Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.

Factors Affecting Incidence Rate of Exertional Heat Illnesses: Analysis of 6 Years of High School Football Practices in North Central Florida

Background: Although experts have advocated for regionally specific heat safety guidelines for decades, guidelines have not been universally adopted. Purpose: To describe the rate and risk factors associated with exertional heat illness (EHI). Study Design: Descriptive epidemiology study. Methods: For a 3-month period (August-October) over 6 years (2013-2018), athletic trainers at 13 high schools in North Central Florida recorded varsity football practice time and length, wet-bulb globe temperature (WBGT), and incidences of EHI, including heat stroke, heat exhaustion, and heat syncope. Results: Athletes sustained 54 total EHIs during 163,254 athlete-exposures (AEs) for the 3-month data collection periods over 6 years (incidence rate [IR], 3.31 /10,000 AEs). Heat exhaustion accounted for 59.3% (32/54), heat syncope 38.9% (21/54), and heat stroke 1.9% (1/54) of all EHIs recorded. Of the EHIs, 94.4% (51/54) were experienced within the first 19 practices. The first 19 practices had an IR of 7.48 of 10,000 AEs, and the remaining 44 practices had an IR of 0.32 of 10,000 AEs, demonstrating that the risk of EHI for practices 1 to 19 was 23.7 times that of the remaining practices. When comparing morning to afternoon practices, 35.2% (19/54) EHI incidents occurred during morning practices. The risk of EHI during practices with WBGT >82°F (27.8°C) was 3.5 times that of practices with WBGT <82°F. Conclusion: In the current study, the risk of EHI was greatest in the first 19 practices of the season and during practices with WBGT >82°F. As modifiable risk factors for EHI, increased vigilance and empowerment to adhere to acclimatization guidelines can mitigate EHI risk. Health care providers must continue to advocate for implementation of regulations and the authority to make decisions to ensure patient safety.

Heat-related knowledge, perceptions, and needs among oil spill cleanup responders

BACKGROUND: Occupational exposure to heat and hot environments can result in heat-related illness (HRI), injury, and death among workers, particularly those in outdoor environments such as oil spill cleanup responders. Education and training can help prevent these detrimental heat-related health outcomes. PURPOSE: This study assessed: heat-related knowledge, perceptions, and barriers among oil spill cleanup responders, and heat-related training and educational materials currently used and desired. METHODS: A needs assessment was completed by 65 oil spill cleanup responders regarding their occupational heat-related experiences during oil spill cleanup activities and training needs. RESULTS: Most respondents had 25 or more years' experience (52.4%), worked for companies with 19 or fewer employees (53.5%), and were not classified as safety and health professionals (67.7%). Responders reported experiencing HRI risk factors, such as, high temperatures (71.9%) and humidity (85.9%), and wearing personal protective equipment (PPE) and clothing ensembles (96.9%), respirators (71.9%), and personal flotation devices (78.1%). Many reported experiencing symptoms of HRI (41.5%), and 11% reported experiencing heat exhaustion. While most respondents were knowledgeable of heat stress, they were least knowledgeable about: differentiating between heat exhaustion and heat stroke (12.5% responded correctly), salt tablet usage (62.5% responded correctly), effects of air conditioning on acclimatization (70.3% responded correctly), and previous HRI as a risk factor (73.4% responded correctly). Respondents reported they perceived heat stress to be severe and that HRIs affect workers; and most reported feeling confident in recognizing signs and symptoms of HRI, and knowing what to do if a coworker became ill. While multiple prevention controls were reported, only one in four reported using an acclimatization plan. The most common training and education received included just-in-time training (68.9%) and printed materials (50.8%). The most desirable future training and education products were smartphone or tablet applications (61.0%), printed materials (51.2%), and online training (46.3%). DISCUSSION: Oil spill cleanup responders are at high risk for HRI, injury, and death; and those responsible for their training need to be knowledgeable about all the aspects of occupational heat stress. Findings from this study may be beneficial to safety and health professionals and health educators, particularly those interested in developing heat stress training and educational materials for oil spill cleanup responders.

