How to recognize and treat heat illness

Left untreated, heat-related illness will lead to death, but sound rehab practices can prevent or mitigate these problems

As I write this column, the heat continues to blaze across the country. Hundred-degree temperatures seem to be the norm in many parts of the country. In fact, I am in one of the cool spots — Florida.

Despite the record-breaking heat wave, dealing with heat emergencies is common for us. Rehab for our personnel is a critical element for our personnel's survival and ability to function during this time. It is a great time to review heat emergencies with your rehab personnel and firefighters. Being aware of the signs and symptoms may save a life.

When you work on a hot day, sweating and exerting energy, you may start feeling your legs or arms cramp. This is the body's mechanism warning that it is time to cool down and hydrate.

Heat exhaustion
If you ignore the indicators, you quickly progress to heat exhaustion. The symptoms of heat exhaustion include being diaphoretic, feeling a little lightheaded, experiencing headache, and feeling fatigue.

Heat exhaustion is common; however, once you start experiencing these signs and symptoms it is time to take immediate action. Likewise, if you are monitoring patients in rehab, pay close attention to these individuals. Sending the person with heat exhaustion back into the incident scene without proper cooling can have devastating results.

Without the proper care, heat exhaustion will progress to heat stroke. A heat stroke is a true medical emergency and immediate care is critical.

Heat stroke
The heat-stroke patient will exhibit hot, flushed skin, and his perspiration may stop in many cases. The person will become incoherent, with progression to unresponsiveness and seizures. It is important to get a core body temperature reading early (rectal temperature is best, but may not be appropriate on scene).

If immediate attention is not taken, the patient will succumb to the heat stroke and die. Even if the patient survives, he will have long-lasting effects of heat stroke as the body temperature in many cases rises above 106 degrees F. At this elevated temperature, the body cannot compensate and brain cells begin to die off.

First thing to do when treating those with any heat-related illness is getting them out of the environment. Get them into a cool environment. This may be a challenge on the incident scene, especially if you have multiple personnel trying to cool down.

Cooling options
Alexandria, Va., Fire Department converted a city bus into a rehab unit. It is dispatched to a scene and allows personnel a place to escape the heated environment. The back of an ambulance works well; however, it limits the number of individuals who can use it at one time, and it takes the unit out of service.

Also, it is important to remove the person's bunker gear to allow the trapped heat to escape. Cool towels are another effective way to reduce body temperature, and rehab chairs with arm immersion have been found to be beneficial.

It is best to avoid using mist fans in humid environments as the added moisture may result in steam burns when personnel are sent back into a fire.

In short, if personnel are suffering from extreme heat illness, get them out of the environment, remove their clothes, and place cold packs under their arms, neck and in the groin to help reduce body temperature. Treat any underlying symptoms and in cases of heat stroke transport to the hospital immediately.

Stay hydrated
Hydration is a critical element for preventing heat-related illness. Encourage personnel not to wait until incidents to begin hydration, rather begin hydration prior to a shift and continue throughout the shift.

Water is adequate for hydration outside the incident scene. On the incident scene, consider sport drinks to replace electrolyte imbalances. Coconut water has shown to be an excellent alternative to a sports drink. Remember the adage, an ounce of prevention is better than a pound of cure. Keeping hydrated throughout the shift will help when on an incident scene.

Recognizing the signs and symptoms of heat-related illness is imperative to functioning during the summer and especially during the record-breaking heat waves that occur more frequently.

About the author

Dr. Lindsey is the coordinator/lecturer for the University of Florida Fire and Emergency Service degree program. He serves as the chief learning officer for Health Safety Institute. He retired from the fire service as chief of Estero (Fla.) Fire Rescue. Dr. Lindsey earned his doctorate and master’s degree in curriculum and instruction from USF. He holds a bachelor’s degree in fire and safety engineering from the University of Cincinnati. He also has earned his chief fire officer designation and is a graduate of the Executive Fire Officer Program. He was the 2011 recipient of the James O Page Leadership Award from IAFC. You can contact Jeffrey at

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