More training needed according to the coroner...
Possibly one of the greatest indicators that a casualty is suffering heat stroke (hyperthermia), rather than the more mild symptoms of heat exhaustion, is that when their conscious state becomes altered it will likely not improve even when laying them down, or may deteriorate again after lying down (additionally, the cessation of sweating and hot dry skin are important indicators).
This is when ‘aggressive cooling’ is required! The casualties body temperature must be lowered below 40c in order for the organs to regain proper function. If the casualties conscious state continues to deteriorate, you must monitor their airway and breathing, and be prepared to resuscitate the casualty.
One of the biggest concerns I hear in first aid courses is the confusion around whether to cool/heat hyper/hypothermic casualties ‘quickly’ or ‘slowly’. Generally speaking, the latter is preferred. Particularly with cold injuries, slowly rewarming them is best. Hypothermic casualties may have reduced sensation and could easily sustain burns from improper warming techniques. But more importantly, sudden changes to core body temperatures can have negative effects on the circulatory system and potentially cause neurological harm (in other words, it could hurt their brain). The same applies for overheated casualties to a degree, however in the more extreme ‘heat stroke’ scenario, the greater risk appears to be the loss of organ function at temperatures exceeding 40c, and hence a more rapid approach should be taken.
We focus on the fundamentals in our first aid courses, and we emphasise the importance of confidence and skill around performing CPR as the single most important factor in First Aid. But this article is stark reminder, and should be for all First Aid providers, that sometimes getting the little things right is what makes all the difference... and hopefully prevents us needing to use our CPR skills in the first place.
The Australian Resuscitation Council guidelines state the following,
Heat stroke is a life threatening condition:
• call for an ambulance
• resuscitate following the Basic Life Support Flow Chart - DRSABCD/chain of survival
• place the victim in a cool environment
• moisten the skin with a moist cloth or atomizer spray and fan repeatedly
• apply wrapped ice packs to neck, groin and armpits.
• and if the casualty had been exercising, electrolyte fluid may be given.
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