Two Collapses at a 43 °C Rally
A constable is managing a crowd of about 4,000 at a government function in Gaya on 28 May. The IMD reading is 43 °C with relative humidity of 25 per cent; the ground is bare concrete with almost no shade. At 1:40 p.m. two people are brought to the police first-aid point. Case 1 is a 55-year-old woman who collapsed twenty minutes ago. She is confused, does not recognise her son, her skin is hot and dry, she is not sweating, pulse is 120 per minute and her temperature reads 41.2 °C. Case 2 is a 22-year-old volunteer who has been on his feet for five hours; he is sweating heavily, looks pale, has painful cramps in the legs and abdomen, is fully alert and thirsty, and his temperature is 38.4 °C. The first-aid box holds ORS packets, drinking water, two towels, a battery fan and no ice. The CHC is 11 km away and the ambulance is 15 minutes out.
1. Classify the two cases with reasons, and say which one is the emergency.
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Case 1 is heat stroke. The combination of a core temperature above 40 °C with altered mental state - confusion, failure to recognise her son - means the body's thermoregulation has failed, not merely struggled. The hot, dry skin fits the classic picture: once sweating shuts down, evaporative cooling is lost and temperature climbs. Untreated, this progresses to multiorgan failure, and the death rate rises with every minute of delay in cooling. This is the emergency.
Case 2 is heat exhaustion with heat cramps. His temperature is under 40 °C, he is alert and oriented, and he is still sweating - the cooling mechanism is working but water and salt are running out, which is exactly what the cramping and pallor show.
The distinguishing question is not 'who looks worse' but 'has the brain been affected'. Mental status plus a temperature above 40 °C is the dividing line, and it is the reason Case 1 goes first even though Case 2 is also in distress.
2. Give the first-aid sequence for Case 1 in the fifteen minutes before the ambulance arrives, with the reason for each step.
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- Shade and airway: move her to the deepest shade, loosen clothing and check that she is breathing and has a pulse; a confused patient can vomit and choke.
- Cool her now, before any paperwork: soak both towels, wrap the neck, armpits and groin - where large vessels lie close to the skin - and start the fan. Evaporation is the only cooling mechanism available without ice, and at 25 per cent humidity the air is dry enough to accept water vapour quickly, so wet skin plus moving air cools far faster than a fan alone. In 90 per cent humidity the same fan would be almost useless because evaporation would stall, and that difference is the science being tested.
- Do not give her water or ORS by mouth: she is confused, so the swallow reflex is unreliable and fluid can enter the lungs. Nothing by mouth until she is fully alert.
- Re-check temperature and consciousness every few minutes while cooling continues, and hand over the time of collapse, the temperature readings and the cooling done to the ambulance crew.
- Clear a corridor through the crowd so the stretcher reaches the vehicle; keep the crowd back with barricades, not force.
3. Handle Case 2 and justify one prevention change for the constables on the same duty.
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Case 2 should be moved to shade, made to sit, and given ORS in small frequent sips rather than plain water alone. He has lost salt as well as water through five hours of heavy sweating; plain water dilutes the sodium left in the body and can worsen cramps and, in volume, cause dilutional hyponatraemia. ORS replaces both. He should not return to duty that day even if he feels better within twenty minutes, because the fluid deficit is not corrected that quickly and a second collapse in a crowd is more dangerous than the first.
The prevention point is about the pattern, not just this volunteer: the whole duty fell between noon and evening, exactly when radiant heat is highest, and a constable in uniform on concrete is doing the same work. A duty roster that puts half the party on from 12:00 to 16:00 and rotates them every 45 minutes, with drinking water at fixed posts and ORS for anyone sweating continuously for more than two hours, is the change that follows from the evidence in front of the constable. Salt tablets are not a substitute for this and are not to be handed out routinely.