# Pediatric heat illness / hypothermia

Separate cooling from warming pathways and recognize when altered mental status or arrest changes the response.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-temperature-emergencies/
Official source: [SO-P-105 — Thermal Disorders - Pediatric](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-105%20Hyper-hypothermia.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Keep hypothermic bradycardia distinct from the ordinary pediatric bradycardia algorithm.
- Severe heat illness requires prompt cooling and transport; do not wait for a precise temperature to recognize the listed clinical triggers.

## Source documents

- [SO-P-105 — Thermal Disorders - Pediatric](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-105%20Hyper-hypothermia.pdf)

## Mild or moderate heat illness

- Move to shade or a cooler area with airflow. Use a fan when available and passive cooling such as cool wet towels or cold packs as tolerated.
- Encourage water or a balanced, non-caffeinated salt drink only when oral intake can be safely tolerated. Reassess mental status and perfusion for progression.

## Severe hyperthermia

- Confusion/unconsciousness, hot dry skin, or hypotension activates the severe pathway. Contact base early for destination, pediatric-capable preferred. Provide the source’s high-flow oxygen support.
- For hypotension or poor perfusion, saline is 20 mL/kg IV/IO, maximum 250 mL, with base contact; may repeat twice for three total boluses.
- Use available active/passive cooling, including cold packs at the axillae, posterior neck, and groin with airflow. The source directs ALS escort for all pediatric hyperthermia patients.

## Hypothermia with a pulse

- Remove wet clothing, conserve heat, and begin available warming. Monitor and document the rhythm.
- Expect a slow rate and weak pulse; SO-P-105 directs against trying to reverse hypothermic bradycardia in the field. Transport immediately to the nearest ERC.

## Apparent arrest

- Check for a pulse for 30–45 seconds before starting CPR. If arrested, use the pediatric arrest pathway; assist ventilation without hyperventilating and continue warming.
- Do not pronounce in the field under this pathway. Contact base and provide ALS transport to the nearest appropriate ERC. Report exposure, warming/cooling measures, perfusion, rhythm, and fluids.