References

Alele F, Malau-Aduli B, Malau-Aduli A, Crowe M Systematic review of gender differences in the epidemiology and risk factors of exertional heat illness and heat tolerance in the armed forces. BMJ Open. 2020; 10:(4) https://doi.org/10.1136/bmjopen-2019-031825

Armstrong LE, Crago AE, Adams R, Roberts WO, Maresh CM Whole-body cooling of hyperthermic runners: comparison of two field therapies. Am J Emerg Med. 1996; 14:(4)355-358 https://doi.org/10.1016/S0735-6757(96)90048-0

Belval LN, Casa DJ, Adams WM Consensus statement— prehospital care of exertional heat stroke. Prehosp Emerg Care. 2018; 22:(3)392-397 https://doi.org/10.1080/10903127.2017.1392666

Bouchama A, Abuyassin B, Lehe C Classic and exertional heatstroke. Nat Rev Dis Primers. 2022; 8:(1) https://doi.org/10.1038/s41572-021-00334-6

In: Brown SN, Kumar DS, James C, Mark J Bridgwater: Class Professional Publishing; 2019

QuickStats: percentage distribution of heat-related deaths,* by age group—National Vital Statistics System, United States, 2018–2020. MMWR Morb Mortal Wkly Rep. 2022; 71:(24) https://doi.org/10.15585/mmwr.mm7124a6

Chen SH, Chang FM, Niu KC, Lin MY, Lin MT Resuscitation from experimental heatstroke by estrogen therapy. Crit Care Med. 2006; 34:(4)1113-1118 https://doi.org/10.1097/01.CCM.0000205756.04845.15

Christidis N, McCarthy M, Stott PA The increasing likelihood of temperatures above 30 to 40°C in the United Kingdom. Nat Commun. 2020; 11:(1) https://doi.org/10.1038/s41467-020-16834-0

Coenen S, Tran K, de Haan J, de Man R Liver transplantation for non-exertional heat stroke-related acute liver failure. BMJ Case Rep. 2017; 2017 https://doi.org/10.1136/bcr-2017-221029

Filep EM, Murata Y, Endres BD, Kim G, Stearns RL, Casa DJ Exertional heat stroke, modality cooling rate, and survival outcomes: a systematic review. Medicina (Kaunas). 2020; 56:(11) https://doi.org/10.3390/medicina56110589

Hadad E, Moran DS, Epstein Y Cooling heat stroke patients by available field measures. Intensive Care Med. 2004; 30:(2) https://doi.org/10.1007/s00134-003-2084-5

Hadad E, Cohen-Sivan Y, Heled Y, Epstein Y Clinical review: treatment of heat stroke: should dantrolene be considered?. Crit Care. 2005; 9:(1)86-91 https://doi.org/10.1186/cc2923

Hajat S, Vardoulakis S, Heaviside C, Eggen B Climate change effects on human health: projections of temperature-related mortality for the UK during the 2020s, 2050s and 2080s. J Epidemiol Community Health. 2014; 68:(7)641-648 https://doi.org/10.1136/jech-2013-202449

Hart LE, Egier BP, Shimizu AG, Tandan PJ, Sutton JR Exertional heat stroke: the runner's nemesis. Can Med Assoc J. 1980; 122:(10)1144-1150

Hirschhorn R, DadeMatthews O, Sefton J Exertional heat stroke knowledge and management among emergency medical service providers. Int J Environ Res Public Health. 2021; 18:(9) https://doi.org/10.3390/ijerph18095016

HM Government. Fire and rescue workforce and pensions statistics: England, April 2021 to March 2022 2.1. 2022. https://tinyurl.com/yyu7pbp7

Howe AS, Boden BP Heat-related illness in athletes. Am J Sports Med. 2007; 35:(8)1384-1395 https://doi.org/10.1177/0363546507305013

