Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.

Heat illness experience at BMH Shaibah, Basra, during Operation TELIC: May–July 2003

This is an observational study of heat-related illness in UK Service Personnel deployed into summer conditions in Northern Kuwait and Southern Iraq. Among 622 hospitalisations reported during a 9-week period at the historical British Military Hospital, Shaibah, 303 consecutive admissions are reviewed in detail. Several clinical syndromes attributable to thermal stress were observed. These ranged from self-limiting debility to life-threatening failures of homeostasis, with 5.0% developing a critical care requirement. Hyponatraemia was a commonly occurring electrolyte disturbance by which, relative to the local reference range, a majority of heat-attributed admissions were affected. Reductions in measured serum sodium could be profound (<125 mmol/L in 20.1% of all heat-related casualties). Hypokalaemia was observed in half of cases, though only a minority were affected by severely low potassium (<2.5 mmol/L in 4.0%). Despite preventive measures prescribed on hospital discharge, illness and significant biochemical derangements could recur upon return to duties in the heat. We reiterate the need for primary prevention of heat illness wherever possible and importance of early, effective interventions to treat and protect Service Personnel from secondary injury. We also highlight the requirement for comprehensive assessment to inform prognostication and occupational decision-making in relation to extreme climatic heat, including aeromedical evacuation. We draw additional attention to the contribution of psychological factors in select cases and identify research questions to improve understanding of environment-induced incapacitation in general.

Procedure for assessing patients referred to the UK’s military Heat Illness Clinic: a case series

IntroductionThe UK military operates a Heat Illness Clinic (HIC) to aid the return to exercise, training and occupational duty recommendations for individuals who have suffered exertional heat illness or heatstroke. This paper describes the process of assessment and reports representative data from n=22 patients referred to the HIC.MethodThe assessment included clinical consultation, and measurement of maximal oxygen consumption (V̇O2max) and a heat tolerance test (HTT) conducted on a treadmill in an environmental chamber with an air temperature of 34°C and 44% relative humidity. Patients began the HTT wearing military clothing, carrying a rucksack (mass 15 kg) and walking at 60% V̇O2max, at 30 min the rucksack and jacket were removed and the T-shirt at 45 min, individuals continued walking for 60–90 min. Patients were considered heat tolerant if rectal temperature achieved a plateau.ResultsN=14 patients were heat tolerant on the first assessment and of the n=8 patients required to return for repeat assessment, five were heat tolerant on the second assessment and the remaining three on the third assessment.ConclusionsIn conjunction with patient history and clinical evaluation, the HTT provides a physiological basis to assist with decisions concerning patient management and return to duty following an episode of heat illness.

Characteristics of Prehospital Heat Illness Cases During the Annual Heat Wave Period in Telangana, India

Objectives: Global warming and more intense heat wave periods impact health. Heat illness during heat waves has not been studied in the prehospital setting of a low- and middle-income country (LMIC). Early intervention in the community and in the prehospital setting can improve outcomes. Hence, this paper aims to describe the characteristics of heat illness patients utilizing the ambulance service in Telangana state, India with the aim of optimizing public prevention and first aid strategies and prehospital response to this growing problem. Methods: This retrospective observational study reviewed patients presenting to Telangana’s prehospital emergency care system with heat illness symptoms during the heat wave period from March through June in 2018 and 2019. Descriptive analysis was done on the prehospital, dispatch, and environmental data looking at the patients’ characteristics and prehospital intervention. Results: There were 295 cases in 2018 and 230 cases in 2019 from March-June. The overall incidence of calls with heat illness symptoms was 1.5 cases per 100,000 people. The Scheduled Tribes (ST) had the highest incidence of 4.5 per 100,000 people. Over 96% were from the white income group (below poverty line) while two percent were from the pink income group (above poverty line). From geospatial mapping of the cases, the highest incidence of calls came from the rural, tribal areas. However, the time to response in rural areas was longer than that in an urban area. Males with an average age of 47 were more likely to be affected. The three most common symptoms recorded by the first responders were vomiting (44.4%), general weakness (28.7%), and diarrhea (15.9%). The three most common medical interventions on scene were oxygen therapy (35.1%), oral rehydration salt (ORS) solution administration (26.9%), and intravenous fluid administration (27.0%), with cold sponging infrequently mentioned. Conclusion: This descriptive study provides a snapshot of the regions and groups of people most affected by heat illness during heat waves and the heterogeneous symptom presentation and challenges with management in the prehospital setting. These data may aid planning of prehospital resources and preparation of community first responders during heat wave periods.

SYMBOLIC MEANING OF KESANDINGAN RITUAL IN PROBOLINGGO

Kesandingan, one of the rituals in Probolinggo, East Java, is a cultural phenomenon that mingles with religious elements of society. It is something sacred and mystical that parents do when a toddler (an infant under three years old) experiences heat illness for days, tends to be fussy, cries a lot, and cannot sleep at night. This research aims to explain the process of symbolic communication of kesandingan ritual and to understand the symbolic meaning behind the ritual. It is a descriptive-qualitative study through observation, in-depth interviews, and documentation. The data analysis uses a qualitative-naturalistic technique. The result demonstrates that the symbolic communication process of kesandingan ritual in Mentor, Sumberasih, Probolinggo, comprises seven series: burning incense, wiping incense smoke on the child's face, giving the child holy water to drink, wiping the child with floral water, preparing food, making a wish on the child's bed, and distributing food. Meanwhile, the symbolic meaning of kesandingan ritual refers to divine, social and personal dimensions. Ritual kesandingan merupakan salah satu ritual masyarakat Probolinggo Jawa Timur yang sudah menjadi fenomena budaya yang berbaur dengan unsur religi masyarakat. Ritual kesandingan merupakan sesuatu yang sakral dan mistis yang dilakukan orang tua saat anak batita (bawah tiga tahun) mengalami sakit panas berhari-hari, rewel, kerap menangis dan tidak bisa tidur terutama malam hari. Tujuan penelitian ini untuk menjelaskan proses komunikasi simbolik ritual kesandingan dan memahami makna simbolik dibalik ritual tersebuat. Penelitian ini merupakan penelitian deskriptif-kualitatif, pengumpulan datanya melalui observasi, wawancara mendalam, dan dokumentasi. Sedangkan analisis datanya menggunakan teknik analisa data kualitatif-naturalistik. Sebagai hasilnya, diketahui bahwa proses komunikasi simbolik ritual kesandingan di desa Mentor Kecamatan Sumberasih Kabupaten Probolinggo meliputi tujuh rangkaian yaitu: membakar kemenyan, mengusap asap kemenyan ke wajah anak, memberi minuman kepada anak dengan air doa, mengusap wajah anak dengan air bunga, menyiapkan makanan, memanjatkan doa ditempat tidur anak, dan membagikan makanan. Sedangkan makna simbolik ritual kesandingan mencakup tiga dimensi, yaitu: dimensi ketuhanan, sosial, dan personal.