(Transcript is automatically generated).

Erik: [00:00:00] I am really hot and I am really thirsty and I have no idea where I am. 

Matt: Get him into that ice bath is more important than throwing him in the back of your ambulance.

Narrator: You are listening to EMS, with your hosts, Erik Axene and Matt Ball. 

Matt: Alright, we're talking about hyperthermia today.

Erik: Hyperthermia on the, on the EMS show.

Matt: That's right. That's right. [00:00:30] Make sure to like and follow. Uh, you can, if you subscribe to our website, you can get CE content for these podcasts. Mm-hmm. Um, or you can watch 'em on YouTube for free, but make sure to like follow, hit the like button.

Give us a comment that really helps us out. We appreciate it. 

Erik: Yeah. Becoming a follower, I didn't realize how important that stuff was.

Matt: Well, in liking and comment. It puts us into the matrix or whatever. I don't 

know.

Erik: Yeah. Let's get this context.

Matt: Two old dudes trying to figure out social media. Yeah. We just wanna reach people. Um, we wanna get the message out there. But you know, right now we're, we're in Texas, 

Erik: we're [00:01:00] in the heat dome. 

Matt: It is the end of June in Texas, which we know is always gonna be hot, but the rest of the country is experiencing a heat wave. I was talking to my mom mm-hmm the other day. Lives outside Chicago.

And Chicago can get very hot. It's not uncommon to have temps in the high nineties, but for June, for mid-June to have it be, I think she said it was. Like 96 the other day. Right. That's pretty warm for mid-June. Usually that's July, August weather. Yep. Um, so a lot of the country is experiencing higher temperatures than they're used to.

Erik: Yes. [00:01:30] Now it's interesting you mentioned the temperatures. So the way to really monitor the, the stress on the body is to get something called a wet globe. I think it's called a wet globe temperature or something like that. But the important thing is, is that it's not just the temperature that's showing up on thermometer, the, the humidity.

Right. You know, the exposure. There's a lot of factors that create. I mean, if you're, if you're in the shade, in the heat, it's a whole lot different than being exposed.

Matt: Oh, it's a dry heat. 

Erik: Well, it is better if it's a dry heat. It's yes. But, but when it's, you [00:02:00] can, you know, when you have a thermometer, a glass bulb, thermometer, and a wet towel out where you are maybe having an athletic activity 

Matt: mm-hmm.

Erik: That temperature that will register on that thermometer, uh, is really the, the best measurement for the, uh, the effect that's the temperature the environment's gonna have in your body. And that's actually what schools use to determine whether or not they're gonna cancel football practice or whatever.

Matt: Oh, really? 

Erik: Yeah. It's interesting. So we monitor here, uh, where I'm a medical director. Mm-hmm. We look at that, that that [00:02:30] temperature rating is really how we make decisions on whether or not we, we cancel things. 

Matt: Now as a physician, what would you say, what's your cutoff for a patient body temperature to be considered hyperthermic?

Erik: Oh, good question. So really it's a clinical diagnosis. That's right. I mean, you might be 102, but still be all. Turned. Yeah. Yeah. If you're altered that, that takes you over from heat exhaustion to heat stroke. Right. And that's where, you know, the, the risk of course is, you know, damaging brain cells and 

Matt: Yeah.

If they have comorbidities, you [00:03:00] know, different things they don't regulate, you know, whatever the case may be, somebody could have a lower temperature and have a worse problem than you and I correct to thermoregulate better. And we could be 101 and not be as dangerous as or in a dangerous spot as them.

Erik: Well you said, you said the word right there, thermal regulation. That's really what's going on in our bodies to try to regulate our temperature. We are homeotherms. Yes. We have a temperature range that we wanna stay within because that's where our body's chemical reactions occur best. And that's where the proteins in our body stay [00:03:30] together in that temperature range.

That's right. And you get outside of that temperature range, you can, you can have some problems, uh, whether it's, you know, the enzyme's not working 'cause it's too cold, or the enzyme's falling apart because it's too hot. 

Matt: Too hot. Yeah. 