Heat Strain with Two Different Ventilation Vests During a Simulated 3-Hour Helicopter Desert Mission

BACKGROUND: The study investigated the heat strain of personnel operating in the rear cabin of a helicopter during desert-climate missions, and to what extent the strain can be mitigated by use of battery-driven ventilation vests.METHODS: Eight men undertook 3-h simulated flight missions in desert conditions (45C, 10% humidity, solar radiation). Each subject participated in three conditions wearing helicopter flight equipment, including body armor, and either: a ventilation vest with a 3-dimensional mesh (Vent-1), a ventilation vest with a foam sheet incorporating channels to direct the air flow (Vent-2), or a T-shirt (NoVent); each mission comprised a 10-min walk, followed by sitting for 30 min, kneeling on a vibration platform for 2 h, and finally 30 min of sitting. Core temperature, heart rate, skin temperatures and heat flux, oxygen uptake, sweating rate, and subjective ratings were recorded. Evaporative capacity and thermal resistance of the garments were determined using a thermal manikin.RESULTS: All subjects completed the NoVent and Vent-1 conditions, whereas in the Vent-2 condition, one subject finished prematurely due to heat exhaustion. The increase in core temperature was significantly (P 0.01) greater in Novent (0.93C) and Vent-2 (0.88C) than in Vent-1 (0.61C). Evaporative capacity was significantly higher for Vent-1 (7.8 g min1) than for NoVent (4.1 g min1) and Vent-2 (4.4 g min1).DISCUSSION: Helicopter personnel may be at risk of heat exhaustion during desert missions. The risk can be reduced by use of a ventilation vest. However, the cooling efficacy of ventilation vests differs substantially depending on their design and ventilation concept.Grnkvist M, Mekjavic I, Ciuha U, Eiken O. Heat strain with two different ventilation vests during a simulated 3-hour helicopter desert mission. Aerosp Med Hum Perform. 2021; 92(4):248256.

ASSESSMENT OF CLINICAL EFFICACY OF COOLING GEL PATCH

Objective: To determine the efficacy of cooling gel patch in various clinical indications and comparison of cooling gel patch with water spray and cold sponging in fever and heat exhaustion. Study Design: Comparative cross sectional study. Place and Duration of Study: Garrison Medical Centre Okara Cantt, from Sep to Dec 2018. Methodology: A total of 48 male patients, age ranges from 20-40 years were assessed with different clinical indications of cooling gel patch. Patients with fever, heat exhaustion, headache, muscle cramps and toothache were included in this study and patients with acute illness other than fever were excluded. A control group of 20individuals was also analyzed against fever and heat exhaustion in which water spray and cold sponging wasused. Frequency and percentages of each indication were calculated and chi square test was applied. Results: Total of 48 individuals living in plain terrain with various clinical indications of cooling gel patch wereassessed. Cooling Gel Patch was tested on 16 sportsmen with heat exhaustion out of which 2 (12.5%) individualhad minimal effect whereas control group of 10 showed good response in 8 (80%) sportsmen with water sprayand cold sponging with p-value .000578. Six patients with headache and 4 individuals with toothache reportedno reduction in symptoms. Two out of 6 patients with muscle cramps reported mild relief in symptoms. Sixteenpatients reported with high grade fever and out of these, 12 (75%) individuals showed no reduction in temperature after 4 hours of application......

Evaluation of trauma management in injured Iranian Hajj pilgrims in 2015 Mina stampede

Introduction: The Muslim annual pilgrimage (Hajj) ceremony in 2015 was one of the most catastrophic and tragic events of the Hajj pilgrimage in history. Thousands of pilgrims have been tragically stampeded to death and injured in the land of Mina in Mecca, Saudi Arabia, on September 25 in 2015. The last official statistics declared that at least 2,431 pilgrims died and 427 pilgrims were missed in the blocked street. Furthermore, 464 corpses were Iranian Objectives: The purpose of this study was to evaluate the treatment of the injured pilgrims by the Iranian Hajj Medical Team in Mina and assess its strengths and weaknesses in order to develop a comprehensive approach in dealing with similar events. Methods: The records of the patients were obtained from the archives of the Islamic Republic of Iran Hajj Medical Center. Firstly, the demographic data, method of triage, cause of admission, treatment methods, and referral to Mecca hospitals were extracted, and then some interviews were performed with the members of the medical team who were present at the incident scene. Finally, a protocol was proposed for the management of patients in similar incidents. Results: Out of a total of 1,633 referred patients, 567 injured pilgrims were admitted and treated during the incident. Due to the incomplete medical records, a total of 403 complete medical sheets were included in this study. Moreover, 362 cases (89.8%) improved after cooling and proper fluid replacement. They were discharged with therapeutic measures. A total of 41 injured pilgrims (10.2%) were referred to urban hospitals, and 13 cases of the referrals were due to acute respiratory distress syndrome. Furthermore, 12 subjects were referred for dialysis, and 4 cases of the referrals were due to anxiety disorders. Moreover, three cases of diabetic ketoacidosis, one case of epidural hemorrhage, one case of intracranial hemorrhage, one case of spleen hematoma, one case of sigmoid volvulus, and one case of gastrointestinal bleeding were successfully treated. The most common diagnosis was observed to be dehydration, followed by heat exhaustion and contusion. Approximately, all the victims had some degrees of the aforementioned injuries. Initial therapeutic attempts included rehydration, cooling in the cold tunnel, and correction of electrolyte imbalances. Performing a complete blood count with differential, blood urea nitrogen, sodium, and potassium tests, and urinary catheterization were determined as per case (if needed); nevertheless, fluid therapy and cooling were carried out (as primary resuscitation) for all the injured patients. Conclusions: Therapeutic efficacy was evaluated as excellent due to zero mortality. As a result, it was decided to propose a treatment method for the Hajj Medical Team as a protocol for the management and treatment of injuries caused by mass gathering (e.g., contusion and heat exhaustion) in similar events. For the implementation of the best measures in similar situations, it is compulsory to organize medical teams with trained personnel.

