From the Guidelines
Heat stroke treatment should prioritize immediate active cooling, with whole-body cool- to cold-water immersion for 15 minutes or until neurological symptoms resolve, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When treating heat stroke, it is essential to move the individual from the hot environment, remove excess clothing, limit exertion, and provide cool liquids if the person is able to swallow, as stated in the guidelines 1. Key considerations for heat stroke treatment include:
- Activating emergency services for people with heatstroke, characterized by altered mental status 1
- Initiating immediate active cooling using whole-body cool- to cold-water immersion for 15 minutes or until neurological symptoms resolve, for both adults and children 1
- Using alternative forms of active cooling, such as commercial ice packs, cold showers, ice sheets and towels, cooling vests and jackets, and evaporative, fanning, or a combination of techniques, when water immersion is not available 1
- Measuring core temperature during active cooling, with a target core temperature of 39° C (102.2° F), for trained and willing first aid providers 1 It is crucial to prioritize these cooling measures to rapidly lower the body temperature and prevent organ damage, as heat stroke can be life-threatening due to high temperatures denaturing proteins and damaging cells throughout the body.
From the Research
Heat Stroke Treatment Overview
- Heat stroke is a life-threatening condition that requires immediate treatment, with the primary objectives being rapid cooling and support of organ-system function 2.
- The prognosis of heat stroke is directly related to the degree of hyperthermia and its duration, making rapid cooling the most important feature in treatment 3.
Cooling Methods
- Immersion in an ice-water bath is considered the most effective cooling method, with evaporative cooling being a rapid and effective alternative 2, 4.
- Evaporative plus convective cooling may be augmented by crushed ice or ice packs applied diffusely to the body, and chilled intravenous fluids may also supplement primary cooling 4.
- Cold water immersion or convection evaporation method can be implemented based on the specific patient characteristic 5.
Treatment Protocols
- Aggressive IV rehydration should be continued for the first 24 to 72 hours to prevent the development of rhabdomyolysis-induced acute renal failure, with the goal of maintaining a minimum urine output of 2 mL/kg/h 2.
- Treatment of heat cramps consists of fluid and salt replacement (PO or IV) and rest in a cool environment, with IV magnesium sulphate being effective in relieving muscle cramping in severe cases 2.
- Preventive strategies include early recognition by health workers, socialization to vulnerable groups, and adequate acclimatization 5.
Recommendations
- Ice-water immersion has been shown to be highly effective in exertional heat stroke, with a zero fatality rate in large case series of younger, fit patients 4.
- Evaporative plus convective cooling is often promoted for older patients with nonexertional heat stroke 4.
- Protocols based on evaporative cooling are advocated as the most efficient, based on military and civilian experiences worldwide 6.