Erik: And so that thermal regulation is key, what you said. So, um, let's talk about.

Some things that the body will do to compensate when we get hot. So you and I we're doing the podcast outside. It's, it's a hundred degrees direct heat here in Texas. What is our, what are [00:04:00] we gonna see in our bodies right away? 

Matt: Oh, right away You're gonna start sweating, correct. You're gonna start sweating.

And that's a, a way that your body's trying to cool off. That's right. You're getting water dripping down your skin. Hopefully it's a little bit of a breeze. And that's gonna help cool your temperature down. Correct. Your body temperature down. 

Erik: Correct. And then there's also the, the capillaries in the, of the surface in our skin.

Vasodilate, we're gonna, we're gonna vasodilate, we're gonna constrict, we're gonna to try to maintain a temperature. 

Matt: Yeah. 

Erik: Uh, and we also, we have this thing called the brain. [00:04:30] We do. We do. Isn't that crazy? It's an amazing organ. But this is actually really important, is to know that we're at risk and we know that we need to go shoot the podcast of the shade over there or go inside, right? 

Matt: Yeah. It's like being a firefighter inside of a house fire. Yeah. The old school guys, I never experienced this, but the old school guys, before they had hoods. Yeah, their ears. They're like, oh, this is getting too hot. My ears are starting to burn. That was their temperature regulator saying, ah, hey, this, it's getting too hot.

We need to back out. Oh, that's interesting. Same thing. You feel it. You're sitting outside, you're like, whew, man, I'm getting a little uncomfortable. [00:05:00] Yep. We need to get in the shade, we need to get inside, whatever. 

Erik: And then you start to get dehydrated. Our body's going to get that thirst, right Impulse. And so we're gonna want to get some water.

Right. So these are all parts of the mechanisms of thermal regulation for when we get too hot. Here's a cool story, Matt. So I was reading a book recently. Uh, written by a hand surgeon, I think outta New York, but it was called, I think the name of the book was The Physiology of the Extremes. And there was this one chapter on heat emergencies. It was really interesting.

Matt: Really? From a hand [00:05:30] surgeon.

Erik: Yeah. And they were, they were in New York. Yeah, I know. Well, they were covering, well, this gets weirder. So they were actually covering, uh, you know, um, the Ultra Marathon runners mm-hmm. That run in the Sahara Desert for like a hundred miles. 

Matt: Oh yeah. Yeah. The Badlands 100 or whatever.

Erik: That's right. Well, these, these folks are training in that high temperature. So they're, they're actually running at temperatures that would really maybe scare the normal person. Yes. 104, 105 degrees

Matt: doesn't scare David Goggins.

Erik: No, it sure doesn't. 

Matt: He lives to run at 104 degrees.

Erik: Does he do [00:06:00] this kind of thing? Oh yeah. That's what he did. I didn't understand.

Matt: He did. That was one of his famous stories was after his SEAL career and all that stuff. And I believe it's called, I believe the race is the Badland 100 and it's, it was, was considered the hardest, I wanna say if I'm not incorrect, I think it goes through, um, Death Valley maybe. It goes through a very extreme hot place. Hot place, yeah. And it's a hundred mile race, Uhhuh and I, he, uh, he called the race organizer and said like, Hey, I want to test myself. I wanna do this. And the guy's like, hang [00:06:30] on, bro. Like, you don't just sign up for this race. You have to prove that you can run a hundred miles within 24 hours.

Which took David Goggins to, he had to get a, he had to run a, um, sanctioned race. Oh. Okay. And have a time. And then that's a whole other story. But yes, he's, he's known for running in those crazy conditions. 

Erik: Well, what they've found with these ultra marathoners, and maybe this, uh, gentleman that you speak of has this too, but our body actually generates these things called chaperone proteins.

Matt: Yeah. We've talked about this before. 

