Guidelines Summary
The Red Cross, the National Safety Council, and the National Institute for Occupational Safety and Health provide recommendations on heat stroke prevention and treatment.
Updated guidelines for the prevention and treatment of heat illness were published in 2019 by the Wilderness Medical Society. [20]
Prevention and planning
Screen for significant preexisting medical conditions.
Recognize that being overweight is associated with greater risk of heat illness.
Ensure euhydration before activity.
Ensure ongoing rehydration with a “drink to thirst” approach sufficient to prevent greater than 2% loss of body weight.
Use the wet-bulb globe temperature index to assess heat risk.
Field treatment
Consider rectal temperature, when available, as the most accurate measurement of core hyperthermia compared with axillary, oral, or aural thermometry.
Do not delay initiating empiric cooling in a hyperthermic individual with an altered sensorium; cooling should not be delayed by a measurement value that may be below the diagnostic threshold of 40°C (104°F).
Use passive cooling measures to minimize thermal strain and maximize heat loss.
Minimize dehydration and use intravenous fluids for rehydration.
Cold-water immersion is the optimal cooling method for heat stroke.
Consider evaporative or convective cooling as adjunct methods if cold water immersion is unavailable.
Do not use antipyretics.
Hospital treatment
Cold-water immersion should be considered for exertional heat stroke in the hospital setting.
One may consider evaporative and convective cooling 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 exertional heat stroke.
Cool heat stroke patients to a target temperature of no less than 39°C (102.2°F).
Give cold intravenous fluids for adjunctive cooling in heat stroke.
Do not use dantrolene for treating heat stroke patients.
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Sample display of equipment useful for noninvasive cooling techniques. Clockwise from top: ice pack and water, air-cooling blanket, Foley catheter, and intravenous fluids.
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Sample display of equipment useful for cooling via gastric lavage. Clockwise from top: ice water, nasogastric tube, endotracheal tube, and lavage bag.
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Sample display of equipment useful for cooling via peritoneal lavage. Clockwise from top: iced water, peritoneal catheter, and saline fluid.
