I read with interest the article by Wallace and Steel regarding the management of exertional heat stroke from primary care physicians.1 Without question, improper management and care of an exertional heat stroke (EHS) patient can lead to increased risk of morbidity and mortality, thus necessitating the adoption and implementation of current standards of care for the recognition and management of EHS.2–4
With a focus on the primary care physician in this article, the authors discuss the onsite treatment of EHS (for example, during a mass participation event such as a road race) and subsequent care following the event. Within the section on EHS treatment, there are a few concerns that must be addressed. First, to reduce the risk of long-term morbidity or mortality related to EHS, the primary goal for EHS treatment is to reduce core body temperature below the critical threshold of cell damage (>40.83°C) within 30 minutes of collapse.2–4 Minimising the time above the critical threshold for cell damage decreases the extent of tissue and organ damage within the body. Demartini and colleagues showed that, when body temperature was reduced below the critical threshold in 274 individuals who had succumbed to EHS, there was 100% survival without any known sequelae.5 Second, the mode of body cooling should be such that the cooling rate is optimal (>0.15°C/min) for EHS treatment.6 Alternative options such as tarp-assisted cooling have been shown to be just as effective as cold-water immersion and can be implemented with ease.7,8
To optimise the treatment and care of individuals suffering EHS, it is essential that patient care take an interdisciplinary approach. Coordinating care between onsite medical providers (for example, athletic trainers, other sports medicine professionals), emergency medical services, and primary care physicians allows for a seamless transition of care between medical providers to optimise patient outcomes.
- © British Journal of General Practice 2018