Erik: Yeah. And [00:07:00] what they do is they create an insulation almost around some of these proteins that would normally fall apart at a certain temperature. The chaperone proteins will protect it and hold it together so we can actually function at higher temperatures. Yeah. And which is great in the body because a lot of things change with oxygen dissociation. Mm-hmm. A lot of things change with, with metabolic rate when we get the temperature up. Yeah. Uh, so, so actually these marathon, these ultra marathoners are actually functioning at a very high level at, you know, technically a fever or [00:07:30] hyperthermia. So your question earlier was, what Temperature makes me concerned?

Well, gosh, it's, it's subjective. It is subjective, yeah. Yeah. If I went out and ran at Death Valley after we would die one mile,

Matt: we would be dead.

Erik: My cerebral cortex. Danger. Danger. Right. Exactly. Get, get into the shade.

Matt: Your chaperone proteins are we're we're leaving the dance, bro. You're on your own, 

Erik: right? Yeah. So what happens sometimes unfortunately is that we do get into trouble. Yeah. For various reasons. 

Matt: That's right. 

Erik: Uh, quick story. I was out, uh, uh, [00:08:00] dirt biking with a friend of mine out in, uh, California somewhere. And we were, we were out in the hills and we got lost and one of the bikes broke down.

Matt: Oh, of course.

Erik: And so, um, I was actually, for a while there. Was kind of scared. Sure. Uh, and of, and know we didn't have our shirts on. I mean, we were idiots. No water didn't have any water with us. And we were very concerned. And I started to get to that point. It's like, I am really hot and I am really thirsty, and I have no idea where I am.

I was really getting a little scared. [00:08:30] Yeah. But, but I, but I remember that clearly though, as being a time when I started to push it to the limit, I, I knew that I was in a bad spot. Well, sometimes our patients get into bad spots, whether it's a football player at two Adays. Yeah. Who's, you know, being a tough guy that doesn't want to take water, or maybe the, hopefully not the coach.

Hopefully there's a good system for getting water, but you know, sometimes we're called to the scene with somebody with a heat emergency. So I think it's really important. We talk about this construction work, construction. Another big subjective Yeah, [00:09:00] that's right. I, I 

look around and I see these guys, just the other day, I don't remember, I saw these guys on a roof and I'm thinking, oh my goodness.

Oh, I mean it was like, it was over with the heat index and everything. It was over, well over a hundred degrees and I thought, oh my. Gosh, that looks so hot. Which is one thing a lot of these guys, you'll see 'em. Mm-hmm. And they're wearing like you, you and I'd probably be out there shirtless and shorts, you know? Right.

Matt: No, no, no. The people that come from hotter climates, they're smart. Right. And they typically will wear long sleeve shirts. A lot of them will have hoods on and they'll be [00:09:30] wearing long pants and everything because that sweat then soaks that shirt. Yeah. And actually helps keep them cooler. 

Erik: That's right. In fact, uh, I was curious how much water I lost mowing the lawn. I've got about an acre.

Matt: Of course you would do that. And I I Did you measure your sweat?

Erik: Well, what I did, no. I wanted to be scientific because I, I was, at the time, I was working with a friend to lose some weight. Mm-hmm. And we were weighing each other, well, he didn't weigh me and we wore, we were weighing each other.

Yeah, yeah, yeah. I was losing [00:10:00] weight and, and, uh, I noticed that I had really had a really low weight after I had mowed the lawn. I was like, I wish I would, would've mowed before just to see how much I lost. Yeah. 'cause when I mow the lawn, like you. Were talking about. I, I mow it in a, in a, like a light color sweatshirt, sweatpants.

Mm-hmm. Sun hat. I mean, everything is Yeah. 

Covered. 

Covered. And to protect my skin. But also, like you said, when it, you sweat that wet cotton can really keep you cool. That's right. Well anyway, [00:10:30] so I, I did, I lost seven pounds of water. Now it takes you about three hours, a hundred degree heat with the humidity.

Seven days wearing sweat, pants, sweat. Were you sweatshirt,

Matt: were you drinking any water as you were doing?

Erik: No. So you Nothing. 

Matt: You were super dehydrate.

Erik: Nothing. And I was tired. 

Matt: Pee was yellow.

Erik: I just wanted to see what I probably went, grabbed her.

