What is the best way to cool off a heat stroke victim?
The simple answer? Using the resources at hand, aggressively lower the person’s body temperature to 39°C (102.2°F) as quickly as possible. Anything longer than 30 minutes has the potential to have more profound and long lasting pathophysiologic effects. The debate about treatment revolves around the efficacy and safety of cold water/ ice bath immersion versus the mist/ fanning method. When feasible, I advocate cold water immersion. In fact, it is at least twice as fast as the best misting methods. It appears to be as safe and maybe safer when one considers the relative rates of cooling.
How so? Cold water dissipates heat from the body 20 to 30 times faster than air does at the same temperature. Evaporation speeds cooling but not as much. People argue against cold immersion for fear that the cold will induce vasoconstriction and/or shivering and therefore inhibit cooling or even increase body temperature. If these factors are important, one would expect to find clinically relevant support in the medical literature. I have never found any. (Jump into cold lake and see what your body temperature does!) In addition, some worry that cold immersion for heat stroke will precipitate a cardiac arrest. Again, the literature does not appear to support this concern clinically, even in the elderly. In the end, temperature height and duration are the key factors linked to morbidity and mortality in heat stroke.
The real question regarding treatment should revolve around what means are at hand to modify those factors that caused the heat stroke to begin with. First, stop the heat stress by leaving the environment and resting. If there is insufficient cold water for immersion, apply water in small droplets, like mist from a spray bottle, and get the air moving. The misted water will evaporate more quickly and probably cool better than pouring a bottle over your patient’s head. A combination of techniques can work well, too. On the other hand, ice bags in the groin and around the neck do not cut it. Because the problem with heat stroke is related to increased heat production and/or decreased dissipation, not the thermostatic readjustment in the hypothalamus seen with a fever, don’t use antipyretics (e.g., ibuprofen, acetaminophen). And don’t forget about appropriate volume replacement.
Greg Friese from CentreLearn sent me this link to a pretty good, non-scientific article about recovery from heat stroke.