What is the protocol for managing heat illness?

Protocol for Heat Illness Management

For individuals with heat illness, immediate cooling through whole-body cold water immersion is the most effective first-line treatment, especially for those with heatstroke (heat illness with altered mental status), and emergency medical services should be activated immediately. 1

Classification of Heat Illness

Heat illness exists on a spectrum from mild to severe:

• Heat Cramps: Painful involuntary muscle spasms affecting calves, arms, abdomen, and back
• Heat Exhaustion: Moderate illness with inability to maintain blood pressure and cardiac output
  • Symptoms: weakness, dizziness, nausea, syncope, headache, fatigue, heavy sweating
  • Core temperature ≤104°F (40°C)
• Exertional Heat Stroke: Severe multi-system illness with CNS abnormalities
  • Symptoms: delirium, convulsions, coma, endotoxemia, circulatory failure
  • Core temperature ≥104°F (≥40°C)
  • Potentially fatal if not treated promptly

Emergency Protocol for Heat Illness

For All Heat Illness Cases:

1. Move the person from the hot environment
2. Remove excess clothing
3. Limit physical exertion
4. Provide cool liquids if the person can swallow 1

For Heat Exhaustion:

1. Have victim lie down in a cool place
2. Remove as many clothes as possible
3. Cool with cool water spray
4. Encourage drinking cool fluids with carbohydrates and electrolytes 1
5. Monitor for progression to heat stroke

For Heat Stroke (Medical Emergency):

1. Activate emergency medical services immediately 1
2. Initiate rapid cooling:
   • Preferred method: Whole-body (neck-down) cold water immersion for 15 minutes or until neurological symptoms resolve 1
   • If immersion not available: Apply ice packs to neck, axillae, and groin; use cold showers, ice sheets/towels, cooling vests, or evaporative cooling with fanning 1
3. Continue cooling until core temperature reaches 39°C (102.2°F) or symptoms improve 1
4. Monitor vital signs and mental status
5. Prepare for transport to medical facility

Special Considerations

For Children:

• Use the same cooling protocols as adults, with whole-body cold water immersion being the preferred method 1
• Adjust fluid replacement volumes: 100-250 mL every 20 minutes for 9-12 year-olds; up to 1.0-1.5 L per hour for adolescents 1

For Athletes:

• Have on-site rectal temperature monitoring capabilities at finish-line medical facilities 1
• Use a six-person team for safe submersion of combative or somnolent athletes 1
• Remove from ice submersion when core temperature decreases to 101.4°F (38.6°C) to prevent hypothermia 1

Prevention Strategies

1. Hydration:

   • Ensure sufficient, sanitary fluid is readily accessible
   • Consume fluids before, during, and after physical activity
   • For long-duration (≥1 hour) activities, consider electrolyte-supplemented beverages 1

2. Acclimatization:

   • Allow gradual adaptation to heat (typically over 10-14 days)
   • Progressively increase exposure to environment, intensity, and duration of activity 1

3. Activity Modification:

   • Modify exercise based on environmental heat stress
   • Anyone experiencing heat illness should not return to activity for the remainder of the session 1

4. Emergency Preparedness:

   • Develop written emergency action plans
   • Ensure availability of cooling equipment and trained personnel 1

Common Pitfalls to Avoid

1. Delayed cooling - The leading cause of morbidity and mortality in heat stroke 2
2. Failure to recognize heat stroke - Altered mental status is the key distinguishing feature
3. Inadequate cooling methods - Cold water immersion is superior to other cooling techniques
4. Relying on oral temperature - Rectal temperature is the most accurate method for core temperature assessment
5. Premature return to activity - Athletes with heat stroke should refrain from physical activity for at least 7 days after medical clearance 3

By following this protocol, heat illness can be effectively managed to minimize complications and prevent fatalities.