Matt: Your wife's looking at you going, what an idiot.

Erik: But I weighed myself. Yeah. Seven pounds of water. Wow. Boy, I drank a ton of water though.

Matt: I bet you did afterwards. Did did you feel crummy at all?

Erik: I felt very tired. Yeah. [00:11:00] And, uh, but I, I, I mean, if I really felt bad, I would've done something, but I didn't, I'm a bigger guy too. Yeah. So when you weigh 250 pounds, you can, you know what's seven pounds?

Right? Right. 60% of your body's water. Seven. Pounds on you is a little different than seven pounds on me. Right. Well that's part of the reason why if a baby isn't left in a car too long oh yeah. They can't thermal regulate like we can their body surface area in a masses and volume is so wonky. Whereas a bigger guy like me, I can handle that.

Right? That's right. But a little kid in a [00:11:30] hot, hot car, oh my gosh. Getting up over 140 degrees in there. They can, they can Yeah. Die. Yeah. Pretty quick. And that's why it's so important to, uh, taking care of our kiddos in the heat. Yep. Yep. The other population that would be worth talking about too is the geriatric population.

The medications can affect them.

Matt: It's always the young and the old with everything. 

Erik: It is, yeah. Unfortunately, us middle people, we we're stupid sometimes. Yes. And we go dirt bike without,

Matt: especially as, as middle aged men. Yeah. We still think we seven pounds of clothes on and we, [00:12:00] yeah. So let's. Go ahead. Go ahead.

Erik: Oh 

no, I was just gonna say that that geriatrics, yeah, we get into bad situations sometimes. Whether we have risk factors of our age, risk, factors of comorbidities, risk factors of exposure in our jobs, risk factors of athletic activities or or leisure activities like hiking. You get into trouble, right? So for whatever the reason you're the responder, 9 1 1 is called, you're on scene and you gotta take care of the patient.

Matt: So before we do that, there's one more patient [00:12:30] population. Yeah, that is probably. Watching this podcast right now. Oh gosh. Firefighters. Yeah. Of firefighters. Especially us here in Texas. Yep. So, I don't know, like up north what they do, but I know here in Texas most, you know, departments are very cognizant.

When the temperatures get super high, you get a structure fire. Yep. I'm putting on 60 whatever pounds of gear that does not breeze doesn't bleed that much. Oh yeah. It's, I mean, depending on like your gear,

Erik: I didn't know actually how heavy it was. 

Matt: Well, so it's all, so again, everything's relative, right? Yeah.

You're a bigger guy. 

Yep. My, your gear is [00:13:00] gonna weigh a little bit more than mine. Is right, because I have less material. Right. But yeah, I mean 50 to 80 pounds of gear. And that's just like the gear, well,

Erik: well your oxygen takes total certain things to be

Matt: O2, two tanks. Whether if you're using 30 minute or 45 minute bottles, that makes a difference.

25 ish pounds is probably what your oxygen bottle or your, your SEBA weighs and then your gear. But the big thing is that we're talking about is that gear does not breathe. Mm-hmm. It's three layers thick and it's, it just holds all that heat inside [00:13:30] because it's trying to protect you. Right? Yep. And.

You're wearing hood, so how do you get rid of most of your heat? Yeah. Right? And so now you've got a hood on with a helmet on. Oh yeah, right? You're wearing all this gear weight and now you're doing a full on CrossFit workout. Yeah, you're pulling hose. You're doing all, so you are losing a tremendous amount of sweat fluids.

That's why it's so important for our fire firefighters. Make sure you are hydrating before your shift. Do not come into your shift dehydrated because you're setting yourself up for a real bad thing [00:14:00] if you're running command. If you're running a fire, you gotta be mindful of that. Maybe in February they could go through two bottles before they have to come out and go to rehab.

Not in this kind of heat. Yeah. One bottle, 15, 20 minutes. They need to go to rehab. They need to get rehydrated before they can think about getting back or else you're setting yourself. They just had, where was it? New York. New York. I just saw the other day, the New York City Fire Department experiencing higher temps than normal.

