Environmental Emergencies: Emergency Care for Heatstroke

Overview of Heat Stroke

Heat stroke is an acute medical emergency that occurs when the temperature regulating mechanism of the body fails to stabilize the core body temperature. It normally occurs during long periods of heat waves especially if they are accompanied by high humidity. People who are at high risk are those not accustomed to hot humid temperatures, the elderly and very young, those who have debilitating diseases and those taking special medications that affect the thermo-regulating mechanism of the body.

Exertion heat stroke or heat stroke due to strenuous activities affects more of the healthy adult population wherein healthy individuals during intensive physical activities such as engaging in sports under extreme heat conditions result in a temporary dysfunction in the body’s temperature regulating mechanism.  Hyperthermia occurs when there is an inadequate dissipation of heat from the body which is very dangerous as it can lead to heat stroke and eventual death.

Gerontologic Considerations for heat stroke

HeatstrokeMost heat-related deaths happen in the elderly mainly because of their advance age can no longer cope and compensate stress imposed by intense heat. Elderly people’s compromised ability to perspire as well as their diminishing thirst stimulation to compensate for any increase in ambient heat makes them a high risk population for heat related emergencies. The risk of heat stroke is greater among the elderly also because this age group do not voluntarily drink enough fluids to keep their bodies well hydrated partly because of their apprehension of urinary incontinence. Proper care and consideration should be given to these individuals when caring as well as teaching them measures in preventing heat stroke.

Management   

The primary goal of managing heat stroke is to reduce the high temperature as quickly as possible because the longer the victim’s body temperature remains overheated, the risk of mortality increases as well. Simultaneous treatment focuses on stabilizing oxygenation prioritizing airway, breathing and circulation of emergency basic life support.

After the individual’s clothing is properly removed, the core temperature should drop slightly to 39 degrees Celsius. One or more of the following methods may also be used especially when treating victims on the field while waiting for transport to the emergency department.

  1. Cool sheets and towels or continuous sponging with cool water.
  2. Continuously apply ice to the neck, chest, groin and axillae while spraying with tepid water.
  3. Immersion of the patient in a cold water bath (if possible).

When the individual is properly transported to a more appropriate medical facility such as the emergency department and proper endorsement is given by field rescuers/paramedic,  the same methods to keep the victim cool is normally followed. Moreover, the victim’s core temperature is constantly monitored with caution not to overdo the cooling procedures as it may lead to hypothermia.

Throughout the treatment, the victim’s status is constantly evaluated including vital signs, ECG findings and level of responsiveness along with the continuous monitoring of the core body temperature.

Preventing  Heat Stroke

Teaching people regarding the seriousness of heat stroke can significantly help them prevent its onset. The following ways can help prevent heat stroke from occurring:

  1. Advise elderly individuals to avoid immediate exposure to high temperatures.
  2. Emphasize the importance of maintaining good hydration by drinking plenty of fluids especially on a hot humid day.
  3. Direct frail and elderly people living in urban environments with high environmental temperatures in places where air conditioning  is available such as malls and libraries.
  4. Advise people even healthy adults to refrain from engaging in outdoor physical activities during the hottest time of the day (between 10 A.M. and 2 P.M.).

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