Writing About Medicine: Heat Emergencies

With record-breaking, 100+ degree temperatures here in the PNW, I figured I’d share an excerpt from my WIP, a ‘Writer’s Guide Modern Medicine.’ This is part of a chapter titled “Environmental Emergencies.’ As always, the information contained on this website is meant for WRITERS. It is not medical advice and should not be used as a substitute for medical attention. Feel free to leave any suggestions for improvement in the comments. Stay cool!

*Backstory: Dan and Delilah are siblings hiking the Pacific Crest Trail.* One day, as they’re crossing the Mojave desert, Delilah notices her leg muscles keep cramping. Daytime temperatures have soared into the upper 90’s, and the distances between water sources are long, so she’s been conserving water, drinking rarely. But as the sun climbs higher and higher, she starts to feel tired deep in her bones. Every step is an effort, and her head is pounding. She’s sweated through her shirt and is starting to feel nauseated. When they stop for lunch in the shade of a rock formation, she collapses to the ground and vomits. Dan hurries over and feels her forehead; she is cool and clammy to the touch.

Heat Exhaustion

            Heat exhaustion is characterized by extreme fatigue, headache, nausea and vomiting, dizziness, and profuse sweating. Your character’s skin will be cool and clammy, their heart will be racing and they’ll be breathing fast. The lightheadedness and dizziness is caused by low blood pressure. Heat exhaustion is uncomfortable and unpleasant but is generally not life-threatening.

Seeing Delilah’s state, Dan fills the rest of his canteen with Gatorade powder and makes Delilah drink it – slowly, so she doesn’t vomit. They find a spot in the shade that has a breeze, and Delilah sits and sips until she’s feeling better. They decide to wait there for a few hours until the heat of the day passes.

 Heat Exhaustion can be treated with electrolyte-rich fluids and finding whatever external method of cooling down is readily available, whether that is a shady spot or a cool bath. If your character doesn’t improve within an hour, they should be taken to the hospital. There, Heat Exhaustion will be treated with IV fluids and external cooling, such as air conditioning and fans.

The next day, Delilah is feeling more like herself. She and Dan decide to start out before sunrise to avoid hiking during the heat of the day.

Heat Stroke

            Heat Stroke, by comparison, is a life-threatening emergency. Common in the very old and the very young, Heat Stroke is differentiated from heat exhaustion by hyperthermia – a body temperature greater than 104^oF. If your character is suffering from Heat Stroke, they will have hot, dry skin and may, paradoxically, be shivering. They may seem confused tired, or delirious, and may have jerky or stilted movements. If untreated, Heat Stroke can lead to seizures and collapse the of cardiovascular system.

While heat stroke victims generally don’t sweat, it is possible for your character to sweat profusely and still have heat stroke, assuming they fit the other criteria. The uncertainty of the diagnosis–especially if your characters don’t have a rectal thermometer handy–can add some serious tension. Remember; misdiagnosis can be fatal.

            The first step in treatment for heat stroke is to bring down the victim’s body temperature, fast. This includes cooling with water sprays, fans, ice packs in the groin and armpits, even cool IV fluids. Cold-water baths (and especially ice baths) are not recommended unless someone who knows what they’re doing is monitoring the victim’s rectal body temperature very closely. Cooling too fast can be just as dangerous as the heat stroke itself.

Victims of heat stroke need to be taken to a hospital, where they will be safely cooled, rehydrated, and stabilized. They’ll also be given muscle relaxants and anti-seizure medications, and monitored closely for signs of organ dysfunction.