General When Every Second Counts

When Every Second Counts: Steward Health Care Tackles Exertional Heat Stroke

Steward’s Emergency Management Services Embark on Operation H.E.A.T., a Campaign to Champion an Evidence-Based Method that Offers Quick and Efficient Treatment for Exertional Heat Stroke with 100% Survivability.

Exertional Heat Stroke (EHS) is a life-threatening condition that occurs when the body’s core temperature rises dangerously high due to intense physical exertion in hot and humid environments. While heat-related illnesses can be fatal, quick, and appropriate diagnosis and treatment can result in a 100% survival rate. However, current popular approaches fall short of delivering the most effective treatment and eliminating the mortality rate.

To shed light on the dangers of EHS, the recommended gold standard treatment, and Steward’s efforts to raise awareness and impact the delivery of care, we sat down with Dr. Mark Pearlmutter, Senior Vice President for Hospital-Based Services at Steward Medical Group, and Gilberto Martin and James Figuerora, Emergency Medical Services (EMS) Regional Managers for Steward Health Care’s South Florida Region.

Understanding Exertional Heat Stroke

What is Exertional Heat Stroke?

Dr. Pearlmutter: EHS occurs when the body’s internal temperature rises above 104 degrees Fahrenheit (40 degrees Celsius). This dangerous rise in core body temperature can have severe consequences, including organ failure, damage to the central nervous system, and even death.

A person suffering from EHS requires immediate treatment to lower the body’s temperature rapidly and prevent irreversible damage.

Who is most at risk of suffering from Exertional Heat Stroke?

Gilberto Martin: EHS often affects individuals engaged in strenuous physical activity outdoors. This includes athletes, military personnel, first responders, and day laborers working in hot environments.

James Figuerora: As our climate warms up and temperatures increase, communities that traditionally have engaged in prolonged exposure to hot environments are increasingly at risk of suffering from different types of exertional health illnesses such as heat cramps, heat exhaustion, and EHS.

The CDC has already warned that “Heat illness during practice or competition is a leading cause of death and disability among U.S. high school athletes.”

The Traditional Approach vs. the Evidence-Based Approach

What has been the traditional way to treat Exertional Heat Stroke?

Dr. Pearlmutter: Despite well-established, evidence-based best practices, the prehospital standard of care relies on traditional, passive cooling techniques such as removing the patient’s clothing, fanning, applying ice packs, and using cooling blankets.

A National Institute of Health study cautioned that, as the first point of care, EMS providers are limited by inadequate training, protocols, and equipment necessary to efficiently deliver life-saving treatment to patients suffering from EHS.

What should be the gold standard for treating Exertional Heat Stroke?

Gilberto Martin: Cold-water immersion has emerged as the most effective treatment for EHS. This method enables rapid cooling, with cooling rates exceeding 0.15 degrees Celsius per minute, allowing heat transfer to occur more efficiently and leading to a swift reduction in core body temperature.

A patient suspected of suffering from EHS should be assessed immediately using rectal thermometry. If EHS is confirmed, the patient should be treated on-site using whole-body cold-water immersion. Once the body temperature reaches 102 degrees Fahrenheit, the patient may be transported to a hospital.

In August of 2001, the dangers of EHS dominated the national spotlight as Minnesota Vikings offensive lineman Korey Stringer succumbed to EHS. This unfortunate incident highlighted the limitations of existing treatment practices, and Korey’s wife, Kelci, has since worked tirelessly to promote better treatment for EHS.

Operation H.E.A.T.: Steward’s Campaign to Improve Patient Outcomes

What is Operation Hot Environmental Awareness Training (H.E.A.T.)?

James Figuerora: As stewards of our patients well-being, it is our duty to deliver the most efficient, proven standard of care. Not only should we train and equip our own team members, but we should also spread awareness outside of our hospital walls and advocate for protocols and policies that embrace best practices that are proven to improve patient outcomes.

Steward’s Operation H.E.A.T. embodies that spirit of stewardship. Through this initiative, Steward’s EMS and emergency department teams collaborate with key community partners to promote the “cool first, transport second” message of cold-water immersion. Operation H.E.A.T.’s curriculum covers:

  • Planning – development of an organizational action plan
  • Prevention – know the risks
  • Recognition – learn to spot the signs early
  • Treatment – cool first, transport second

What’s heating up in South Florida?

Gilberto Martin: Operation H.E.A.T. has received much traction in Steward’s South Florida market. And that is in part thanks to the unwavering support of Regional President Joshua Putter, under whose leadership the initiative grew from a community outreach effort to strategic partnerships with the local first responders and emergency departments.

We started with the local high schools, and the impact of using this highly efficient method to reduce the body’s temperature has spread like wildfire. Now, not only are the various EMS stations across the region reaching out to us, but so are the fire departments and even the police departments.

Educating and Advocating for Improved Patient Outcomes

It is crucial to spread awareness, educate health care professionals, and advocate for cold-water immersion protocols in order to save lives and protect individuals from the life-threatening consequences of EHS. As we continue to educate and equip stakeholders with the tools necessary to quickly treat EHS via cold-water immersion, we will significantly enhance survival rates, minimize long-term consequences, and protect the well-being of those most at risk of suffering from EHS.

When every second counts, cold-water immersion treatment makes this life-threatening condition 100% survivable. Let’s encourage our health care providers and communities to embrace this proven method to improve patient outcomes.

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