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How to recognize, treat heat illness

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


The use of aggressive prehydration and rehydration strategies is paramount to preventing serious illness.


Article updated July 31, 2017

In the summer months, 100-degree temperatures seem to be the norm in many parts of the United States. Despite temperatures regularly being in the 90s or the 100s, dealing with heat emergencies is common for EMS and fire personnel. 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 can quickly progress from being warm from exertion or having heat cramps to heat exhaustion. The symptoms of heat exhaustion include:

  • Being diaphoretic
  • Feeling a little lightheaded
  • Experiencing headache
  • 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 rehydration, rest and cooling can have devastating results.

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

Heat stroke

The heat-stroke patient will exhibit hot, flushed skin and perspiration may stop in many cases. The patient will become incoherent, with progression to unresponsiveness and seizures. It is important to get a core body temperature reading early. Rectal temperature is best.

If immediate attention is not taken to end the heat challenge and cool the patient, the patient will 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.

Rehab cooling options for fire and ems personnel

The first thing to do when treating those with any heat-related illness is getting them out of the hot 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.

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 firefighter’s bunker gear to allow the trapped heat to escape. Cool towels are another effective way to reduce body temperature, and chairs with arm immersion have been found to be beneficial.

In short, if personnel are suffering from heat stroke, get them out of the environment, remove their clothes, fan them to convect away heat and place cold packs under their arms, neck and in the groin to help reduce body temperature. Follow local protocols and policies for cold-water immersion. Treat any underlying symptoms and in cases of heat stroke transport to the hospital immediately.

Stay hydrated pre-incident, during incident

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. The best firefighter rehab is strong ‘pre-hab’.

Water is adequate for hydration outside the incident scene. On the incident scene, keep drinking water and consider sport drinks to replace electrolyte imbalances. 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.

Dr. Jeffrey Lindsey is an Assistant Professor in Emergency Health Services at George Washington University. He retired from the fire service as the Fire Chief for Estero Fire Rescue. Additionally, he serves as the education coordinator for 24-7 EMS and author for Brady Publishing. He is an experienced leader, educator, lecturer, author, and consultant in emergency services. 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, and an associate in paramedicine from Harrisburg Area Community College. Dr. Lindsey has more than 29 years of diverse experience in the emergency services industry.