Heatstroke is a Medical Emergency

Recently, one of a pair of seasoned hikers suffered heatstroke during a 100-degree trek up Mt. Diablo, and died before paramedics arrived. This tragedy is instructive, because it is a reminder that being in good physical condition, having experience in the outdoors and having a companion, do not always protect you from heatstroke.

What can you do to prevent this from happening to you? And what might you do if you or a companion must stop because of heat exhaustion?

Heatstroke is the most serious and severe stage of overheating and dehydration that occurs when the body's cooling mechanisms such as sweating and reddened skin cannot keep up with the increasing heat caused by the a hot environment and physical exertion.

Heatstroke is a medical emergency that can be fatal if not treated quickly and appropriately.

Reduce the risk of heatstroke by following these tips when in a hot environment.

1. Who is most likely to get heat stroke?
1. Infants: their cooling mechanisms are not fully developed, and they can't control their environment or their fluid intake
2. The elderly (over 60), especially those with heart, lung, or kidney disease
3. Those taking certain medications: medicines that narrow your blood vessels, regulate your blood pressure, increase urination of salt and water or for psychiatric illnesses.
4. Athletes who push themselves to exhaustion and underestimate their fluid needs
5. Outdoor workers physically exerting themselves under the sun
2. What can you do to prevent heatstroke?
1. Keep hydrated. The average adult needs 2½ liters of fluid daily, but many will need a liter or more per hour during exertion in a hot environment. In such a situation, drink before you are thirsty. If your urine is dark or you can't urinate every 2 hours, drink more. Sports drinks are best because they include electrolytes (salts and sugar). You can make your own by adding a teaspoon each of sugar and salt to one liter (or quart) of water. Avoid caffeinated beverages such as colas, coffee, tea and energy drinks.
2. Stay cool. Wear a hat and white or tan clothes to reflect light and heat. Cotton clothes retain moisture so may help cooling. Loose clothes allow air flow. Find shade, splash water on your face and body and wet your clothes, since water absorbs heat more quickly than air. Expose yourself to a breeze if you can stay in the shade. Fan yourself.
3. What does heatstroke look and feel like?
1. Symptoms and signs may include high temperature, severe fatigue, headache, dizziness, agitation, confusion, lethargy, red, hot dry skin (when it should be sweaty), muscle cramps, rapid heart rate despite resting, hallucinations, seizures, unconsciousness.
4. What should you do if you suspect heatstroke?
1. Call 911 right away.
2. Find shade if at all possible.
3. Remove non-cotton clothes to expose more skin to the air.
4. Wet the person and fan with air, giving priority to head and neck.
5. If available, apply icepacks to groin and armpits.
6. Give small amounts of water only if the person is conscious.
7. Lie down with legs elevated.

If any of the treatments cause shivering, stop immediately. Shivering increases body temperature. For more information about heat-related illness, visit www.cchealth.org.

Dr. Goldstein is the Chief of Emergency Medicine at Contra Costa Regional Medical Center in Martinez.

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