Environmental

Heat exhaustion at a fun run event

Foundation

Adult · 35yr · male

Patient Information

Dispatch	A 35YO male has been brought to the FAP by marshals after collapsing near the finish line of the Perth City Fun Run. He is conscious but confused and very hot to touch. (Daniel Hartley)
Patient	Daniel Hartley — 35yr (80kg)
Incident History	Pt was running the 10km course on a hot morning. Marshals found him sitting on the ground approximately 100m from the finish line, unable to stand unassisted, sweating heavily and confused.
Emergency Contact	Sarah Hartley (Wife) — 0412 553 891

Initial Rapid Assessment

Response	Voice
Airway	Patent. Nil airway obstructions. Nil stridor.
Breathing	Elevated respiratory rate. Breathing is rapid and shallow. Nil audible wheeze or crackles.
Circulation	Rapid and weak radial pulse. Skin hot, flushed and diaphoretic. Nil external bleeding.
Disability	GCS 13 (E3V4M6). Confused — not fully orientated to time, place or person. Moving all four limbs.
Exposure	Wearing running shirt and shorts. Skin hot and flushed across face, neck and arms. No rashes or visible injuries. Profuse sweating noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	96% (RA)	Mild	24	118	98/62	2s	13	4 4 ++	39.8	4.8 mmol/L	3
10 mins	97% (RA)	Nil	20	104	106/70	<2s	14	4 4 ++	38.6	4.8 mmol/L	2

History Taking

Treatment Response

Diagnosis

This patient is suffering from Heat Stroke — an excessive elevation of core body temperature with CNS dysfunction (confusion, altered GCS) that does not resolve with rest, occurring in the context of significant physical exertion in hot conditions.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not move the patient to a cool environment or shade within the first 2 minutes, the patient's GCS drops to 12 and he becomes more agitated and difficult to manage.)
! (If the trainee does not remove clothing and begin active cooling within 3 minutes, the patient's temperature rises to 40.4°C and he begins to shiver and becomes more confused.)
! (If the trainee attempts to walk or stand the patient to assist cooling or transport, the patient's BP drops to 88/54 and he becomes pale and nearly loses consciousness.)
! (If the trainee does not check BGL as part of vital sign survey, prompt: 'The patient is confused — is there anything else you would routinely check?')
! (If the trainee asks about seizures: advise that none have occurred yet but to monitor closely as seizures are a known complication of heat stroke.)

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — confirm patent airway, breathing adequate, assess circulation and disability.
3. Move patient to coolest available environment at the FAP — shade, air-conditioned tent or cool area.
4. Position patient supine.
5. Perform Vital Sign Survey — GCS, SpO2, RR, BP, HR, temperature, BGL, pain score.
6. Perform BGL — document 4.8 mmol/L; no glucose administration required.
7. Apply supplemental oxygen if indicated to maintain SpO2 94–98% — nasal cannula 2–4 L/min or simple face mask 5–8 L/min as clinically required.
8. STRIP — remove running shirt, shoes and socks to maximise skin surface exposure.
9. SOAK — spray or sponge patient with tepid water across head, neck, torso and limbs.
10. FAN — use available fan or manual fanning to promote evaporative heat loss.
11. IMMERSE — apply ice packs to neck, groin and armpits if ice bath unavailable.
12. COVER — cover patient with wet cold cloths and continue fanning.
13. Provide small sips of water if patient is fully conscious (GCS 15) and able to safely swallow — do not force fluids given current GCS 13.
14. Reassess GCS and temperature after 10 minutes of active cooling — expected improvement to GCS 14 and temperature 38.6°C.
15. Consider antiemetic: if patient reports moderate to severe nausea, administer Ondansetron 4mg oral wafer.
16. Monitor closely for seizure activity — manage as per Seizures CPG if seizure occurs while continuing active cooling.
17. Record full observations every 10 minutes.
18. Consider delaying transport by approximately 15 minutes to allow adequate active cooling prior to ambulance arrival.
19. Continue active cooling during transport to hospital.
20. Activate ambulance if no improvement in GCS or temperature after 15 minutes of active cooling, or if patient deteriorates.
21. Scenario ends on arrival of ambulance and IMISTAMBO handover.
22. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Heat Stroke · Seizures · Oxygen · Ondansetron · Blood Glucose Monitor · Primary Survey · Tympanic Thermometer

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Signs/Symptoms	Headache, dizziness, nausea, generalised weakness and confusion. Feels very hot. Excessive sweating throughout the run.
Allergies	Nil known drug allergies.
Medications	Nil regular medications.
Pertinent History	Fit and healthy. No significant past medical history. Has run fun runs before but says today is much hotter than expected.
Last Oral Intake	Approximately 500mL water 45 minutes ago before the start of the run. No food in the last 3 hours.
Events Leading	Patient was competing in the 10km Perth City Fun Run on a hot, humid morning. He did not adequately pre-hydrate and ran faster than his usual pace.
Treatment Prior	Marshals moved him to shade and gave him a small amount of water to sip prior to EHS arrival.

Onset	Gradually worsening over the last 2km of the run. Sudden deterioration and collapse approximately 15 minutes ago.
Pain	Headache — frontal, constant, non-radiating.
Quality	Dull, pressure-like headache. General feeling of weakness and being unwell.
Radiates	Nil
Severity	3/10