Heatstroke

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Scene 1 · Opening

23.40, the fourth night of the heatwave. The tarmac of the car park is still giving back the day's heat, the air has not dropped below thirty-one degrees.

She has been unloading her van for four hours. She stops halfway down a row, sways, and props herself against a door.

Her skin is burning, and it is dry: she has stopped sweating.

Scene 2 · What you find

She answers you, but slowly, and she no longer knows where she parked.

The building throws a strip of shade twenty metres away, against the north wall. It is the only cool place in the car park.

What do you start with?

• Right move : I get her out of the heat: into the shade of the building, sitting down, and I call 15.
  Take the casualty away from the cause : That is the first line of the procedure in the guidance, before anything else: take the casualty away from the cause. The PSC1 spells out what that means for illness brought on by heat: settle the casualty somewhere cool and well ventilated. And pass on a report for advice without delay.
• Mistake : I leave her sitting against her van, she stopped of her own accord, that is already something.
  The tarmac is thirty centimetres from the back of her neck : Taking the casualty away from the cause is the first action, and the cause is right there, under her and around her: a car park giving back the heat it has stored all day. The guidance asks you to settle her somewhere cool and well ventilated, not simply to let her sit down.
• Not the best choice : I lean on the horn to bring people out.
  A window opens on the third floor and closes again : At midnight, in a heatwave, a car horn gathers nobody. Your phone calls people who actually turn up.

Scene 3 · Cooling her

She is sitting against the north wall, in the shade, and the dispatcher says a crew is on its way.

He added one sentence: “Cool her down, with whatever you have.” You have a bottle of water, a clean tee shirt in the van, and your two hands.

How do you cool her?

• Right move : I take her clothes off and leave her underwear, I wet the tee shirt and lay it on her forehead and the back of her neck, and I fan her without stopping.
  Strip, wet, fan : The guidance lists the means in that order: take the casualty's clothes off, leaving her underwear; fan her to increase heat loss by convection; wet her to increase heat loss by evaporation; lay cloths or sheets soaked in cold water on her body. All of that with a tee shirt and a bottle.
• Mistake : I sit her in the fountain basin, the water in there is icy.
  A bath is not a bystander's move : The guidance sets it apart and hedges it: possibly, after medical advice where that can be had, give a cool bath. It is not the first line, and it is not iced water. What a bystander does without being told is strip, wet, fan and lay damp cloths on.
• Mistake : I cover her with a blanket, she is shivering and I do not want her getting cold.
  Her skin stays burning and dry : The guidance asks for the exact opposite: take the casualty's clothes off, leaving her underwear, and increase heat loss by fanning and by evaporation. Covering somebody whose body can no longer shed its heat shuts the one way out that is left.

Scene 4 · Drinking

The wet tee shirt is on the back of her neck, you are fanning her with a flattened box. Her skin is starting to give up a little of its heat.

She answers in whole sentences now, and she asks for a drink.

She is conscious and thirsty. What do you do?

• Right move : I give her a drink, often, and I keep fanning her.
  Make up for the water and the salt she has lost : The health insurance guidance describes what to do about moderate dehydration in an adult or an older child: lay the person down and undress her, cool her with damp cloths, fan her, and make up for the water and salt she has lost by giving her drinks often and more than usual. What allows you to give her a drink here is the branch “the casualty shows no life-threatening distress” of the civil safety guidance, which asks you to settle her in a comfortable position and rehydrate her, with a single reservation: unless the casualty is vomiting.
• Mistake : She has just been sick, but I make her drink anyway: she has lost too much water.
  She brings it back up, and loses more : The guidance puts the exception in the same sentence as the action: rehydrate the casualty, unless she is vomiting. Pushing it rehydrates nothing, it empties her further, and it puts her airway at risk. In that case you cool her and you wait for the crew.
• Mistake : I turn the heater up in my car and sit her in it to make her sweat.
  This is not a fever : The procedure is to cool the casualty, in every case, with whatever means you have: fan her, wet her, lay cloths soaked in cold water on her. Making her sweat is the reasoning for a viral fever, and this is not one: her body has stopped shedding heat, it does not need any more adding.

Scene 5 · She goes down

She stops in the middle of a sentence, her eyes close, and she slides down the wall.

You talk to her, you shake her shoulder: nothing. Her chest, though, is rising.

She has stopped responding, and the bottle is still in your hand.

• Right move : Nothing more to drink. I roll her onto her side, I keep cooling her, and I call 15 back.
  Two things at once: the breathing and the temperature : The guidance separates the two cases: if the casualty is in a life-threatening state, apply the matching procedure; if she is not, settle her comfortably and rehydrate her. She has just crossed over, so nothing more in the mouth, recovery position, and the cooling carries on: in every case, cool the casualty.
• Mistake : I go on pouring water into her mouth, that is what she is short of.
  Nothing is being swallowed : Rehydration is an action reserved for a conscious casualty: the guidance puts it in the branch where there is no life-threatening state, and the other branch asks you to apply the matching procedure. Somebody who is not responding does not swallow: the water goes into her lungs.
• Mistake : I stop cooling her: maybe that is what made her pass out.
  Her skin goes back to burning : The guidance writes “in every case” before the instruction to cool: it does not depend on whether she is conscious. What made her go down is the heat she built up over four hours, and the one thing bringing it back down is what you have just stopped.

Scene 6 · The wait

She is on her side, in the shade, in her underwear, with two wet cloths on her forehead and the back of her neck.

The dispatcher said four minutes. Your arms are burning from fanning with a piece of cardboard.

Four minutes. What do you do?

• Right move : I keep cooling and fanning her, and I watch her breathing without leaving her.
  Cool to the end, and watch : The guidance closes the procedure with exactly those two things: cool the casualty with whatever means you have, and watch her closely, meaning how the signs of a life-threatening state and her temperature are changing. And the guidance says how far you are going: the target is to get the temperature back below 39,4°C. Four minutes of wet cardboard is a rescue action.
• Mistake : I get her back on her feet to take her to my air-conditioned car.
  She goes down again, further from the shade : Somebody who is not responding does not get stood up: she stays on her side, where she is, watched. The cool place has already been reached, and the guidance asks you to cool her and watch her, not to move her.
• Mistake : I stop and go and sit down: the crew will take over in four minutes.
  Four minutes without cooling is four minutes won by the heat : The procedure asks you to watch the casualty closely, how the signs of a life-threatening state and her temperature are changing, and to cool her in every case. The action does not stop because a crew is on its way: it stops when they take it over.

Scene 7 · The crew

The blue light crosses the tarmac and stops three metres away. They carry on doing exactly what you were doing, with proper sheets and proper cold packs.

One of them asks how long you have been fanning her. You say seven minutes, and he tells you that is very good.

You did nothing but shade, water and moving air. That was everything this one asked for.