Collapse at the 800 m Finish Line
Sports Day, 2:20 p.m., Guwahati: 35°C and 84% relative humidity. A Class X boy, T, collapses at the finish of the 800 m. He is confused, answers slowly, his skin is hot and dry, pulse is 130 beats/min, and the coach says he stopped sweating. Another boy, U, is sitting on the grass clutching his calf, sweating heavily, and complaining of nausea. The school first-aid box contains oral rehydration salts, a fan, two towels and bottled water. The nearest hospital is 12 km away and an ambulance has been called but will take about 15 minutes. A teacher suggests giving T cold water to drink and making him walk to the shade. About 200 students are watching, and the next event is due to start.
1. Triage T and U. What first aid do you give, and why do you reject the teacher's suggestion for T?
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T is the priority - suspected heat stroke. Confusion, collapse, hot dry skin and a pulse of 130 after exertion are emergency signs. Do not make him walk and do not give oral fluids: his consciousness is altered and he is at risk of aspiration; walking increases heat production and cardiovascular strain. Move him or bring shade, remove excess clothing, fan him, apply wet towels to the neck, armpits and groin, and keep monitoring breathing and response. Call the ambulance again to confirm and prepare to transfer. Cooling starts immediately, not after transport.
U has heat cramps with heat exhaustion features. Move him to shade, give small sips of oral rehydration solution, gently stretch the calf, and monitor. If he vomits, becomes confused or stops sweating, treat him as severe and escalate.
Why the teacher's plan is unsafe: A confused athlete cannot safely swallow; walking a heat-stroke casualty can worsen collapse. The key is rapid cooling and urgent transport. The next event should be delayed and students moved to shade - continuing in 84% humidity puts more runners at risk.
2. What prevention plan would you propose for next year's Sports Day, and when should T and U return to sport?
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Prevention: Schedule distance events before 11 a.m. or after 4 p.m.; provide shade, water stations and electrolyte drinks; shorten or postpone events when temperature and humidity are high. Introduce a 7–14 day acclimatisation period for students who will run in heat, teach pacing and self-monitoring, and use a buddy system. Brief teachers on the signs of heat illness and have a written emergency plan, charged phone, ice and a vehicle plan. Reduce the number of spectators standing in the sun and announce water breaks.
Return to sport: T should not return until medically cleared after heat stroke; recovery can take days to weeks, and returning too early risks recurrence and organ injury. Start with light indoor activity in a cool environment and progress over several days. U may return when symptoms have resolved, urine is pale and he is drinking normally, starting with light training in the cool part of the day. Both should be observed for 24 hours, and parents informed. 'Toughening up' is not a treatment for heat illness.