Peter Antevy covers 2023 protocols for heat emergencies in the field. Cool the patient first, transport second: organ damage happens fast. Heat stroke means altered mental status or seizures, usually over 103°F. Start IV fluids (1 L normal saline for adults, 20 mL/kg for kids) and use full-body ice-water immersion to drop core temperature below 103°F before hospital arrival.
Questions this video answers
Greater than 103 degrees (F).
Bring core temperature below 103 degrees (F) as soon as possible.
One liter of normal saline; may repeat once.
20 mL per kg per bolus, repeat up to twice for a total of 60 mL per kg.
Axillary or rectal temperature (rectal preferred if oral is not accurate).
Chapters
Today we're going to talk about heat emergencies. There's been some changes to the 2023 protocols, and I would like to take a moment to just add a little bit of education to this and give you a practical demonstration on one of the things that we're looking for to treat these patients. First and foremost, that we got to remember with heat emergencies, especially with summer coming up, is that they happen a whole lot more frequently than we would realize. And as you know, it gets extremely hot here in the summertime, and there's a lot of people that are working outside and they can get overcome very quickly. And this also applies to people that are working in enclosed environments with poor ventilation. Think about our firefighters that do training all the time. This can happen in the summertime. They're in gear, they're inside those burn buildings, and they get incredibly hot. Or on a structure fire, you can see this pop up in many different ways. So it's important that we recognize some of the true emergencies when it comes to heat issues and that we know how to treat this as aggressively as possible. So, first and foremost, we got to remember this is that we need to cool first and transport second. The emergency is the heat. The emergency is not going to be fixed at the hospital. The emergency has to be handled before we even start transporting. This is a big key to saving patients that are truly in heat stroke, that have. That are experiencing all sorts of organ damage secondary to that elevated body temperature. So no matter what, cool first, transport second. One of the things that we want to do in all heat emergencies, it doesn't matter if it's heat exhaustion or heat stroke. We want to get the patient out of the environment, get them in the back of the truck as soon as possible, turn that AC down like we all like to do, and go ahead and start cooling this patient off. Any excess clothing should come off. And obviously you want to respect the patient's dignity. However, in a true emergency, where this patient's body temperature is extremely high and this patient is absolutely. In a true emergency, we got to do what we got to do. Expose the patient, get the clothes off, and we'll begin the active cooling process. Obtaining a temperature is key. This is a big deal. Now, remember, a lot of these people have been hydrating already, so an oral temperature might not be the best route. You can get an axillary temperature, and you can also obtain a rectal temperature in the event that that oral temperature is not accurate. If this patient is able to actually drink, if they're able to, if they're mentally aware enough, they're able to control their own airway reflexes. Oral hydration is key. Get that in them as soon as possible. Obviously, starting an IV and then giving them fluids as well is always going to be helpful for these types of patients. But oral hydration cannot be overlooked. It's important that we remember this function as well in this process. So let's talk about heat cramps and heat exhaustion. Now, heat exhaustion is probably something we're all very familiar with. After coming out of a structure fire, you're incredibly hot. Your body temperature is elevated. However, you're still fully alert. You're very much awake. You've got some cramping, you're not feeling, you're feeling fatigued, but you're AAO times four and your body temperature is below 103. These patients will benefit from IV fluids. These patients will benefit from ice packs. And if you go ahead and look in the protocol, it'll tell you the forehead, neck, axilla, forearms, hands and groin area. Put ice packs everywhere. See, we don't want to wait until their body temperatures so high that they now become altered. Let's start cooling them down early. Normal saline. This patient will benefit from a liter of saline if it's an adult. And you can repeat that dose once. For pediatrics, we can give 20mls per kg and you can repeat that twice to a total of 60mls per kg. But as always, reference your hand tevy app for the exact amount of mls based on that patient's age. Let's talk about heat stroke now. So heat stroke is when heat exhaustion progresses to the point that now it's affecting our organs, now it's affecting our cognitive abilities. And we're no longer just cramping, but you may have seizures, you may have a low blood pressure, and your temperature is typically going to be over 103 degrees. For these types of patients, it is absolutely imperative that we get aggressive on treating this. We have got to bring that Temperature down below 103 as soon as possible. We can't wait till we get to the hospital. We got to get this done immediately. So active cooling is going to be achieved, is going to be performed to achieve that, that temperature of less than 103 degrees. That's our goal. So when we talk about initiating rapid cooling, this is the change. This is something that really we got to pay attention to what we're recommending. And this is based on literature. This is not based on something that we've dreamed up here in the sim lab. This is something that we've actually done a lot of research on and the evidence is showing. And if you pay attention to anything that athletes are doing right now after workouts, they're doing complete ice baths, they're immediately immersing their bodies in into a total ice bath so that it reduces inflammation. And there's a whole lot of benefits that come along with that. It's impractical for us to carry around ice baths, but what we can do we have with Omega Mover, we have the ability to put that waterproof sheet out. And we carry coolers on our rescues full of ice. We carry coolers on our engines full of ice. The recommendation from the medical services division and from our medical directors. If you have a patient who has a temperature greater than 103 degrees and they have signs and symptoms of heat stroke, such as altered mental status, seizures, hypotension, those patients need active cooling and they need aggressive cooling. So we're going to literally put this patient in a mega mover and we're going to cover their body with ice water and we're going to transport them to the hospital just like that. This sounds barbaric almost, right? This doesn't sound like it's very scientific, but I'm telling you, the science is all pushing us that if we're going to save these patients life, we cannot just put ice packs on them. It's not enough to drop their core temperature. We've got to get their core temperature down below 103 or they will suffer end organ damage. That is what we want to prevent. So obviously those patients are going to continue to get a liter of fluids. Pediatric patients would still get 20 mls per kg to a total of 60 mls per kg if it's indicated.
So what we wrote in the protocol book is what we're going to demonstrate right now. So here's what I want to show you. These guys are going to take this mannequin right here and we're going to say that this patient meets criteria for heat stroke, has an elevated body temperature and has altered mentation, go ahead and put this patient on the megamover.
Now, I want you to take that cooler and dump it all over the patient. Now, if this has water in it, that's okay. I don't have water in this. It's just ice. Now I want you to keep all that stuff on the patient.
So you might have to hold the sides.
There you go.
Load this patient right up into the truck just like this. Transport them to the hospital. The goal is to cool them down below 103 degrees as soon as possible. We do not want to wait 15, 20 minutes.
By then, organ damage has already occurred. Now, if there's ever a situation where you cannot just cover them in ice and transport them to the hospital, you're going to have to do what you can with ice packs in the groin, neck, forearm area, everywhere you can put ice packs on them. But the reality is that's just really ineffective in saving these patients life. Thank you so much for your time. I hope you understand a little bit more about heat emergencies and what the. And what the medical directors are asking us to do. Again, sometimes these things might need some explanation as well. So if you're ever on a scene where you're doing this, it would be a good idea to go ahead and pull somebody, a bystander to the side. If it's a parent, if it's a loved one, and just say, listen, we're doing this because we got to get their temperature down. It's the best thing for them. The family might need some reassurance on this one. I hope this gives you the confidence to be able to act in the the future. And we can save a lot of lives by doing this.
