The Heat is On!!

It’s 0900, and it’s already 92 degrees Fahrenheit with 80% relative humidity, and you and your brother are in the back corner of your property decked out in heavy gloves, boots, wicking material shirts, chainsaw chaps, and hard hats with face protectors to get trees cut and prepped for firewood for the upcoming winter.

As you continue working, you take water and bathroom breaks and remind your brother to do the same. He’s always been pretty stubborn and doesn’t get to the cooler quite as often as you.

By around 1300, it’s 100 degrees with a heat index of 110 and zero breeze. It’s miserably hot. You’re getting ready to grab a sandwich and cool off a bit in the shade when you notice your brother’s chainsaw has become silent. You walk around the other side of the truck, talking to him about how hot it is today, and you notice him walking away from you in an unsteady gait. You call out to him, and there’s no response. You run up to him and pull his helmet off. The first thing you notice is that he is sweating like crazy, and his wicking-material shirt is literally soaked with sweat. You put the back of your hand onto his forehead, and he’s burning up, and his face is flushed.

What do you do?

Heat injuries are just as insidious as cold injuries, but they do progress in stages if you know what to look for.

What is it?

This looks like heat stroke. There are different types of heat stroke. Classic and Exertional. Classic is characterized by the person being overwhelmed by the outside temperature, and the body loses its ability to cool, while exertional is caused by the metabolic processes inside the body doing what they normally do, but overheating the body due to dehydration and inability of the core to radiate the heat off of the body, and can occur with relatively low temperatures and humidity.

In either case, heat stroke is a true medical emergency, and we need to get EMS on the way and get the victim cool quickly to prevent organ damage and/or death.

How do you recognize it?

 Their skin can be hot and dry, but depending on the ambient humidity, it may still be moist, and they can still be sweating long into heat stroke. Our bodies cool by evaporation, essentially a “swamp cooler”. But, the higher the ambient humidity, the less evaporation occurs, the more moisture traps the heat, and the less cooling occurs. Thus, it can be said that a higher-humidity environment can cause heat casualties, just as a hot, dry environment, where the victim doesn’t even recognize the rapid evaporation of sweat. Couple this with no breeze and no hydration, and it won’t take long for the situation to become life-threatening.

FYI, heat exhaustion victims may have pale, cool, clammy skin and be very sweaty. They may be nauseated, suffering from muscle cramps, and possibly have vomiting and diarrhea. They are suffering from a form of hypovolemic shock due to sweating out all of their electrolytes and need electrolyte replacement and cooling before they progress to heat stroke.

The heat stroke casualty may have an altered mental status due to the high core temperature (greater than 104 F) and may exhibit nausea, vomiting, and seizures. A major concern, in addition to cooling the victim, is maintaining an open airway and preventing aspiration.

How do you treat it?

Call 911 and get them cool quickly! If you have a thermometer, take a core temperature reading as a baseline (yes, “core” means rectal temperature). In this case, the brothers have some heavy black trash bags in their truck and a cooler full of ice and water. Perfect recipe for recooling.

Get the casualty into the shade, call 911, and attempt to cool them. Get their clothes off and start packing cold packs into the groin area, the base of the neck, and the armpits. Basically, you’re trying to cool the areas where a high degree of blood flow occurs. This helps get the cooling to the core area. Essentially, you’re packing the “Junctions” with cold packs. You can even place a cool cloth in the palms of their hands and place a frozen water bottle on top of it to apply cold therapy to those capillary-rich areas. If you want to be even more aggressive, you could use the bags and lay the victim in them and ‘dam up’ the edges and put ice and water in to form an improvised immersion cooling bath. Constantly monitor (every 5 minutes) for significant cooling. Once the temp is at 102, you can get them out of the bath, as we don’t want to induce hypothermia.

If they are lucid, you may try oral rehydration with small sips of cool fluid. Be very, very cautious and constantly observe for nausea, vomiting, and seizures. Protect their airway!

Wait for 911 to get there, let them know what happened, and let them get the victim to the ER and into treatment.  The sooner the heat injury is treated, the better the prognosis.

Just remember to keep it simple and plan accordingly.

• Around 1L/hr. Alternate water and no-sugar/low-sugar electrolyte solutions.
• Rest periods to cool off. Take 15 minutes out of every hour, at the very least. If it’s too hot, leave the work for another day. Safety first.
• If you’re not urinating every 1-2 hrs, you’re not drinking enough fluid (that doesn’t mean beer, soft drinks, or coffee). If your urine looks like a yellow highlighter, drink more water and electrolyte solutions (low to no sugar is important, as sugar can affect the fluid balance in the gut, leading to diarrhea, which will increase electrolyte depletion)
• Buddy Checks are important. Take care of each other and ensure each other is getting enough rest and fluid.
• Know the signs and symptoms of heat exhaustion and head off any injuries before they progress.
• Know them.

Life is complicated. Taking care of each other is pretty simple.

Until next time, stay safe.

Simplicity Under Stress