Yeah, yeah. And several of the FDNY guys, these guys are very [00:14:30] experienced. They wear their gear all the time. They fight a lot fire. Right. Super fit too probably, 

and it's probably super fit. But this is what they do. They're acclimated and operating in these environments, but they're not acclimated at doing it in these air temperatures.

Yeah. And several of them had to be transported to the hospital. They were hypothermic. They were having hyperthermic. Hypothermic. Yeah. They were, I thought you said both. Oh, I might have. Yeah. But they, they were having, uh, whether it was heat stroke or heat exhaustion, but they were transported due to the heat, so.

Firefighters, another huge population that we typically don't think of [00:15:00] ourselves as the patients, and we need to keep that in mind. 

Erik: So, uh, when, when our, when the environment or the situation causes us to overrun our body's ability to thermal regulate, that's when we get into heat exhaustion. So, you know, normally we're able to compensate with sweating and Yes, hopefully getting a cold glass of water going into the shape.

Going into the ac Exactly. Whatever we can thermal regulate, but sometimes we can't do that. Yeah. Like a football player in full game. Your helmet, firefighters, same, exerting themselves, firefighters, gear, all this stuff. [00:15:30] Sometimes you just can't get to the place you need to get to. Cool down. 

Yeah. 

Well, what can happen, what we run the risk of is not being able to thermal regulate.

So normally when we're compensating and keeping our temperature down in that safe range, when things don't go well and we run outta water light, dehydrated, um, then now we're temperature's starting to creep up and we can't Thermal regulate. It's like you're running on a treadmill that's going too fast in the wrong direction.

Right. That's right. And so eventually you'll get to a point where you get to heat [00:16:00] stroke. 

Mm-hmm. 

And the sign of heat stroke is pretty simple. It's just like with, with sepsis, it's organ dysfunction. And the first organ to go the most sensitive one. Right. This is the one that's most sensitive to these things.

This is the brain. That's right. And the brain will, um, start to create an ultra mental status. That's right. And that's the sign of heat stroke. 

And a lot of people talk about heat stroke. Oh, you'll stop sweating. Right. That's kind of hard to judge sometimes, right? Yeah. Because maybe they're still wet and you're thinking.

Matt: They're still sweating or actually they've stopped sweating. That's just sweat from [00:16:30] 10 minutes ago. Right, right, right. Or you feel their clothes and you're like, oh, their clothes are wet. They're still sweating, but they, the altered mental status is a much easier thing to identify. Yes. And obviously we're identifying that is due to the heat.

Mm-hmm. Right. We're checking blood sugars, we're checking other things to make sure, okay, is this heat related? We're getting their temperature Right. But altered mental status, when you've got that, what you believe is a hyperthermic patient Yep. And they are altered. That is a true. Medical emergency, life threatening medical emergency.

Erik: So why don't we, [00:17:00] uh, I got a case for you, Matt. Okay. So I was mountain biking not too long ago here in the area. Mm-hmm. And, uh, just it was hot and I don't like to actually mountain biking. I can see, but boy do I pre hydrate and I bring water with me. Yeah. What a great workout, right? Yeah. Well, uh, I came upon somebody who's sitting on the ground with their bike on the ground and they didn't look very good.

Sure enough, I heat exhaustion. Mm-hmm. Maybe even heat stroke. Yeah. What's the first thing you would do if you came on scene to somebody? Like this, uh, exerted themselves too much. I'll tell you what I did, but what, [00:17:30] what would you do?

Matt: Well, if possible, the first thing I would do is try to get 'em outta that hot environment.

Erik: Exactly. That's right.

Matt: That's, I mean, obviously if they're out on a trail or you, you, you know, you don't have an ambulance or you know you're on your bike, but get 'em into the shade at least. Right. Get a cool towel on them. 

Erik: They were sitting in the open. Yeah. Terrible. In the heat. Yeah. And I had to direct them off to the side.

Yeah. They were scared of snakes and all this stuff, but we got in the shade and the wood, which the more media problem. Yeah. And she was not in good, in good shape. Now what I also did is I took my water bottle, [00:18:00] I poured it on her, pour it all over. Yeah. Poured on her, get her wet, got her wet. Cool her down a little bit.

