Heatwaves are becoming more frequent and intense with climate change. WHO estimates that heat causes hundreds of thousands of deaths each year worldwide. Nurses in the Gulf, the Sahel, South Asia and increasingly in Europe and North America see patients with heat-related illness, especially older adults, outdoor workers, pilgrims and people with chronic conditions. Heat stroke is a medical emergency with a high death rate, but rapid cooling saves lives.
Who is at risk?
- Older adults, infants and young children.
- People with heart, lung or kidney disease, diabetes, obesity, dementia or mental illness.
- People taking diuretics, antihypertensives, antipsychotics, anticholinergics or stimulants.
- Outdoor workers, athletes, military personnel and pilgrims (e.g. during Hajj).
- People living alone, homeless or without cooling.
Heat exhaustion vs heat stroke
| Heat exhaustion | Heat stroke | |
|---|---|---|
| Core temperature | Usually below 40°C | Usually 40°C or above |
| Mental state | Normal (may be tired, dizzy) | Altered: confusion, agitation, seizures, coma |
| Other signs | Heavy sweating, headache, nausea, cramps, weakness, fast pulse | Skin may be hot and dry or still sweaty (in exertional heat stroke); fast heart rate, low BP, organ damage |
| Action | Move to cool place, cool, oral fluids; seek care if not improving within 30 minutes | Emergency: immediate rapid cooling and medical care |
Any confusion in someone who is hot is heat stroke until proven otherwise.
Rapid cooling: “cool first, transport second”
- Cold water immersion (up to the neck) is the most effective method for exertional heat stroke, where available and safe.
- Otherwise: remove clothing, spray or sponge with cool water and fan continuously (evaporative cooling), apply ice packs to the neck, armpits and groin, and use cold wet towels rotated frequently.
- Aim to bring core temperature down to about 38.5–39°C, then stop active cooling to avoid overshoot.
- Antipyretics (paracetamol) don’t work for heat stroke and shouldn’t be relied on.
Nursing care
- A–E; airway protection if consciousness is reduced; oxygen.
- Core temperature monitoring (rectal or oesophageal is most accurate in heat stroke).
- IV fluids as prescribed, with caution in older patients and those with heart failure.
- Check blood glucose; treat seizures.
- Monitor for complications: kidney injury (urine output, creatinine), muscle breakdown (dark urine), liver injury, clotting problems, and arrhythmias.
Prevention in heatwaves
- Drink regularly; avoid alcohol and heavy exertion in the hottest hours.
- Stay in cool or shaded places; use fans and wet cloths; check on older neighbours.
- In hospitals and care homes: monitor room temperatures, offer fluids frequently, review high-risk medicines.
Protect yourself too
Nurses working in hot wards, wearing PPE (such as during Ebola or COVID responses), or doing outreach in hot climates are at risk of heat stress. Take breaks, drink regularly, and limit time in full PPE according to guidance.
Based on WHO heat and health guidance and published consensus on exertional heat stroke management. Educational content: follow local protocols.