LEARNING OBJECTIVE: Identify the signs, symptoms, and emergency treatment of heat cramps, heat exhaustion, and heat stroke.

Excessive heat affects the body in a variety of ways. When a person exercises or works in a hot environment, heat builds up inside the body. The body automatically reacts to get rid of this heat through the sweating mechanism. This depletes water and electrolytes from the circulating volume. If they are not adequately replaced, body functions are affected, and, initially, heat cramps and heat exhaustion develop. If the body becomes too overheated or water or electrolytes too depleted, the sweat-control mechanism of the body malfunctions and shuts down. The result is heat stroke (sunstroke). Heat exposure injuries are a threat in any hot environment, but especially in desert or tropical areas and in the boiler rooms of ships. Under normal conditions, it is a preventable injury. Individual and command awareness of the causes of heat stress problems should help eliminate heat exposure injuries.

Heat Cramps
Excessive sweating may result in painful cramps in the muscles of the abdomen, legs, and arms. Heat cramps may also result from drinking ice water or other cold drinks either too quickly or in too large a quantity after exercise. Muscle cramps are often an early sign of approaching heat exhaustion.

To provide first aid treatment for heat cramps, move the victim to a cool place. Since heat cramps are caused by loss of salt and water, give the victim plenty of cool (not cold) water to drink, adding about one teaspoon of salt to a liter or quart of water. Apply manual pressure to the cramped muscle, or gently massage it to relieve the spasm. If there are indications of anything more serious, transport the victim immediately to a medical treatment facility.

Heat Exhaustion
Heat exhaustion (heat prostration or heat collapse) is the most common condition caused by working or exercising in hot environments. In heat exhaustion, there is a serious disturbance of blood flow to the brain, heart, and lungs. This causes the victim to experience weakness, dizziness, headache, nausea, and loss of appetite. The victim may faint but will probably regain consciousness as the head is lowered, which improves the blood supply to the brain. Signs and symptoms of heat exhaustion are similar to those of shock; the victim will appear ashen gray, the skin cool, moist, and clammy and the pupils may be dilated (fig. 4-50). The vital signs usually are normal; however, the victim may have a weak pulse, together with rapid and shallow breathing. Body temperature may be below normal.

Treat heat exhaustion as if the victim were in shock. Move the victim to a cool or air-conditioned area. Loosen the clothing, apply cool wet cloths to the head, axilla, groin, and ankles, and fan the victim. Do not allow the victim to become chilled. (If this does occur, cover with a light blanket and move into a warmer area.) If the victim is conscious, give a solution of 1 teaspoon of salt dissolved in a liter of cool water. If the victim vomits, do not give any more fluids. Transport the victim to a medical treatment facility as soon as possible. Intravenous fluid infusion may be necessary for effective fluid and electrolyte replacement to combat shock.

Heat Stroke
Sunstroke is more accurately called heat stroke since it is not necessary to be exposed to the sun for this condition to develop. It is a less common but far more serious condition than heat exhaustion, since it carries a 20 percent mortality rate. The most important feature of heat stroke is the extremely high body temperature (105F, 41C or higher) accompanying it. In heat stroke, the victim suffers a breakdown of the sweating mechanism and is unable to eliminate excessive body heat build up while exercising. If the body temperature rises too high, the brain, kidneys, and liver may be permanently damaged.

Sometimes the victim may have preliminary symptoms such as headache, nausea, dizziness, or weakness. Breathing will be deep and rapid at first, later shallow and almost absent. Usually the victim will be flushed, very dry, and very hot. The pupils will be constricted (pinpoint) and the pulse fast and strong (fig. 4-50). Compare these symptoms with those of heat exhaustion.

When providing first aid for heat stroke, remember that this is a true life-and-death emergency. The longer the victim remains overheated, the more likely irreversible brain damage or death will occur. First aid is designed to reduce body heat fast. Reduce heat immediately by dousing the body with cold water or by applying wet, cold towels to the whole body. Move the victim to the coolest place available and remove as much clothing as possible. Maintain an open airway. Place the victim on his back, with the head and shoulders slightly raised. If cold packs are available, place them under the arms, around the neck, at the ankles, and in the groin. Expose the victim to a fan or air conditioner, since drafts will promote cooling. Immersing the victim in a cold water bath is also very effective. If the victim is conscious, give cool water to drink. Do not give any hot drinks or stimulants. Discontinue cooling when the rectal temperature reaches 102F; watch for recurrence of temperature rise by checking every 10 minutes. Repeat cooling if temperature reaches 103F rectally.

Get the victim to a medical facility as soon as possible. Cooling measures must be continued while the victim is being transported. Intravenous fluid infusion may be necessary for effective fluid and electrolyte replacement to combat shock.