Heat-Related Illness
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Heat-related illnesses occur when the body is unable to cool itself during extremely hot weather or strenuous activity. When the heat index is above 95°F, mortality increases with higher temperatures and longer heat waves. Heat stroke is a medical emergency defined by a core body temperature over 104°F and alterations in mental status. Early recognition of symptoms and rapid cooling can prevent fatalities from heat stroke. Certain medications, medical conditions, and strenuous exercise can increase risks of heat-related illness.
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![Introduction
• When the heat index is higher than 95°F (35°C), mortality increases in
relation to elevation of temperature and duration of the heat wave
• In most cases, these fatalities are preventable
• Early recognition of symptoms and rapid cooling are crucial, because
heat stroke is a medical emergency
Metzger KB, Ito K, Matte TD. Summer heat and mortality in New York City: how hot is too hot? Environ Health Perspect. 2010;118(1):80-86.
Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005;71(11):2133-2140.
Jardine DS. Heat illness and heat stroke [published correction appears in Pediatr Rev. 2007;28(12):469]. Pediatr Rev. 2007;28(7):249-258.
Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25): 1978-1988](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Methods: OOHCA data was analyzed for the following periods: August 1, 2009 - May 31, 2010 (historicalcontrol group) and August 1, 2010 - May 31, 2011 (study group). Except for the intra-arrest induction of hypothermia, no other aspect of the regional resuscitation protocols differed between the two periods. Standard Utstein definitions were utilized. Due to the large sample sizes, Chi-square analyses without Yates' correction were utilized, and a p <0.05 was considered significant.
Results: 5,582 resuscitations for nontraumatic adult cardiac arrests during the control period were compared to 4,727 resuscitations in the study period that included the intra-arrest induction of hypothermia. The groups did not differ with respect to age, response time, bystander witnessed status, or frequency of bystander CPR. Patients in the study period were less likely to be male (52.3% vs 54.6%, p = 0.019), less likely to be white (32.8% vs 35.1%, p = 0.013), and less likely to have an EMS-witnessed arrest (8.3% vs 9.5%, p=0.026). Return of spontaneous circulation (ROSC) and sustained ROSC were improved in the study group as compared to the control group: 31.7% vs 29.0% (p=0.003) and 24.1% vs 21.9% (p=0.0014), respectively.
The administration of large-volume, ice-cold saline for the intra-arrest initiation of therapeutic hypothermia improves immediate survival for out-of-hospital cardiac arrest.
Further work is required to assess the impact of this effect on long-term, neurologically intact survival and specific patient population for which this therapy may be of greatest benefit.
Special Thanks from the AHA to All of the Certified First Responder, Emergency Medical Technicians, and Paramedics of the FDNY and the New York City 9-1-1 System.
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- 1. Heat-Related Illness Ade Wijaya, MD – December 2018
- 2. Introduction • When the heat index is higher than 95°F (35°C), mortality increases in relation to elevation of temperature and duration of the heat wave • In most cases, these fatalities are preventable • Early recognition of symptoms and rapid cooling are crucial, because heat stroke is a medical emergency Metzger KB, Ito K, Matte TD. Summer heat and mortality in New York City: how hot is too hot? Environ Health Perspect. 2010;118(1):80-86. Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005;71(11):2133-2140. Jardine DS. Heat illness and heat stroke [published correction appears in Pediatr Rev. 2007;28(12):469]. Pediatr Rev. 2007;28(7):249-258. Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25): 1978-1988
- 3. Risk Factors Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005;71(11):2133-2140. Centers for Disease Control and Prevention (CDC). Heat-related mortality—Arizona, 1993-2002, and United States, 1979-2002. MMWR Morb Mortal Wkly Rep. 2005;54(25):628-630. Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. 2007;35(8):1384-1395. Casa DJ, Armstrong LE, Ganio MS, Yeargin SW. Exertional heat stroke in competitive athletes. Curr Sports Med Rep. 2005;4(6):309-317. Lopez RM, Casa DJ. The influence of nutritional ergogenic aids on exercise heat tolerance and hydration status. Curr Sports Med Rep. 2009; 8(4):192-199.
- 4. DEFINITIONS • Mild heat-related illness: a core temperature < 104°F (40°C) and no central nervous system symptoms • Heat exhaustion is the inability to continue activity because of environmental conditions, and is postulated to be caused by a central mechanism that protects the body in times of overexertion • Heat stroke: an elevated core temperature of 104°F or above and central nervous system disturbances develops slowly over day • Exertional heat stroke: a more rapid onset and is associated with higher core temperatures. Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005;71(11):2133-2140. Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25): 1978-1988 Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. 2007;35(8):1384-1395. 7. Martinez M, Devenport L, Saussy J, Martinez J. Drug-associated heat stroke. South Med J. 2002;95(8):799-802.
- 5. Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25): 1978-1988 Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. 2007;35(8):1384-1395. 7. Martinez M, Devenport L, Saussy J, Martinez J. Drug-associated heat stroke. South Med J. 2002;95(8):799-802. Bytomski JR, Squire DL. Heat illness in children. Curr Sports Med Rep. 2003;2(6):320-324.
- 7. Pathophysiology Lisa R. Leon, Abderrezak Bouchama. Heat Stroke. Compr Physiol 2015, 5: 611-647. doi: 10.1002/cphy.c140017
- 8. Medications and Substances That Contribute to Heat-Related Illness Centers for Disease Control and Prevention (CDC). Heat-related mortality—Arizona, 1993-2002, and United States, 1979-2002. MMWR Morb Mortal Wkly Rep. 2005;54(25):628-630. Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005;71(11):2133-2140. Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. 2007;35(8):1384-1395. Casa DJ, Armstrong LE, Ganio MS, Yeargin SW. Exertional heat stroke in competitive athletes. Curr Sports Med Rep. 2005;4(6):309-317. Lopez RM, Casa DJ. The influence of nutritional ergogenic aids on exercise heat tolerance and hydration status. Curr Sports Med Rep. 2009; 8(4):192-199.
- 9. Becker, J. A., & Stewart, L. K. (2011). Heat-related illness.American family physician, 83(11).
- 11. Becker, J. A., & Stewart, L. K. (2011). Heat-related illness.American family physician, 83(11).