high humidity because the humidity makes perspiration an inefficient cooling mechanism.
Classic Heat Stroke
Classic or nonexertional heat stroke is more common as a result of environmental temperatures rather than from physical exertion. Young children, elderly and individuals with chronic illness are commonly victims of this type of heat stroke during heat waves.
→ These patients tend to take a longer time responding to treatments and will likely need to be admitted to the hospital as a result of their heat illness.
Signs and Symptoms of Heat Stroke
- Rapid pulse
- High temperature/Fever
- Red, hot, dry skin
- Rapid breathing/Panting
The patient’s respirations can look like panting. Breathing will become rapid to help increase body heat loss by exhaling air.
Cardiac output increases to push more blood to the skin and muscle as the body attempts to enhance heat radiation and aid in cooling.
What to do for Heat Stroke
Ideally an EMT getting called to a patient with heat stroke should immediately request an ALS unit.
Your initial assessments will likely reveal a patient with an altered level of conciousness, hot dry skin, rapid breathing, increased heart rate and a temperature of about 104°F or higher.
A heat exhaustion patient that goes from sweating heavily to completely dry skin while also experiencing a decrease in consciousness may have progressed to heat stroke.
For these patients aggressive cooling and volume replacement are the main priorities of heat stroke treatment. In some situations BLS will need to transport and should perform the interventions below while rapidly transporting to the nearest ED. Heat stroke is the most serious heat related illness and will likely need additional interventions.
How to Treat Heat Stroke
Heat stroke treatment should be transferred to ALS whenever possible because IV fluid replacement and cooling are the main goals. Patients are also at risk for seizures and may need IV anticonvulsants en route to the hospital.
EMT Heat Stroke Treatment
- Remove from Heat – Take to shade or an air conditioned place. Immediate cooling is the most important intervention in heat stroke.
- Management of ABC’s – Patient may be unconscious and need airway support.
- Clothing – Remove excess clothes for cooling and any restrictive clothing.
- Postitioning – Put in supine position with legs elevated.
- Vital Signs – Obtain vitals and continue to monitor temperature of patient.
- Assessments – Perform assessments as needed while performing cooling interventions. Include mental status, skin, heart, lungs, neurological, Glasgow Coma Scale, etc.
- Rapid Cooling – Place ice packs on axillae, groin and trunk. Pour water on patient and fan for evaporative cooling.
- Don’t Cause Shivering – Stop cooling interventions if patient’s temperature drops to 102°F.
- O2 – Apply oxygen as needed.
AEMT/Paramedic Heat Stroke Treatment
Hypotension, seizures, renal failure, hyponatremia and multi organ failure are all possible complications of heat stroke.
In addition to the EMT care provided above, paramedics can:
BGL – Get a blood glucose level on any altered patient.
IV – Initiate IV access and administer fluids.
BP – Monitor BP and provide blood pressure support as needed.
Seizure – Be prepared to administer anticonvulsant therapy in the event of seizures.
EKG – Monitor EKG for onset of heat related cardiac dysrhythmias.
What Heat Related Illness Looks Like
Here is a couple video showing contestants on survivor experiencing a heat related illness live. Caleb is a great example of heat stroke for anyone who has never seen the signs and symptoms of heat stroke take place on a real person.
Video – Heat Illness on Survivor
Later interviews with Caleb reveal that he doesn’t remember much after walking towards a shady spot in the sand. He says he felt dizzy and had a bad headache before becoming unconscious.
After being evacuated by helicopter, Caleb spent 5 days in the ICU receiving heat stroke treatment. He said he didn’t begin to feel well again until about the third day.
Heat Illness Risk Factors
Now that you know how to identify when a heat illness is life threatening and how to treat heat stroke, let’s discuss who is most at risk for getting overheated.
→ Anyone can develop a heat related illness, but there are factors which make you more likely to develop heat exhaustion or heat stroke.
Children – Young children haven’t fully developed the ability to regulate temperature yet. They are also at risk for a heat related illness because they have smaller organ and vascular systems which don’t dissipate heat as efficiently as adults.
