With summer upon us, you’re probably excited for beach days, fun runs and other outdoor activities. But with temperatures rising, you need to watch out for heat-related illnesses — especially heatstroke. It can come on fast, and when it does, speed is critical. It’s best to have a heatstroke plan ready before you need it. Here’s what you should know.  

What is heatstroke? 

Heatstroke occurs when your body makes more heat than it can dissipate through means such as sweating. “Once the body is over 104.5 F, it’s a medical emergency that must be treated within 30 minutes in order to limit any short-term or long-term damage and to prevent fatality,” says Robert Huggins, PhD. He is a kinesiology and exercise-science researcher. He’s also the president of research and athlete performance and safety at the University of Connecticut’s Korey Stringer Institute in Storrs.  

In severe cases, heatstroke can lead to endotoxemia. This is a condition in which your cells break down and leak their contents into your body. It triggers inflammation followed by cell death and eventually multi-organ shutdown, says Huggins. But this is rare: According to the Centers for Disease Control and Prevention, heat-related death occurs only about 700 times per year on average in the United States. And if you know what to look for, you’ll be able to act fast before the heat does any serious damage. (If treatment or recovery includes prescription medication, Optum Perks can help you pay for your medication. Learn how.)

There are 2 types of heatstroke:  

  • Non-exertional or “classic” heatstroke. This tends to affect people who have trouble regulating body temperature. For example, an elderly person might get heatstroke from being in a hot apartment. Or a baby might get heatstroke from being in a hot car for too long.  

    According to the National Institute on Aging, risk factors for classic heatstroke include heart problems, being overweight or obese, and alcohol consumption. Certain medications, especially diuretics and blood pressure medicine, can also increase your risk. 

  • Exertional heatstroke. This is generally the result of intense exercise. “Our normal exercising body temperature is between 101 F and 104 F,” says Huggins. “When you produce too much heat and can’t get rid of it at the same rate, your system becomes overwhelmed, like a vehicle that is overheating and doesn’t have enough fluid in the radiator.” Just as a car overheats, so does your body, says Huggins. 

What are the signs and symptoms of heatstroke?

There are 2 telltale signs of heatstroke.  

  1. Core body temperature above 104.5 F. This is the threshold for cell damage. The more time a person spends above 104.5 F, the higher the risk of lasting harm. Unfortunately, core temperature isn’t something you can easily measure while you’re at the beach or pool. “The only way to confirm the core temperature in an outdoor setting is by rectal thermometer, so it needs to be performed by a trained health care provider, such as a doctor, sports medicine doctor or another medical professional that has the tool,” says Huggins.     

  2. Mental status changes, such as loss of consciousness, confusion or disorientation. This is the more obvious clue: If someone you’re with seems lost, unreasonably irritated or angry, you could be dealing with heatstroke.  

What’s the best first aid for heatstroke?

When it comes to heatstroke, you must act fast, says Huggins. You need to begin cooling immediately. Here are your options for rapid treatment:    

  • Place the person in a bath of cold water. “That could be a tub, kiddie pool, trash can — anything that is capable of holding ice water,” says Huggins. This is the most reliable way to cool somebody quickly. This method is often seen at running races.  
  • The TACO method. “It stands for tarp-assisted cooling oscillation,” says Huggins, noting that it’s taught in the military. For this method, you take a tarp, line it with sheets soaked in ice water and wrap it around the person like a cold, wet blanket.  
  • Repeated rotation of ice towels. Lie the person down in the shade and continually replace ice towels over the entire surface of the body. 
  • Remove clothing and ice the person down.

    If none of these options are possible, at a minimum move the person to the shade, remove all their clothing and cool as much of their body as possible until help arrives. “The more skin you actively cool, the quicker the body will return to a safe level with a core temperature of 102 F or lower,” says Huggins. 

Contrary to popular belief, placing ice packs on arteries isn’t effective. It’s too slow. “It’s almost as bad as just sitting there and passively getting rid of the heat,” says Huggins. “You’re better to put a person in a cold shower, or if you’re out in nature, put them in a cool river or stream — the colder the better.” (If you’re spending a lot of time outdoors, you might also want to bone up on your summer allergy treatment options.)  

Keep in mind that a person who is experiencing heatstroke may not realize it. “By the time someone is experiencing heatstroke, the person already has an altered mental state and thus is not thinking clearly,” says Samuel H. Werner, DO. He is a board-certified family medicine physician. He’s also currently completing a residency in osteopathic neuromusculoskeletal medicine at the Edward Via College of Osteopathic Medicine in Blacksburg, Virginia. “The brain is one of the most heat-sensitive organs, which is why it is so critical to watch for signs of confusion, agitation and, of course, loss of consciousness or seizures.”  

When should you call 911? 

Cooling the person down is the first priority, but calling 911 should be a close second. If you can, have somebody else make the call while you begin cooling. Then keep cooling until emergency medical services or someone with more medical training arrives.  

Some people with heatstroke may resist help or become combative. They could also be unconscious. After calling 911, do your best to help the person stay calm while you cool them as efficiently as possible.   

When medical help arrives, they will continue to cool down the person, give IV fluids, check vital signs and transport the individual to the hospital after cooling is complete. At the hospital, they might also run blood and urine tests along with tests to check the individual’s heart, liver and lung functions. If the patient is shivering and agitated, they might be given a benzodiazepine, which acts as a sedative. (Benzodiazapines include Xanax® and Ativan®.) 

What are the other heat-related conditions I should be aware of during summer? 

Heat exhaustion is another one to watch out for. It’s a sign of severe dehydration, and it can look a lot like heatstroke. “Heat exhaustion also manifests itself in disorientation, nausea and confusion, but you don’t have a core temperature of over 104.5 F,” explains Huggins. “It is unlikely that you will experience heat exhaustion at the same time as heatstroke, but know that it’s not a progression — you don’t go from heat exhaustion to heatstroke.” (Dehydration has other serious health implications. It might even cause anxiety.)  

Heat exhaustion isn’t as life-threatening as heatstroke. But since you probably won’t know whether it’s heatstroke or heat exhaustion, you should treat any heat-related confusion the same way: Cool the person down using the methods above, and make sure the individual is drinking cool water.  

How can I prevent heat-related conditions? 

Prevention is the best way to limit damage. The first step? Keep drinking water while you’re in the sun. “The old saying, ‘If you feel thirsty, you’re already dehydrated’ is a good motto to live by during the summer,” says Dr. Werner.  

If you’re working out in the heat, do so with a buddy who can catch signs of overheating. Try to acclimate to the higher temperature: Don’t run a race in 90-degree weather if you haven’t already done some training at that temperature, for instance. And wear loose-fitting clothing, which helps your body shed heat. 

Remember: It’s okay to take it easy as the temperature rises. The important thing is that you stay safe.  

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Additional sources

Risk factors for Heat Stroke: National Institute on Aging
Heat-related deaths in the United States:Centers for Disease Control and Prevention
Medical treatment for heatstroke:StatPearls Publishing
The threshold for cell damage: Prehospital Emergency Care (2018).  “Consensus Statement- Prehospital Care of Exertional Heat Stroke.”