Separate cooling from warming pathways and recognize when altered mental status or arrest changes the response.
OCEMS source summary · Updated 2026-09-16
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.
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.