Prevention and Treatment of Heat Illness
Publication Date: July 1, 2019
Last Updated: March 14, 2022
Recommendations
Prevention and planning
Screen for significant pre-existing medical conditions. (1 – Strong, B)
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Minimize use of medications that could limit the thermoregulatory response. (1 – Strong, C)
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Recognize that an overweight body habitus is associated with greater risk of heat illness. (1 – Strong, B)
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Promote regular aerobic activity before heat exposure. (1 – Strong, C)
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Allow for acclimatization with 1 to 2 h·d-1 of heat-exposed exertion for at least 8 d. (1 – Strong, C)
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Ensure euhydration before activity. (1 – Strong, B)
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Ensure ongoing rehydration with a “drink to thirst” approach sufficient to prevent >2% loss of body weight. (1 – Strong, B)
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Consider history of heat injury as a reversible risk factor for recurrence. (1 – Strong, C)
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ENVIRONMENTAL CONSIDERATIONS
The wet-bulb globe temperature index (WBGT) should be used for the assessment of heat risk. (1 – Strong, A)
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ACTIVITY CONSIDERATIONS
Consider which mechanisms of heat accumulation or dissipation are dominant during an activity, and consider heat loss as a key feature of breaks. (1 – Strong, C)
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CLOTHING AND EQUIPMENT
Clothing and equipment for a given activity should be evaluated and modified as needed to optimize evaporative, convective, conductive, and radiative heat exchange or isolation. (1 – Strong, C)
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Field treatment
Removal from the heat and rapid cooling is critical because the extent of morbidity is directly related to both to the degree and duration of hyperthermia. (, U)
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MINOR HEAT ILLNESS TREATMENT
Heat syncope patients whose event is recurrent and inconsistent with exercise-associated collapse or other clear explanation should be referred for further cardiology diagnostics. (2 – Weak, C)
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TEMPERATURE MEASUREMENT
When available, rectal temperature should be considered the most accurate measurement of core hyperthermia compared to axillary, oral, or aural thermometry. (1 – Strong, B)
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In a hyperthermic individual with an altered sensorium, the initiation of empiric cooling for heat stroke should not be delayed by a measurement value that may be below the diagnostic threshold of 40°C. (1 – Strong, B)
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PASSIVE COOLING
Passive cooling measures should be used to minimize thermal strain and maximize heat loss. (1 – Strong, C)
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HYDRATION
Dehydration should be minimized in heat illness. (1 – Strong, C)
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Intravenous fluids should be used for rehydration in EHS. (1 – Strong, B)
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COLD WATER IMMERSION THERAPY
Cold water immersion is the optimal cooling method for heat stroke. (1 – Strong, A)
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EVAPORATIVE COOLING
Evaporative or convective cooling can be considered as adjunct cooling methods if cold water immersion is unavailable. (1 – Strong, C)
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CHEMICAL COLD PACKS/ICE PACKS
Ice packs should be applied to cover the entire body. (1 – Strong, C)
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If chemical cold packs are used, they should be applied to the cheeks, palms, and soles rather than the skin covering the major vessels. (, )
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ANTIPYRETICS
Antipyretics should be avoided in heat illness. (2 – Weak, B)
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Hospital treatment
CONDUCTIVE COOLING
Cold water immersion should be considered for EHS in the hospital setting. (1 – Strong, A)
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Cold water immersion can be considered for treatment of classic heat stroke patients. (1 – Strong, C)
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EVAPORATIVE AND CONVECTIVE COOLING
Evaporative and convective cooling may be considered in classic heat stroke in the hospital setting, but cooling rates with this method are inferior to those with conductive cooling. Evaporative and convective cooling is not indicated in EHS, unless effective conductive cooling is not available. (1 – Strong, C)
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TARGET COOLING TEMPERATURES
Heat stroke patients should be cooled to a target temperature of no less than 39°C. (1 – Strong, B)
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ADJUNCTIVE COOLING TREATMENTS
Cold intravenous fluids should be given for adjunctive cooling in heat stroke. (1 – Strong, C)
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Intravascular cooling catheters or cold water lavage are not recommended primary treatments for heat stroke. (2 – Weak, C)
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PHARMACOLOGIC TREATMENT
Dantrolene should be avoided for treatment of heat stroke patients. (2 – Weak, B)
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Recommendation Grading
Overview
Title
Prevention and Treatment of Heat Illness
Authoring Organization
Wilderness Medical Society
Publication Month/Year
July 1, 2019
Last Updated Month/Year
April 13, 2023
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Ambulatory, Childcare center, Emergency care, Hospital, Medical transportation
Intended Users
Paramedic emt, athletics coaching, nurse, nurse practitioner, physician, physician assistant
Scope
Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D018883 - Heat Stroke, D006359 - Heat Exhaustion
Keywords
prevention, Heat Illness, hyperthermia, heat stroke, recognition, Heat cramps, Heat syncope