Yeah. She drank some too. Yeah. Yeah. She didn't have water. 

Matt: But cooling that skin down, that temperature down is crucial. I think it's important to note that, you know, we talk about a lot of times with hypothermia, they're too cold. Yeah, yeah. Metabolic rate has slowed. They've almost gone into like a, a, uh. Uh, hibernation state.

Yeah. Their brain, their metabolic demand has slowed considerably, right? Yep. With hyperthermia, it's the exact opposite. We can slowly, we, or we should slowly [00:18:30] rewarm. Yeah. Our hypothermic patients. Yeah. With hyperthermic patients, their metabolic rate has dramatically increased. We have got to. Cool them down very fast.

'cause literally their brain is cooking. Yeah. And we've gotta bring their, their, their temperature down quickly, efficiently. 

Erik: Good. So we talked about some of the assessment thing we set, assessed our mountain bikers. So, and we talked about treatment. Let's talk a little bit more about treatment.

Matt: So I think get 'em in the cool environment.

Erik: Cool environment. That's the number one Easy thing. Easy. That's like the first thing you gotta do. Yep. And then once you're in the [00:19:00] cooler environment and you've got this hyperthermic patient, we could, I mean, there's been a lot of talk about ice packs in the axilla or whatever. That's fine, but it's really doesn't do much.

Yeah. Yeah. Um, even, even IV fluids. Yeah. Um, I mean that can help, but it's not, it is good for, you know, the dehydrated patient. Obviously we should do that. Yeah. But if you're trying to get the temperature down, one of the coolest things that we could do, no pun intended, actually. Pun intended. Yeah. Uh, is evaporative cooling.

Yeah. Like we pour the water on that patient. Right. And the gentle [00:19:30] breeze. And the shade. Boy, that, that's gonna cool you down pretty quick. Yeah. Ice bath. If you have an ice bath in the back of your ambulance, please tell me what agency you work for.

Matt: Well, but, but, but be creative. Right. So football players, you talked about that very common issue here in Texas in the summertime, right?

They will probably at that high school, uh, have an ice bath facility, have ice baths. So ask the coach, Hey, do you, if you got a patient that you think is severely hyperthermic in heat stroke, do you guys have an ice bath? Get 'em into that ice bath is more important than throwing them in the back [00:20:00] of your ambulance.

Erik: That's correct.

Matt: I know of one case that was here in Texas. Another way to think creative thinking outside the box we're really good at that as first responders, they responded to, I believe it was a Costco for a medical emergency, showed up as a homeless person in, uh, true heat stroke, altered mental status.

Really messed up. These firefighters were super creative and they thought we've got to do something right now. Or I want to say his body temperature's like 107. Yeah. I mean, he was cooking. 

Oh yeah. 

And they were like, we don't not have, we don't have [00:20:30] time.

Erik: I've seen 109. That's the highest I've ever seen.

But yeah, go ahead.

Matt: 107 is bad. Yeah, it's bad. So what do they do? They went to their engine. Mm-hmm. They got a tarp, those big giant Costco shopping carts. Oh yes. Yeah. They got, they went inside. They, uh, put the tarp inside of the big Costco shopping cart, asked Costco, said We need ice. And they dumped a bunch of ice and got it filled up with water and put the.

The patient into the shopping cart filled with ice water and cool them 'em off that way's. So think outside the box, right? Yeah. 'cause that's what they need. They don't [00:21:00] need to be transported right now to the hospital. Right, right, right. You gotta get 'em cooled off. 

Erik: And that's something else that we did in the agency where I'm a medical director, we work with the athletic trainers of the local high schools where we said, Hey, you know what?

If you do have a heat emergency, it's okay to leave that, you know, to stay on scene, to get to that, that, yes. That ice tank. Yes. And work with the athletic training department, uh, to get that patient the care that they need. 

