Heat illness and heat stroke

Meet the patient

A 22-year-old infantry recruit collapses 8 km into a timed pack march in 36-degree heat on day three of a heat wave. He deployed from a temperate climate two weeks ago. In the medical tent he is confused, combative, still sweating profusely. Rectal temperature is 41.8 degrees. Heart rate 148, blood pressure 96 over 58, capillary glucose 2.6. A tub of iced water with a stirrer sits beside him. The retrieval helicopter is 90 minutes away.[2]

Three questions decide his survival: is this stroke or exhaustion? (CNS dysfunction, not the sweat), which cooling method? (NATA: full-body CWI 1-15 C for EHS), and what determines outcome? (duration above the critical threshold — NATA: cool first, transport second).[10]

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1. [1]Bouchama A, Knochel JP Heat stroke N Engl J Med, 2002.PMID 12075060
2. [2]Epstein Y, Yanovich R Heatstroke N Engl J Med, 2019.PMID 31216400
3. [3]Leon LR, Bouchama A Heat stroke Compr Physiol, 2015.PMID 25880507
4. [4]Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update Wilderness Environ Med, 2024.PMID 38425235
5. [5]Douma MJ, Aves T, Allan KS, et al. First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis Resuscitation, 2020.PMID 31981710
6. [6]Lipman GS, Gaudio FG, Eifling KP, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update Wilderness Environ Med, 2019.PMID 31221601
7. [7]Bouchama A, Cafege A, Devol EB, et al. Ineffectiveness of dantrolene sodium in the treatment of heatstroke Crit Care Med, 1991.PMID 1989755
8. [8]Luhring KE, Butts CL, Smith CR, et al. Cooling Effectiveness of a Modified Cold-Water Immersion Method After Exercise-Induced Hyperthermia J Athl Train, 2016.PMID 27874299
9. [9]Bouchama A, Dehbi M, Chaves-Carballo E Cooling and hemodynamic management in heatstroke: practical recommendations. Crit Care, 2007.PMID 17498312
10. [10]Casa DJ, DeMartini JK, Bergeron MF, et al. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. J Athl Train, 2015.PMID 26381473
11. [11]McDermott BP, Casa DJ, Ganio MS, et al. Acute whole-body cooling for exercise-induced hyperthermia: a systematic review. J Athl Train, 2009.PMID 19180223
12. [12]McDermott BP, Casa DJ, O'Connor FG, et al. Cold-water dousing with ice massage to treat exertional heat stroke: a case series. Aviat Space Environ Med, 2009.PMID 19653575
13. [13]DeGroot DW, Ruby B, Koo A, O'Connor FG Far from Home: Heat-Illness Prevention and Treatment in Austere Environments. Wilderness Environ Med, 2025.PMID 40262113
14. [14]Casa DJ, McDermott BP, Lee EC, et al. Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev, 2007.PMID 17620933