Heat Stroke: The R.A.C.E.-to-Survival Protocol

Heat stroke is the most severe heat-related illness. Defined by an elevated core body temperature and CNS dysfunction, it can be categorized as classic or exertional in nature. In either form, it's a life-threatening emergency that can be rapidly fatal if not recognized and treated quickly. Much has been studied and reported on in the athletic world. However, laborers in the heat are also vulnerable. Exertional heat illnesses, specifically exertional heat stroke (EHS), is the leading cause of exertional (nonaccidental) related deaths (87.6%) in laborer populations. Despite the successes of cold-water immersion (CWI) in the treatment of EHS reported in athletics, there is a paucity of best-practices knowledge in EMS. Several studies have shown that protocols are lacking or nonexistent, educational literature is outdated, and many EMS providers lack the necessary equipment to assess and manage these patients. This presentation will review the successes of CWI in athletics and the incorporation of this standard into EMS protocols. The presentation will provide a new paradigm for EMS to minimize the risk of morbidity and mortality associated with EHS: Recognition, Assessment, Cooling, and Emergency care (R.A.C.E.) for the prehospital treatment of EHS.