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Wilderness Medical Society - snowmass 2005
the skin is massaged to improve skin blood flow. The sheets are frequently rewetted
with icy water.
f) Concurrently the head is constantly irrigated with more ice water, and a fan is
directed at the patient.
g)
The patient is not routinely immersed in the ice water in case CPR is necessary.
However if the rectal T is not reduced suffiently, the patient is immersed directly into
the ice water. With the above procedure, rectal T usually decreases to 39.5C within
15-0 minutes
.
Heat Wave:
Three or more days of air temperatures greater than or equal to 90F (32.2C).
The National Association of Medical Examiners definition from heat-related deaths includes
exposure to high ambient temperature either causing the death or as substantially contributing to
it, cases where the body temperature at time of collapse was greater than or equal to 105F
(40.6C) and a history of exposure to high ambient temperature and the reasonable exclusion of
other causes of Hyperthermia. Because death rates from other causes increase during heat
waves, deaths classified as caused by Hyperthermia represent only a portion of heat-related
death.
References:
1)
Cheung SS, McLellan TM, Tenaglia S. The thermophysiology of uncompensable heat
stress. Sports Med. 2000; 29(5): 329-59.
2)
Bolster DR. Exercise, thermoregulation, and pre-cooling. Am J Med Sports. 2000; 155-
164.
3)
Chorng-Kuang How, Chii-Hwa Chern, Lee-Min Wang, Chen-Hsen Lee. Heat stroke in a
subtropical country. Am J Emerg Med. 2000; 18: 474-477.
4)
Costrini A. Emergency treatment of exertional heatstroke and comparison of whole body
cooling techniques. Med Sci Sports Exerc. 1990 Feb; 22(1): 15-18.
5)
Dematte JE, O'Mara K, Buescher J, Whitney CG, Firsythe S, McNamee T, et al. Near-fatal
heat stroke during the 1995 heat wave in Chicago. Ann Intern med. 1998; 129:173-81.
6)
Epstein Yoram. Exertional heatstroke: lessons we tend to forget. Am J Med Sports. 2000;
2: 143-152.
7)
Epstein Y, Moran DS, Shapiro Y, Sohar E, Shemer J. Exertional heat stroke: a case series.
Med Sci Sports Exerc. 1999; 31(2): 224-8.
8)
Gaffin SL, Gardner JW, Flinn SD. Cooling Methods for heatstroke Victims. Ann Intern
Med. 2000; 132: 678.0
9)
Hubbard RW, Matthew CB, Durkot MJ, Francesconi RP. Novel approaches to the
pathophysiology of heatstroke. Ann Emerg Med Sept 1987; 16:1066-1075.
10) Lin MT. Pathogenesis of an experimental heatstroke model. Clin Exp Pharmacol Physiol.
1999 Oct; 26(10):826-7.
11) Mattern J, Garrigan S, Kennedy SB. A community-based assessment of heat-related
morbidity in North Philadelphia. Environ Res. 2000; 83(3): 338-42.
12) Misc. Authors. Letters to the Editor: Features and outcomes of classic heat stroke. Ann
Intern Med. 1999; 130:613-615.
13) MMWR. Heat-related illnesses, deaths, and risk factors-Cincinnati and Dayton, Ohio, 1999
and the US 1979-1997. MMWR. 2000;49:470-473.
14) MMWR. Heat-related illnesses and deaths-Missouri, 1998 and the US, 1979-1996. MMWR.
1999;48:469-473.
15 )Montain SJ, Latzka WA, Sawka MN. Fluid replacement recommendations for training in
hot weather. Mil Med. 1999; 164(7): 502-8.
16)
Porter AMW. The death of a British officer-cadet from heat illness. Lancet 2000;
355:569-71.
17)
Romero JJ, Clement PF, Belden C. Neuoropsychological sequelae of heat stroke: report of
three cases and discussion. Mil Med. 2000; 165(6): 500-3.

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