Exertional Heat Stroke Best Practices in US Emergency Medical Service Guidelines

Abstract

BackgroundExertional heat illnesses (EHI), specifically exertional heat stroke (EHS) is a top cause of non-accidental death among US laborers. EHS management requires coordination between Emergency Medical Services (EMS) and workplace officials to implement cold water immersion (CWI) and cool first-transport second (CFTS). ObjectiveThe purpose was to 1) quantify and identify existing statewide EMS guidelines, 2) determine if statewide EHS guidelines improved outcomes for EHI in laborers, and 3) to examine the odds of laborer EHS fatalities due to EHS when best practices are present in EMS statewide guidelines. MethodsThe Paramedic Protocol Provider database and official EMS websites were examined if they had statewide EMS guidelines, and of those with statewide guidelines a two-way chi-square analysis with associated odds ratios examined EHI outcomes. Statewide EMS guidelines underwent a content analysis regarding EHS best practices by three independent reviewers. Significance was set a priori at p<0.05. ResultsOf 50 states, DC and Puerto Rico, 57.7% (n=30) had statewide EMS guidelines while 42.3% (n=22) did not. There was a significant association for EHI outcome for states recommending CWI as a cooling method vs those that did not (X2(1) = 3.336, p=0.049). The odds of EHS deaths for laborers were 3.0 times higher if CWI was not included in the EMS guidelines. There was a significant association in EHI outcomes for states without CFTS (X2(1) = 5.051, p=0.017. The odds of laborers dying from EHS were 3.7 times higher in states without CFTS. ConclusionsLaborers are 3.0-3.7 times less likely to die from EHS when statewide EMS guidelines contain CWI and CFTS, respectively.