FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- Do not give oral fluids to someone who cannot safely protect the airway.
- Pediatric fluid doses and required base contact differ; use the pediatric thermal guide.
Recognize severity
- Mild/moderate features include malaise, tachycardia, nausea, or vomiting while conscious. Confusion/altered consciousness, hot dry skin, or hypotension activates the severe pathway.
- Assess the exposure, work/exertion, fluid intake, medications, mental status, and circulation. Reassess frequently for progression.
Mild or moderate illness
- Move away from the heat to shade/cooler air with good airflow; use a fan when available.
- Encourage water or a balanced electrolyte drink without caffeine/stimulants if oral intake is safe. Use cool wet towels or cold packs as tolerated.
Severe illness
- Check SpO₂ and provide oxygen when room-air saturation is below 95%.
- For hypotension/poor perfusion with clear lungs/no CHF, give saline 250 mL IV and reassess; repeat to a maximum 1 L to support perfusion.
- Use available active or passive cooling, including cold packs at the axillae, posterior neck, and groin, plus airflow with appropriate skin exposure.
Transport and reassessment
- Provide ALS escort to the nearest appropriate ERC; contact base if further stabilization orders are needed.
- Continue cooling and monitoring during transport. Report mental-status and perfusion trends, exposure, cooling methods, fluids, and treatment response.
VISUAL FIELD REFERENCE
Heat illness: recognize a change in severity
Adult / adolescent · ALS
Mild / moderate
Mild/moderate features include malaise, tachycardia, nausea, or vomiting while conscious.
Move away from the heat to shade/cooler air with good airflow; use a fan when available.
Severe
Confusion/altered consciousness, hot dry skin, or hypotension activates the severe pathway.
Use available active or passive cooling, including cold packs at the axillae, posterior neck, and groin, plus airflow with appropriate skin exposure.
- Do not give oral fluids to someone who cannot safely protect the airway.
- Continue cooling and monitoring during transport. Report mental-status and perfusion trends, exposure, cooling methods, fluids, and treatment response.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-E-025
UNDERSTAND THE CARE
Why mental status and perfusion guide severity
Exposure history establishes the setting, but the patient’s current function determines urgency. Document exertion, environment, intake, medications, consciousness and circulation together. The mild/moderate pathway assumes a conscious patient who can safely tolerate its measures; worsening mental status or perfusion moves the assessment to the severe branch.
Applying the guidance
Cooling and monitoring continue during movement and transport. Oral intake depends on safe swallowing and airway protection, while the fluid pathway has its own clear-lung and perfusion conditions. Record which cooling methods were started and whether the patient’s mental status, breathing and pressure changed.
Putting it together
Teaching example: an exertional patient initially converses normally but becomes confused during packaging. Communicate the deterioration, use the severe pathway and continue cooling rather than treating the original category as fixed.
Diagram text & teaching checkpoints
- Exposure
- Heat, exertion, duration and intake.
- Severity
- Mental status and circulation.
- Cooling
- Begin available measures and continue transport care.
- Reassessment
- Watch for progression and airway risk.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Sweating does not exclude severe heat illness
Do not wait for dry skin. CDC/NIOSH lists both dry skin and profuse sweating among possible heat-stroke findings. A hot, sweaty patient with confusion or altered consciousness still needs urgent reassessment and the appropriate severe-illness pathway.
Use the OCEMS clinical triggers above together with the exposure history. Treat the list as possible findings, not a requirement that every feature appear. Record the neurologic change and cooling already started instead of using perspiration as reassurance.
Clinical background: CDC/NIOSH heat-related illnesses. OCEMS treatment and transport instructions remain those in SO-E-025.