Heat exhaustion in elderly female at summer community fair

Patient Information

Dispatch: You are called to a patient (Margaret Holt, 75-year-old female) who has been brought to the FAP by a bystander. She is sitting in a chair, pale, sweaty and complaining of dizziness and nausea.
Patient: Margaret Holt — 75yr (60kg)
Incident History: Pt has been attending the Kalamunda Community Summer Fair for approximately 3 hours in 36°C heat. She was found sitting on a bench looking unwell by a bystander. Pt states she has felt dizzy and nauseous for the past 20 minutes and has not had much to drink today.
Emergency Contact: David Holt (Son) — 0412 338 774

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil stridor.
Breathing: Slightly increased rate. Nil wheeze or crackles. Talking in full sentences.
Circulation: Pulse rapid and weak. Skin pale, cool and clammy to touch. Nil external bleeding.
Disability: GCS 15 (E4V5M6). Oriented to time, place and person. Complaining of dizziness and headache.
Exposure: No rashes or visible injuries. Clothing heavy for conditions — long-sleeved blouse and cardigan. Skin cool and moist.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	22	108	96/62	3s	15	4 4 ++	38.2	5.4 mmol/L	3
10 mins	98% (RA)	Nil	18	92	108/70	<2s	15	4 4 ++	37.6	5.4 mmol/L	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from heat exhaustion secondary to prolonged sun exposure, inadequate fluid intake and physical exertion in a hot environment at a community fair.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not move the patient out of the sun or into a cooler environment within 2 minutes of arrival, the patient's GCS drops to 14 and she becomes more confused and stops sweating — suspect progression toward heat stroke.)
! (If the trainee does not remove or loosen the patient's heavy clothing, the patient states she feels 'even hotter' and her temperature rises to 38.8°C at the 10-minute mark.)
! (If the trainee does not offer oral fluids despite the patient being GCS 15 and fully conscious, the patient's BP remains at 96 systolic at 10 minutes.)
! (If the trainee does not take observations including temperature and BGL, prompt them: 'The patient asks if she should be worried — is there anything else you want to check?')

Treatment Objectives

1 Ensure scene safety and don appropriate PPE including gloves.
2 Perform Primary Survey — confirm patent airway, adequate breathing, assess circulation and conscious state.
3 Move patient into a cool, shaded environment — inside the FAP tent or air-conditioned area if available.
4 Position patient supine or semi-recumbent (as tolerated) and do NOT walk the patient unnecessarily.
5 Loosen and remove heavy outer clothing (cardigan, sleeves) to aid cooling.
6 Apply cooling measures: soak or spray tepid water over skin, fan patient to promote heat loss, apply cold packs to neck, groin and axillae.
7 Perform Vital Sign Survey — obtain full observations including temperature (tympanic), BGL, SpO2, BP, HR, RR and GCS.
8 Perform pain assessment using 0–10 numerical rating scale.
9 Offer oral fluids (cool water) given patient is fully conscious GCS 15/15 — encourage to sip slowly.
10 Consider Ondansetron 4mg sublingual tablet if nausea becomes moderate to severe or patient vomits — confirm no contraindications (no hypersensitivity, not on apomorphine).
11 Reassess vital signs at 10 minutes — expect improvement in BP, HR, CRT and temperature if cooling and fluids commenced.
12 Monitor for signs of progression to heat stroke: cessation of sweating, worsening confusion, seizure, or deteriorating GCS.
13 If symptoms do not improve with rest and cooling within 15 minutes, or patient deteriorates, arrange urgent ambulance support via CSP — IMISTAMBO handover.
14 Consider delaying transport by approximately 15 minutes to allow adequate cooling if patient is responding to treatment and vitals are improving.
15 Continue cooling during transport if conveyance is required.
16 Document all observations, treatments and clinical findings on ePCR.
17 Scenario ends on arrival of ambulance and IMISTAMBO handover.
18 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Heat Stroke · Ondansetron · Oxygen · Blood Glucose Monitor · Tympanic Thermometer · Blood Pressure · Pulse & Respirations · Pulse Oximetry · Pain Assessment

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