From the Guidelines
Heat stroke is a severe medical emergency that requires immediate action, and the most effective treatment is rapid cooling, intravenous fluids, and intensive monitoring and support in a hospital setting. The symptoms of heat stroke include confusion, lack of sweating despite heat, rapid heartbeat, headache, nausea, and unconsciousness, and it occurs when body temperature rises above 104°F (40°C) due to prolonged exposure to high temperatures or physical exertion in hot weather 1. If you suspect heat stroke, call emergency services right away and move the person to a cooler location. Remove excess clothing and cool the body with cold water, ice packs on the neck, armpits, and groin, or immersion in cold water if possible, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Recommendations
- Move the individual from the hot environment and remove excess clothing to help lower body temperature 1
- Provide cool liquids if the person is able to swallow, but do not give medications as they may interfere with the body's ability to regulate temperature 1
- Activate emergency services for people with heatstroke (heat illness with altered mental status) 1
- Initiate immediate active cooling using whole-body cool- to cold-water immersion for 15 minutes or until neurological symptoms resolve, or use other forms of active cooling such as commercial ice packs, cold showers, or evaporative cooling when water immersion is not available 1
Prevention and High-Risk Groups
People at higher risk of heat stroke include the elderly, young children, those with chronic illnesses, and individuals taking certain medications like diuretics or antipsychotics. Prevention involves staying hydrated, avoiding outdoor activities during peak heat, wearing lightweight clothing, and acclimatizing gradually to hot environments. Without prompt treatment, heat stroke can cause organ damage or death, emphasizing the importance of rapid cooling and medical attention 1.
From the Research
Symptoms of Heat Stroke
- Elevated body temperature 2
- Central nervous system dysfunction 2
- Hyperthermia (>40 °C/>104 °F) 3
- Nervous system dysregulation 3
Treatment of Heat Stroke
- Aggressive cooling [(2,4,5,6,3)]
- Management of life-threatening systemic complications 2
- External cooling devices 2
- Immersion in an ice-water bath [(4,6,3)]
- Evaporative cooling [(4,6,3)]
- Ice pack application 6
- Pharmacological treatment 6
- Invasive techniques 6
- IV rehydration 4
- Fluid and salt replacement 4
- Rest in a cool environment 4
- IV magnesium sulphate to relieve muscle cramping 4
- Body bag filled with cold water and ice as an alternative to cold-water immersion 5
Cooling Methods
- Immersion in water at different temperatures 6
- Evaporative cooling 6
- Ice pack application 6
- Pharmacological treatment 6
- Invasive techniques 6
- Water immersion techniques (using 1-17 °C water) 3
- Passive cooling 3
Important Considerations
- Early recognition and treatment are essential to reduce morbidity and mortality 2
- Rapid cooling should be initiated immediately at the time of collapse 6
- Cooling should be based on feasible field measures, including ice or tepid water 6
- Management should be matched to the patient's age and medical background 6