CASE 01 / HEAT EMERGENCIES
Exertional Heat Stroke
Altered hiker. Core temperature 41.7°C. Your department doesn't have an immersion tub.
10-minute scenario · 10–15-minute debrief · Low-tech
Heat stroke is time-critical.
The challenge isn't just knowing that rapid cooling matters. It's discovering how your team would actually deliver it, with the equipment and people available in your department.
Learning objectives
Recognize heat stroke and initiate active cooling without delay.
Prioritize effective cooling while managing agitation, hypovolemia and potential complications.
Identify a local equipment or workflow issue that could delay treatment.
Set up
Use your usual resuscitation bay, basic mannequin and real departmental equipment. Have a core temperature available when requested. Don't pre-stage a perfect cooling solution: part of the exercise is discovering what your team can actually deliver … although having some fans and spray bottles nearby doesn’t hurt.
The scenario
A confused, agitated hiker is brought to your ED after prolonged exertion in hot weather. Initial observations:
41.7°C
Core temp
135
HR
90/58
BP
13
GCS
Run the case
STAGE 01 · 0–3 MIN
Recognize the emergency
Confusion, agitation, tachycardia, hypotension and marked hyperthermia.
Facilitator focus: Recognition, core temperature, initial resuscitation and cooling.
STAGE 02 · 3–7 MIN
Make cooling happen
Hyperthermia persists unless effective cooling begins.
Facilitator prompt: “How would you actually cool this patient here?”
STAGE 03 · 7–10 MIN
Reassess and plan
With effective cooling, temperature and physiology begin improving.
Facilitator focus: Reassessment, complications, disposition and transfer planning.
The debrief is a conversation.
Keep it practical. Focus on one or two clinical decisions and what the case revealed about your department.
01 / Reactions
How did that feel? What tipped you toward heat stroke?
02 / Clinical decisions
How quickly could we cool this patient? What would we use at 2 a.m.?
03 / Systems
What might delay care in a real patient? Can we fix one thing?
04 / Takeaway
What's one thing you'll carry into practice?
Knowing that immersion is preferred was easy. Figuring out how to provide it was the useful part.
Our team identified where portable fans were stored, the availability of ice from the ED ice machine, and a possible improvised immersion setup using a body bag from the small morgue near the ambulance bay.
The proposed improvised setup would require local assessment of patient handling, containment, monitoring and safety before clinical use.
The point: test the system, not just the learner.
Clinical takeaways
Rapid active cooling is the priority. Cold- or ice-water immersion is preferred when feasible, with a goal of reducing core temperature below 39°C within 30 minutes of recognition. Antipyretics do not treat heat stroke. Manage associated physiologic disturbances and complications without delaying cooling.
Further reading
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