Current paradigms in the prehospital care of exertional heat illness: A review

Exertional heat illness, including muscle cramps, heat syncope, heat exhaustion, and heat stroke, occur each year in athletes and military soldiers. Exertional heat stroke, the most concerning type of exertional heat illness, is a life-threatening condition defined clinically by a core body temperature greater than 104 degrees F (40 degrees C) and central nervous system dysfunction. Heat stroke may lead to multiorgan failure and death and is one of the leading causes of nontraumatic death in athletes participating in outdoor activities. Current recommendations are discussed regarding prehospital and first responder care of exertional heat illness, particularly heat stroke, with an emphasis on rapid recognition, assessment, and implementation of cooling and advanced care strategies. This overview is of particular interest to orthopaedic team physicians who often are first responders on the field.