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Heat Cramps, Exhaustion, and Stroke: Treating Heat-Related Illnesses When Outdoors

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Mountain bike in the desert | Photo: Jerry Kurjian/Flickr/Creative Commons License

The desert's summer hasn't even begun, and yet high temperatures have already claimed the life of at least one person: Johnny Lee of Placentia, who collapsed and then died while riding mountain bikes with a friend in the foothills of the Santa Rosas on Saturday. The temperature was a record-tying 107°. Lee apparently became dehydrated, and died of hyperthermia: a tragedy that could have been avoided by a modicum of respect for the desert's searing heat.

I've written here previously about the best ways to keep yourself safe in the desert heat, and if you plan on hot-weather recreation it's worth clicking that link and reading ways to keep yourself comfortable and healthy. (Go ahead and do it now: we'll wait.)

But sometimes heat-related illness may sneak up on you unaware, or you may find yourself suddenly faced with tending to someone when hot weather has gotten the better of them. Prevention is always better than first aid, but there are a few things you can do to boost the sufferer's chances of staying alive.

Heat-related illnesses happen when the body can no longer cool itself sufficiently. Risk factors include age, dehydration, and vigorous exertion.

The mildest end of the heat-related illness spectrum is heat cramps: painful involuntary spasms in the body's large muscles, often in the legs. People with heat cramps often sweat profusely.

Heat cramps are your warning sign that worse is to come unless you cool down, rehydrate, and cease strenuous physical activity. Drink plenty of water or sports drink, retreat to the shade, and try gently stretching the muscles giving you that handy warning.

People who power on through their heat cramps can find themselves at the next stage along the heat illness spectrum: heat exhaustion. Heat exhaustion includes heat cramps' symptoms of muscle spasms and profuse sweating, and adds any or all of the following to the list: headache, nausea, vomiting, weakness, and lightheadedness. If the person attempts to stand up quickly, he or she may faint.

Treatment is the same as for heat cramps: cool down, rehydrate, and cease strenuous physical activity. Heat exhaustion is serious, and can progress to life-threatening severity if you don't take it seriously. Cool the person by applying cool or tepid water: a wet bandana or other cotton cloth can be really helpful for this. If you've found some shade, loosening or removing articles of clothing can help your ailing friend cool down more efficiently.

If the person is at all queasy, see if they can keep small sips of water or other fluid down. If nausea keeps the person with heat exhaustion from rehydrating, they will likely need help with IV fluids. Get to a doctor to make sure, in that case.

Most importantly, bail on whatever it is you're doing and go find a cooler, more relaxing place to sit. Your car qualifies, if it's got AC. Soldiering on after a bout of heat exhaustion is a recipe for disaster on the harshest end of the heat illness spectrum. As a wise park ranger once told me as I prepared to hike out of the Grand Canyon on a warm day in May, "Testosterone is not an electrolyte replacement."

That unpleasant far end of the spectrum is heat stroke. Heat stroke happens when most of the body's climate control methods fail: sweating stops, ability to think clearly fades, and core temperature can rise above 106°. The bright clear lines between heat exhaustion and heat stroke are 1) the person is no longer sweating, and 2) they become disoriented or confused, while retaining the above symptoms from the less-severe end of the spectrum. Heat stroke victims may also have trouble breathing, become agitated, hallucinate, lose consciousness, or have seizures. In contrast to someone who has stopped sweating because you've cooled them down sufficiently, a heat stroke victim's skin will likely be hot, flushed, even bright red.

As you might guess from the list of ominous symptoms, heat stroke is an emergency. Seeking immediate emergency medical care is a must. If you suspect someone has heatstroke, you should:

  1. Call 911 or other emergency services immediately.
  2. Cool the victim as much as possible. Many first aid guides mention spraying the patient with a garden hose as a possibility, to give you an idea of just the kind of methods called for at this point. If you're out in the desert with no hose available, improvise with whatever water you have.
  3. If the person is conscious and able to drink, continue to rehydrate them. Small sips of water at frequent intervals will work best

Those last two procedures are essentially to keep your companion alive until the first responders arrive, and to minimize the permanent organ damage -- including brain damage -- that often result from heat stroke.
Obviously, if you find yourself in a place with no cell coverage with significant effort needed to get to where help is available, getting the sick person back to the trailhead is going to be difficult. All the more reason to pay close attention to the earlier symptoms of heat cramps and heat exhaustion, and turn back the moment they become apparent.

Or keep yourself safe by picking something else to do on a hot day, especially if you're visiting the desert from cooler places around the coast. Consider the fact that even those of us who live here and are thus acclimated to higher temperatures rarely go out to get exercise when the thermometer gets above 105°. We may go for the occasional hot weather hike, but we take it easy, drink plenty of water, and rest in whatever shade makes itself available. Save the endurance sports for temperatures you might actually be able to endure.

More Outdoor Safety Tips:
- How to Stay Heat-Safe in the Desert Backcountry
- What to do if You Meet a Rattlesnake
- What to do if You Meet a Black Bear on a Hiking Trail (or City Street)

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