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Heat-Related Illness: It's hot out there! Be alert for heat-related illness.

Jul 27, 2015

[From the Health and Human Services Office of the Assistant Secretary for Preparedness and Response]

The Office of the Assistant Secretary for Preparedness and Response is committed to providing EMS practitioners with timely and useful information. Below is an informational sheet about heat-related illnesses targeted at EMS professionals.  (Emergency Care Coordination Center; eccc@hhs.gov.



As temperatures outside increase in areas across the country, it important for EMS practitioners to be vigilant about heat-related illnesses.  The Office of the Assistant Secretary for Preparedness and Response is committed to providing you with useful resources to help you, as EMS professionals.  In the field, you may encounter patients experiencing heat-related health conditions. Additionally, heat illnesses can pose a threat to your safety.  Below, you will find information and resources on how you can recognize and respond to threats of extreme heat.

Protect Yourself

Ideally, you should avoid exposure to extreme heat, sun exposure, and high humidity. As a responder, you may be in situations in which it is impossible to avoid being in hot environments for extended periods of time. In these cases, you should take the following steps to prevent heat stress:

  • If possible, wear light-colored, loose-fitting, breathable clothing.  Unfortunately, turnout gear, personal protective equipment, and many uniforms are not designed with breathability in mind. Avoid non-breathing clothing if possible.
  • Be aware that protective clothing (turnout gear) or personal protective equipment may increase the risk of heat stress.
  • Take breaks whenever possible in extreme heat and humidity. Get into the shade or a cool area when you can.
  • Drink water frequently. Drink enough water that you never become thirsty. Approximately 1 cup every 15-20 minutes.
  • Avoid drinks with large amounts of caffeine or sugar.
  • Some medications can make it harder to respond to heat stress. Talk with your physician about any questions you may have.
  • Monitor your physical condition and that of your coworkers. (NIOSH)

Quick Clinical Review: Types of Heat-Related Illness


Heat stroke

Heat stroke is the most serious heat-related disorder. It occurs when the body becomes unable to control its temperature: the body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. When heat stroke occurs, the body temperature can rise to 106 degrees Fahrenheit or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not given. (NIOSH)

Symptoms of heat stroke include:

  • High body temperature
  • Hot, red, dry or moist skin
  • Rapid and strong pulse
  • Possible unconsciousness (CDC

Management:

Heat stroke is potentially life threatening and requires rapid intervention and transport to the emergency department. The patient requires removal from the heat, clothing removed and cooled as soon as possible. If immersion is impossible the patient should have ice packs applied to the groin, axilla, and neck area and the patient should be fanned. Fanning the patient while sprinkling with water may increase evaporative losses until the patient's temperature is below 39 C (102.2 F). Massaging the extremities may be helpful. Many of these patients are severely dehydrated and should be bolused with 20 mg/kg of NS. Further replacement of fluids and monitoring should reflect the patient's condition. (CHEMM)


Heat exhaustion

Heat exhaustion is the body's response to an excessive loss of the water and salt, usually through excessive sweating. People most prone to heat exhaustion are those that are elderly, have high blood pressure, and those working in a hot environment. (NIOSH)

Symptoms of heat exhaustion include:

  • Heavy sweating
  • High body temperature
  • Hot, red, dry or moist skin
  • Rapid and strong pulse
  • Possible unconsciousness (CDC)

Management:

Remove the patient from the hot environment. Mild dehydration can be managed with oral replacement of fluids i.e. 1 tsp of NaCl mixed with 500 ml of water or a stock electrolyte solution given over 1 - 2 hours. Severe dehydration should be treated with a bolus of 20 ml/kg of NS given over an hour followed by a rehydration protocol. (CHEMM)


Heat cramps

Heat cramps usually affect people who sweat a lot during strenuous activity. This sweating depletes the body's salt and moisture levels. Low salt levels in muscles causes painful cramps. Heat cramps may also be a symptom of heat exhaustion.


Symptoms of heat cramps include:

  • Muscle pain or spasms usually in the abdomen, arms, or legs. (NIOSH)

Management:

Remove the patient from the hot environment. Mild dehydration can be managed with oral replacement of fluids i.e. 1 tsp of NaCl mixed with 500 ml of water or a stock electrolyte solution given over 1 - 2 hours. Severe dehydration should be treated with a bolus of 20 ml/kg of NS given over an hour. (CHEMM)


At-Risk Populations

Specific populations may be at greater risk for heat related illness, including:


Kids in Hot Cars!

Vehicles heat up quickly! The National Highway Traffic Safety Administration (NHTSA) and other safety advocates and academic institutions have recognized the safety threat posed for leaving children in hot cars. Heat stroke can occur in temperatures as low as 57 degrees. On an 80-degree day, temperatures inside a vehicle can reach deadly levels in just 10 minutes. Heat stroke is the leading cause of non-crash-related fatalities for children 14 and younger. Children are at a higher risk than adults of dying from heat stroke in a hot vehicle especially when they are too young to communicate. Children’s body temperature can heat up 3 to 5 times faster than adults. A core temperature of 107 is lethal.

Helpful Tips to Prevent Child Heatstroke in Cars:
  • If you respond to a call with a child locked in a car, you must act quickly. If the child has any decreased level of consciousness, do not hesitate to gain access in any way necessary.
  • If a child is missing, quickly check all vehicles, including the trunk.
  • Keep an eye out for unattended kids left in cars.


Additional Resources

Centers for Disease Control and Prevention

Federal Emergency Management Agency

National Highway Traffic Safety Administration

Occupational Safety & Health Administration

Office of the Assistant Secretary for Preparedness and Response

U.S. National Library of Medicine