Heat stroke and heat exhaustion among pilgrims: common signs and symptoms, laboratory profile and methods of managements

Background: In the last few years, Hajj season is characterized by high temperature reached up to 46°C.Exposure to great hot environment accompanied with fatigue may result in different heat-related illnesses including heat cramps, heat exhaustion and heat stroke. Objectives: To investigate the types, symptoms, signs, laboratory parameters, associated chronic disease and medical management of heat illness experienced by pilgrims in the fields and emergency centers. Subjects and methods: It is an analytical cross sectional study conducted during Hajj season (2017-2018) including all patients exposed or attended the emergency departments or centers of management heat related medical problems in Ministry of Defense hospitals and centers in Makkah city, Kingdom of Saudi Arabia. A prepared checklist was used to collect data about demographic characteristics of patients, associated risk factors, signs and symptoms as well as data about managements of heat stroke and heat exhaustions. Results: The study included 73 patients diagnosed with either heat exhaustion (52; 71.2%) or heat stroke (21; 28.8%). Their age ranged between 30 and 80 years (57.8±12.7). Males represent 57.5% of them. History of vaccination against seasonal influenza and meningitis was observed among 60% of them.Majority of the patients (74%) exposed to heat for 2-4 hours. The most frequent encountered symptoms were headache (82.2%), extreme weakness (80.8%), and dizziness/vertigo (78.1%). Their body temperature ranged between 31.6-41.2 ˚C (37.4±1.7).Glasgow coma scale ranged between 10 and 15 (14.5±1.2). Dry tongue, sunken eyes, skin rash and complications were observed among 68.5%, 31.5%, 11% and 4.1% of them, respectively. Admission for two hours or more was reported among 20 cases (27.4%), with no significant difference between cases of heat stroke and those with heat exhaustion. Analgesics were given to 9 patients (12.3%); more significantly in cases of heat stroke (19% versus 9.6%), p=0.045. History of transfer was reported among 9 patients (12.3%); more significantly in cases of heat stroke (23.8% versus 7.7%), p=0.041. Air condition was provided to majority of patients (94.5%) more significantly among patients with heat exhaustion than heat stroke (98.1% versus 85.7%), 0.018. Water/ice with Fam was given to 41 patients (56.2%); more significantly to patients with heat stroke (85.7% versus 44.2%).

What the Agricultural Sector in Florida Needs to Know about Heat-Related Illness (HRI)

Heat-related illness (HRI) can range from rashes, fainting, and cramps to heat exhaustion and heat stroke. It can be fatal, and all outdoor workers in agriculture (as well as those in high-heat indoor settings such as greenhouses) are at risk. This new 6-page publication of the UF/IFAS Department of Agricultural Education and Communication provides basic information on how to recognize the symptoms of HRI, on the underlying physiological processes and related risk factors, and on how to treat it. This publication also provides a list of preventative measures that growers, supervisors, and agricultural workers can follow, along with links to additional resources. Written by Paul Monaghan, Karissa Raskin, Maria Morera, Antonio Tovar, Valerie Mac, and Joan Flocks.https://edis.ifas.ufl.edu/wc359