Matt: Super, super important. Yeah. To keep that in mind. So many times people are in such a rush to run to the back of the ambulance, like there's some kind of magic that happens [00:21:30] back there. No. And sometimes in a trauma or something like that, you do need to do that. Yeah. But that's not the answer for every patient. No. And these hyperthermic patients is one of those patients where you could be much better off going to an ice bath or creating an ice bath where you're at and cooling that patient off right there.

Erik: Yeah. Um. Some drug overdoses can cause hyperthermia too. 

Matt: Yeah. Malignant hypothermia in a, in a OR setting is, that's correct. Dangerous. Now they have medications that they give for that, but another risk factor,

Erik: even endocrine emergencies, [00:22:00] thyroid storm can cause hyperthermia.

Matt: You had a bad, didn't you have a bad thyroid storm patient.

Erik: In fact, we even put a, as a, at the time it was a newer device where it put in a central lineup. The, in the inferior vena cava, which was like this water bladder that would circulate cold water internally inside of the IVC, which was. Pretty cool. I don't. That was funny, punny. Uh, it, it really was cool though.

And, and it, it, I don't, I'm not sure on the evidence on how effective that is. Right. Especially compared to the [00:22:30] evaporative cooling or the ice tanks. I mean, that's pretty impressive. 

Matt: We have these chairs, uh, with my department so you know, we get a structure fire. We're very lucky. We have citizens that come out with a rehab truck and we have these actually a long time ago when I was on days.

We, uh, I, I bought these cooling, evaporative, cooling fans. You'd, uh, you'd fill up this big tub with water, right? And then it was plumbed in and it would, it would mist you. Uh, it was these mistress fans. Uh, and then we had these chairs that we would sit in that the arms were open. You would actually sit your arms [00:23:00] down into cool water, huh.

And we had wet rags and all these things. We would do rehab in the shade. It was very, uh, strategic how we would do things in the summertime to make sure we were staying cool. 

Erik: Right? Huh. That's really cool. Well, exerting yourself, um, is, is. A part of what I think what creates the problem. 

Yes. 

Because when you're exerting yourself in a hot environment, it's just a recipe for disaster.

If you're not hydrated or you don't have access to water Yeah. Or don't have access to an environment where you can cool down. Yep. That's [00:23:30] right. Those are, that's where people get into trouble. So you've got your patient and we've, we've poured the water on them. We're in the shade. We've removed them from the heat, obviously.

Yep. And, and, but we're still a couple miles away from where the car is. The parking lot. I mean, it's, it's gonna be. It's kind of, it's an access problem that we had. Mm-hmm. Mm-hmm. Fortunately, she didn't need medical services. She wasn't, she wasn't bad yet. Yeah. After a half hour or so sitting with her, she started to feel a whole lot better.

That's good. And her and her family reunited and they walked back [00:24:00] together. Oh, she was walking, not biking. No. Her family lost her, so, so she was by herself? Yeah. Sitting on the ground next to her bike. Not sure what to do. Yeah. Right. Shouldn't have been out there. Right. And when I had her in the shade, the family.

Came out. Oh, gotcha. I dunno where they came from. Yeah. But then we were able to get her back to her car. But, um, but the treatment though, sometimes these patients with heat emergencies really require ICU level care. Mm-hmm. And so you get a [00:24:30] heat, e heat stroke, you know, I mean, take 'em to stroke, follow your protocols.

But one of the big problems is, uh, something called rhabdo. Mm-hmm. Uh, rhabdomyolysis where your body starts breaking down the muscles and then your kidneys get all gummed up with this. Uh, and so, uh, they,

Matt: that coke like urine.

Erik: That's right. Yeah. That's, it's bad stuffs. And you can really go into renal failure here.

So it's, it's a serious condition. 

Yep. 

Uh, you know, like when I mowed the lawn then, right? Mm-hmm. I mean, I'm kind of putting my body at [00:25:00] risk for getting to that point.

Matt: We've had multiple, to be careful, multiple, multiple people, well, not multiple, but we have had doing pats, a lot of fire departments are hiring, right.

