Primary prevention

Prevention methods are very effective in limiting mortality and morbidity associated with heat stroke.[8] Vulnerable populations should be counselled to maintain adequate hydration, avoid heat exposure, and wear loose and light clothing during hot weather. People who exercise or exert themselves (e.g., firefighters, soldiers, construction workers) should be advised to avoid high-exertion activities when exposed to heat or hot areas, and to acclimatise with 1 to 2 hours per day of heat-exposed exertion for at least 8 days.[1] Because a heat injury releases an inflammatory cascade that may increase risk on subsequent days, patients should minimise heat exposure for 24 to 48 hours after a mild injury.

Doctors and other public health officials should educate people, especially those more vulnerable such as older people and those who have poor access to air conditioning or where there are cognitive obstacles to self-care. PHE: heatwave plan for England Opens in new window

Secondary prevention

Considerations about returning to activity for patients who have had exertional heat stroke:

  • Advise the patient to not exercise for at least 7 days after being discharged from medical care[2][35] 

  • Follow up at 1 week for physical examination and repeat laboratory testing (to ensure resolution of biochemical derangement), or diagnostic imaging of affected organs[2][35]

  • When returning to activity, advise the patient to begin exercise in a cool environment and gradually increase the duration, intensity, and heat exposure over 2 weeks to acclimatise[2][35]

  • Athletes can be cleared for full competition if they are heat tolerant after 2 to 4 weeks of full training[2]

  • Seek help from a sports and exercise medicine physician if there are persisting clinical or biochemical abnormalities, or if return to exercise proves difficult.[35] Heat tolerance testing may be useful, where facilities exist.[2][35]

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