Older Adults – Older adults are more at risk for a heat illness because they are more likely to have preexisting medical conditions and be taking prescription medications. They also tend to sweat less, take longer to feel thirsty and take longer to acclimatize to heat.
Dehydration – Dehydration makes it harder for the body to cool itself, leading to a faster downfall into a heat illness. Staying hydrated can help prevent the onset of heat exhaustion.
Preexisting Conditions – Conditions like cardiac disease or diabetes can affect an individual’s ability to adapt to their environment.
High Heat and Humidity – When temperatures and humidity are high it’s difficult for the body to cool itself using normal mechanisms like sweating.
Homeless – Without shelter the homeless are at risk for a heat related illness whenever there are extreme temperatures.
People who work outdoors: People who work outdoors in the heat have a high risk for a heat related illness. This includes jobs like fire fighters, construction workers, soldiers and farmers.
Alcohol – Alcohol is a diuretic which can lead to dehydration. It can also affect judgement.
Prescription Drug Use – Many prescription drugs can interfere with the bodies cooling mechanisms and put patients at risk for a heat illness.
→ Diuretics lead to dehydration and an electrolyte imbalance.
→ Antihistamines, sedatives and tranquilizers can contribute to heat illness by decreasing the ability to sweat.
→ Beta blockers prevent the body from increasing heart rate and cardiac output as cooling measures.
There are many other medications that can contribute to a heat illness, including ACE inhibitors, antidepressants and calcium channel blockers.
Heat Illness Prevention
As an EMT, educating people about heat illness prevention is a good way help avoid a future emergency situation. You can also help friends and family by giving them information about how to stay safe in extreme conditions.
Be sure to inform loved ones about family members most at risk for a heat related illness so they can check in on them on high heat days.
Emts and paramedics should also be aware of heat illness prevention steps for their own safety. You and your partner are also vulnerable to overheating while caring for patients throughout your shift. On hot days consider replacing caffeinated or sugary drinks with water.
→ Early signs of a heat illness are dizziness, headache, cramps and nausea. A person exhibiting these should stop physical exercise and rest in a cool environment.
Heat Illness Prevention Steps
– Stay Hydrated: Replace fluid loss and stay hydrated with oral intake. If you are sweating profusely, consider a sports drink to help with electrolyte replacement. To stay hydrated you should avoid caffeinated drinks, alcohol and sugary sodas on extremely hot days.
– Physical Activity: Part of heat illness prevention may involve decreasing or cancelling activities that require physical exertion. If the weather is 110°F, consider cancelling tennis practice or rescheduling a 5k run.
It is suspected that people who have had a heat related illness in the past will be more susceptible to a heat illness in the future. For this reason, avoiding getting overheated is worth the hassle.
– Wear Loose Fitting clothing: Wear light-weight, non-restrictive clothing.
– Avoid Direct Sunlight: It’s much hotter in direct sunlight and there is more risk for sunburn.
– Go to Air Conditioning: If your home doesn’t have air conditioning, go to a library, shopping mall, bookstore, coffee shop or any other cooled place. Spending a couple hours in air conditioning on very hot days can help your body avoid overheating.
Many public buildings are being turning into cooling centers during extreme heat. Contact your local Health Department for details on cooling centers near you.
– Schedule Activities: When possible, schedule outdoor work and exercise for early morning when it’s cooler. Take frequent rest breaks in the shade and stay hydrated during activity.
– Know the Signs: An important step in heat illness prevention is to know the signs of a heat illness and pay attention to your body’s signals. Stop what you are doing, get to a cool place and hydrate if you feel dizzy with a headache.
– Don’t Leave Anyone in a Vehicle: Never leave children, pets or even the elderly in a hot parked car with the engine off. Even with the windows down on a hot day, it’s dangerous and there have been many deaths as a result of well intentioned people leaving kids in cars.
– Help High Risk Individuals: Check in on elderly family and friends who don’t have air conditioning during extremely hot days. Encourage friends and family to do the same with friends and family who have risk factors for heat illness.
– Prevent Sunburns: Sunburns interfere with the bodies natural cooling methods and can make you more prone to a heat illness. Use sunscreen with an SPF of at least 15 and reapply frequently to prevent sunburns.