From the Guidelines
Heat exhaustion should be treated immediately by moving the individual to a cool environment, removing excess clothing, limiting exertion, and providing cool liquids if the person is able to swallow, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When diagnosing heat exhaustion, it is essential to identify symptoms such as heavy sweating, weakness, dizziness, nausea, headache, and a rapid pulse.
- Key steps in treatment include:
- Moving the person to a cool place
- Removing excess clothing
- Limiting exertion
- Providing cool liquids if the person is able to swallow, as stated in the guidelines 1
- If the person shows signs of heatstroke, such as altered mental status, it is crucial to activate emergency services immediately, as recommended by the guidelines 1.
- In cases of heatstroke, immediate active cooling using whole-body cool- to cold-water immersion for 15 minutes or until neurological symptoms resolve is reasonable, according to the guidelines 1.
- Other forms of active cooling, including commercial ice packs, cold showers, ice sheets and towels, cooling vests and jackets, and evaporative, fanning, or a combination of techniques, can be used when water immersion is not available, as suggested by the guidelines 1.
- It is also important to note that the target core temperature to cool until is 39° C (102.2° F), as stated in the guidelines 1.
- Prevention of heat exhaustion includes staying hydrated, avoiding outdoor activities during peak heat, wearing lightweight clothing, and acclimatizing gradually to hot environments.
From the Research
Diagnosis of Heat Exhaustion
- Heat exhaustion is part of a spectrum of heat-related illnesses that can affect all individuals, although children, older adults, and those with chronic disease are particularly vulnerable 2
- Signs and symptoms of heat exhaustion may develop suddenly or over time, and can be worsened by dehydration due to inadequate access to water or insufficient fluid replacement 2
- Heat exhaustion can be characterized by nonspecific symptoms such as malaise, headache, and nausea 3
Treatment of Heat Exhaustion
- Heat exhaustion can be managed by the immediate reduction of heat gain by discontinuing exercise and reducing radiative heat source exposure 2
- The individual should be encouraged to drink cool fluids and remove or loosen clothing to facilitate heat loss 2
- In more extreme situations, more aggressive cooling strategies (e.g., cold shower, application of wet towels) to lower core temperature should be employed 2
- Active cooling is recommended for patients with heat stroke and heat exhaustion, and has been shown to be associated with lower in-hospital mortality in patients with severe heat illness 4
Prevention of Heat-Related Illnesses
- Heat-related illnesses such as heat exhaustion can be prevented by increasing public awareness of the risks associated with exposure to high temperatures and prolonged exercise 2
- Programs involving identification of vulnerable individuals, dissemination of information about dangerous heat waves, and use of heat shelters may help prevent heat-related illness 3
- Preventive strategies also include early recognition by health workers, socialization to vulnerable groups, and adequate acclimatization 5
Management of Heatstroke
- Heatstroke is a life-threatening and the most severe form of heat-related illnesses, characterized by body temperature >40ºC and central nervous system dysfunction 5
- The basic principle of heatstroke management is early resuscitation and immediate cooling, which can be achieved through cold water immersion or convection evaporation method 5
- Prompt recognition and immediate cooling through evaporation or full-body ice-water immersion are crucial in the treatment of heatstroke 3