And they come out and do their pats. Well, what are these young, you know, guys that I gotta, you know, I gotta go as hard as I can. You know, and we've had before where patients or uh, guys have collapsed, you know, and we've had to transport guys to the hospital. Yeah. Because they were going all out wearing gear.

They're not acclimated to that. Yeah. Mm-hmm. Right. And they're not, they, they're working out in the gym, you [00:25:30] know, in the air conditioning. They're not weight room strong. Exactly. Exactly. And so they're not acclimated to that kind of stuff. And they collapse, they pass out, they, whatever the case may be, and we gotta take 'em to the hospital.

And a couple of them have ended up in the ICU with rhabdo. Yeah, definitely a concern.

Erik: That's a serious issue. Yeah. 

Uh, and rhabdo doesn't just happen to the, the, the heat, right? Yeah. Just on a side note, this really isn't specifically related to hyperthermia, but uh, uh, the geriatric patient population, if they've fallen, [00:26:00] they can't get up and they're in the same spot for a couple days.

Just that immobilization can cause rhabdo too. So it's such huge, lots of things can cut. Yeah, that's right. Lots of things, but we're not talking about that, but yep. Thermal regulation, heat emergencies right now. Big issue. You're probably gonna see something this summer. 

Yeah. The key is get 'em out of that hot environment.

That's the most important thing. Altered mental status. If they are altered, you might want to think about airway intervention. Mm-hmm. You know, but get 'em cooled off. That's number one [00:26:30] thing. Evaporative cooling. Get 'em wet. If all you have is the back of your ambulance, crank that AC on, get their clothes off, dust 'em with water, get 'em cool.

Right. You know what our our guys do at our agency is we. With our protocols, we, we've done is we grabbed a fan off the engine. Mm-hmm. Is it standard,

Matt: the PPV fan? I don't know what it's called. I, unless if it's the ventilation fan, then yeah. Yeah. So that's the big one. That blows really fast. Yeah. Yeah.

That's a PPV fan. 

Erik: Well spray down the patient, get 'em wet and blow that, turn that fan on. Yeah. Is a real effective way to cool 'em. Another 

Matt: thing to think about [00:27:00] though is you don't want to get 'em to the stage of shivering. That's correct. You don't wanna get 'em so cold. That's that they actually start shivering because that's gonna then increase their temperature.

Erik: I'm glad you mention that. That's so true. Yeah. That's, uh, 

Matt: but you want to do it aggressively. It cautiously. 

Erik: That's right, that's right. Um, so man, great. That's great. Um, uh, any other, any other, no important 

Matt: topic? Just thought it'd be a good thing to talk about with all the heatwave going on in the country right now.

Like I say, a lot of places that don't experience heat like we're used to. Yeah. And just like us, we're not used to the snow and the ice and all those things. We don't have the infrastructure [00:27:30] for it. Yeah. We're not used to it. They're dealing with that, especially up north. Yep. And so these are good reminders for them.

Erik: And one thing I think it's worth mentioning is we've talked about identification, the thermal regulation, the, the man. Management of this, but it's prevention's huge. Yes. You know, staying hydrated, we've talked about that already. Wearing clothes breaks, you know, you are appropriate Right. For the environment.

Um, sunscreen too, I mean for, that's another heat emergency I guess of sorts. Just like frostbites kind of, it's not hyperthermia, but [00:28:00] you can damage your skin. But, um, I think prevention's key, stay, stay in a cool place. Stay out. Don't exert yourself out in heat exposure. That's right. Yeah. And 

Matt: if you're a firefighter and you're on a fire ground, it's hot and you.

You feel off, tell your command like, Hey, I need to come out. Right? Yeah. 'cause we don't want people getting sick and injured for no reason.

Erik: Can't help anybody if you're sick, 

Matt: there's no exactly. There's no reason to push yourself and get into rhabdo or some serious medical condition. You might not be able to come back to work.

So it's okay to say, Hey, I need to take a break. Go sit down, get some water. 

Erik: [00:28:30] It's been a good, uh, good, good topic. Good topic. See you on the next one. Be safe out there.

Narrator: Thank you for listening to EMS, the Erik and Matt Show.