Huggins R, Glaviano N, Negishi N, Casa DJ, Hertel J Comparison of rectal and aural core body temperature thermometry in hyperthermic, exercising individuals: a meta-analysis. J Athl Train. 2012; 47:(3)329-338 https://doi.org/10.4085/1062-6050-47.3.09

Ichai P, Laurent-Bellue A, Camus C Liver transplantation in patients with liver failure related to exertional heatstroke. J Hepatol. 2019; 70:(3)431-439 https://doi.org/10.1016/j.jhep.2018.11.024

Kaewput W, Thongprayoon C, Petnak T Inpatient burden and mortality of heatstroke in the United States. Int J Clin Pract. 2021; 75:(4) https://doi.org/10.1111/ijcp.13837

Kielblock AJ, Van Rensburg JP, Franz RM Body cooling as a method for reducing hyperthermia. An evaluation of techniques. S Afr Med J. 1986; 69:(6)378-380

Laitano O, Leon LR, Roberts WO, Sawka MN Controversies in exertional heat stroke diagnosis, prevention, and treatment. J Appl Physiol (1985). 2019; 127:(5)1338-1348 https://doi.org/10.1152/japplphysiol.00452.2019

Lefrant JY, Muller L, de La Coussaye JE Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med. 2003; 29:(3)414-418 https://doi.org/10.1007/s00134-002-1619-5

Mazerolle SM, Ganio MS, Casa DJ, Vingren J, Klau J Is oral temperature an accurate measurement of deep body temperature? A systematic review. J Athl Train. 2011; 46:(5)566-573 https://doi.org/10.4085/1062-6050-46.5.566

McDermott BP, Casa DJ, Ganio MS Acute whole-body cooling for exercise-induced hyperthermia: a systematic review. J Athl Train. 2009; 44:(1)84-93 https://doi.org/10.4085/1062-6050-44.1.84

Office for National Statistics, UK Health Security Agency. Excess mortality during heat-periods: 1 June to 31 August 2022. 2022. https://tinyurl.com/y3hs7jrf

Patel J, Boyer N, Mensah K Critical illness aspects of heatstroke: a hot topic. J Intensive Care Soc. 2023; 24:(2)206-214 https://doi.org/10.1177/17511437221148922

Pease S, Bouadma L, Kermarrec N, Schortgen F, Régnier B, Wolff M Early organ dysfunction course, cooling time and outcome in classic heatstroke. Intensive Care Med. 2009; 35:(8)1454-1458 https://doi.org/10.1007/s00134-009-1500-x

Proulx CI, Ducharme MB, Kenny GP Effect of water temperature on cooling efficiency during hyperthermia in humans. J Appl Physiol (1985). 2003; 94:(4)1317-1323 https://doi.org/10.1152/japplphysiol.00541.2002

Roberts WO, Armstrong LE, Sawka MN, Yeargin SW, Heled Y, O'Connor FG ACSM expert consensus statement on exertional heat illness: recognition, management, and return to activity. Curr Sports Med Rep. 2023; 22:(4)134-149 https://doi.org/10.1249/JSR.0000000000001058

Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke. BMC Nephrol. 2016; 17:(1) https://doi.org/10.1186/s12882-016-0268-9

Sithinamsuwan P, Piyavechviratana K, Kitthaweesin T Exertional heatstroke: early recognition and outcome with aggressive combined cooling—a 12-year experience. Mil Med. 2009; 174:(5)496-502 https://doi.org/10.7205/MILMED-D-02-5908

Tseng MF, Chou CL, Chung CH Association between heat stroke and ischemic heart disease: a national longitudinal cohort study in Taiwan. Eur J Intern Med. 2019; 59:97-103 https://doi.org/10.1016/j.ejim.2018.09.019

Tseng MF, Chou CL, Chung CH Risk of chronic kidney disease in patients with heat injury: a nationwide longitudinal cohort study in Taiwan. PLoS One. 2020b; 15:(7) https://doi.org/10.1371/journal.pone.0235607

