Heat Stroke: Emergency First Response

Heat stroke is a true emergency. A worker can go from confused to unconscious in minutes, and every minute you wait raises the risk of death or lasting damage. What the crew does in the first few minutes is most of the outcome.

Two things people get told that aren't reliable

"It always starts as heat exhaustion." Often there's a warning stage — and when there is, it's your chance to stop this. But it doesn't have to arrive in order. Someone can go to confusion and collapse without an obvious earlier stage, so don't wait for a tidy sequence before acting.

"They'll have hot, dry skin and have stopped sweating." That's one presentation. A working crew member in exertional heat stroke is often soaked with sweat. If you're waiting for dry skin to confirm it, you will miss it.

Heat stroke: the emergency

The signs that matter are about the brain, not the skin: confusion, strange behaviour, slurred speech, stumbling, collapse, seizure, or loss of consciousness. Skin may be hot and dry or hot and sweaty — it doesn't rule anything in or out.

• Call 911 right away. Don't wait to see whether they come round.
• Move them to shade or a cool spot immediately.
• Cool them fast: cool water over the skin, wet cloths, ice packs to the neck, armpits, and groin. Fan them so the water evaporates. Start cooling before the ambulance arrives — that's the part that changes outcomes.
• Get heavy clothing and PPE off.
• Stay with them until help arrives, watching breathing and consciousness.
• Don't give fluids to anyone confused, drifting, or unable to swallow properly.

The earlier stage, when you get one

Heavy sweating, headache, dizziness, nausea, weakness, cramps, cool clammy skin — and the worker is still alert and making sense. Treat it seriously:

• Stop work, get them into shade, loosen clothing and PPE, let them rest and sip water.
• Cool them — water on the skin, a fan, a cool damp cloth on the neck.
• Don't leave them on their own, and get medical attention. "He sat in the truck a while and seemed fine" is not an assessment.
• If anything gets worse, or any of the brain signs above appear, it's the emergency — call 911 and start cooling. You don't owe it a waiting period first.

Prevent it before it starts

Most heat illness is stopped by water, rest, and shade used all day — and by your employer's heat plan, which is where the actual numbers for this site and this work belong.

• Water: small amounts often. About a cup every 15–20 minutes suits moderate work over a shorter stretch; longer, heavier work in heat-trapping gear needs more, plus electrolytes when people are sweating hard for hours. Don't wait until you're thirsty.
• Rest: breaks in the shade, longer and more frequent as the heat load climbs — and heat load isn't just the thermometer. Humidity, radiant heat, air movement, workload, and PPE all count. Put the heavy work in the cooler part of the day.
• Shade: set the cool rest area up before the shift and make sure everyone knows where it is. No natural shade means a tent, a trailer, or an air-conditioned vehicle.
• Ease in: anyone new to working in heat, or back after time away, builds up over days on a schedule the supervisor sets — a large share of serious heat cases land in those first days.
• Watch each other: heat goes after judgement early, so people genuinely can't see it in themselves.

Watch out for

• Waiting for someone to stop sweating. Sweating does not mean they're fine.
• Treating brain signs as tiredness. Confusion means act bigger, not wait longer.
• Spending time deciding whether to call 911. When in doubt, call.
• Sending someone home alone, or letting them drive, after heat symptoms.

Talk it over

• What signs mean we call 911 rather than sit someone down — and does everyone here know the skin can be wet or dry?
• If it happened this afternoon: who calls, who starts cooling, and who stays with them?
• Is there cool water and ice on site right now, and where's the shade?