Vicario SJ, Okabajue R, Haltom T Rapid cooling in classic heatstroke: effect on mortality rates. Am J Emerg Med. 1986; 4:(5)394-398 https://doi.org/10.1016/0735-6757(86)90185-3

Walter E, Carraretto M Drug-induced hyperthermia in critical care. J Intensive Care Soc. 2015; 16:(4)306-311 https://doi.org/10.1177/1751143715583502

Walter EJ, Carraretto M The neurological and cognitive consequences of hyperthermia. Crit Care. 2016; 20:(1) https://doi.org/10.1186/s13054-016-1376-4

Walter EJ, Galloway R, Stacey MEdinburgh: Faculty of Sport and Exercise Medicine UK; 2018

Walter EJ, Hanna-Jumma S, Carraretto M, Forni L The pathophysiological basis and consequences of fever. Crit Care. 2016; 20:(1) https://doi.org/10.1186/s13054-016-1375-5

Wang JC, Chien WC, Chu P The association between heat stroke and subsequent cardiovascular diseases. PLoS One. 2019; 14:(2) https://doi.org/10.1371/journal.pone.0211386

Ward MD, King MA, Gabrial C, Kenefick RW, Leon LR Biochemical recovery from exertional heat stroke follows a 16-day time course. PLoS One. 2020; 15:(3) https://doi.org/10.1371/journal.pone.0229616

Wu M, Wang C, Liu Z, Zhong L, Yu B, Cheng B, Liu Z Clinical characteristics and risk factors associated with acute kidney injury inpatient with exertional heatstroke: an over 10-year intensive care survey. Front Med (Lausanne). 2021; 8 https://doi.org/10.3389/fmed.2021.678434

Wyndham CH, Strydom NB, Cooke HM Methods of cooling subjects with hyperpyrexia. J Appl Physiol. 1959; 14:771-776 https://doi.org/10.1152/jappl.1959.14.5.771

Yezli S, Yassin Y, Ghallab S Classic heat stroke in a desert climate: a systematic review of 2632 cases. J Intern Med. 2023; 294:(1)7-20 https://doi.org/10.1111/joim.13633

Research

UK prehospital practitioners' knowledge of heat-related illness and heatstroke

02 August 2024
Research
02 August 2024
Volume 16 · Issue 8

Abstract

Background:

Heat-related illness is commonly seen in individuals undergoing physical exercise or exertion (exertional heat illness) and those exposed to high ambient temperatures, for example in heatwaves (classic heat illness). While severe heat-related illness, including heatstroke, requires urgent recognition and treatment to minimise morbidity and mortality, little is known about prehospital practitioners' knowledge of the condition.

Aims:

This study aimed to assess UK prehospital practitioners' knowledge of recognition, treatment and risks of heat-related illness.

Methods:

An online questionnaire was disseminated to UK prehospital practitioners.

Findings and conclusions:

Some aspects, such as the criteria for diagnosis and the need for urgent treatment were generally well known. Other areas, such as risk of mortality and risk of complications and organ dysfunction, were less well known. Further education and awareness of this condition may be warranted.

Heat-related illness refers to a spectrum of medical conditions that result from an increased body temperature and results from the body's lack of ability to cope with an excessive heat load. It is seen in people undergoing physical exercise or exertion (exertional heat illness; EHI) and those exposed to high ambient temperatures, for example in heatwaves (classic heat illness; CHI).

Heat-related illness is common and predicted to become more frequent. It is responsible for tens of thousands of deaths in heatwaves (World Health Organization, 2024), and this incidence has been predicted to rise by over 250% in the next 30 years (Hajat et al, 2014).

Heat-related illnesses are not confined to tropical and subtropical climates; they are observed in more temperate countries such as the UK. This is especially the case as high temperatures are predicted to become more prevalent year on year (Christidis et al, 2020).

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Hyperthermia
Heat-related illness
Heatstroke
Emergency treatment
First aid
Emergency medical services