Collapse at the 800 m Final: Heat Stroke or Heat Exhaustion?
During a BSEH inter-school athletics meet in Rohtak in May, the track temperature is 41°C at 2:00 p.m. A 14-year-old girl collapses immediately after the 800 m final. She is confused, her skin is hot and dry, she is not sweating, her pulse is 128 beats per minute, and her oral temperature is 40.3°C. Ten minutes later, a 15-year-old boy who ran the 3000 m complains of painful calf cramps; he is sweating heavily, his temperature is 38.1°C, and he is alert. The meet has one first-aid tent, two teachers trained in basic first aid, a cooler with 20 litres of water, ice packs, and a telephone. The nearest ambulance is 12 minutes away. A teacher suggests giving the girl cold water to drink and waiting for her to 'cool down naturally' before calling for help.
1. Triage the two athletes. Which condition is the emergency, and what evidence supports your decision?
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The girl is the emergency. Her temperature is above 40°C, she is confused, and her skin is hot and dry with a rapid pulse. Those are signs of heat stroke, specifically exertional heat stroke in a young athlete. Confusion is the key warning: it shows central nervous system dysfunction, which distinguishes heat stroke from heat exhaustion. The boy has heat cramps: painful calves, heavy sweating, a temperature of 38.1°C, and full alertness. The teacher's plan to give the girl water and wait is dangerous. An altered conscious state means she should not be given oral fluids, and delay in cooling increases the risk of organ damage and death. The correct principle is 'cool first, transport second' while the ambulance is called. The boy still needs treatment, but he can wait a few minutes while the girl is cooled and the emergency call is made.
2. Outline the first-aid steps for both athletes, including what should not be done.
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For the girl: call 108 or the ambulance immediately, move her to shade, remove excess clothing, and begin rapid cooling. Cold-water immersion is best if a tub can be improvised; with the equipment available, apply ice packs to the neck, armpits, and groin, cover her with wet towels, fan her, and monitor breathing. Do not give oral fluids because she is confused. Do not give paracetamol or aspirin; they do not cool a heat-stroke patient quickly and may harm the liver or mask problems. Continue cooling until help arrives and keep checking airway and breathing. For the boy: move him to shade, give oral rehydration solution in small sips, gently stretch the cramped muscles, and let him rest. Do not deep-massage the cramp or send him back to compete. If he becomes confused, stops sweating, or his temperature rises, treat him as a heat-stroke case too.
3. Propose a prevention plan for the rest of the meet, using the resources and constraints given.
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The meet should be reorganised around heat risk. Schedule distance races before 10:30 a.m. or after 4:30 p.m., shorten or postpone events if the track temperature stays above 40°C, and add mandatory water breaks. Set up shade and a cool zone near the first-aid tent, with the 20 litres of water used for drinking and wetting towels. Brief athletes on drinking before they feel thirsty and on recognising early symptoms such as dizziness, headache, or stopping sweating. Coaches should watch for confusion and remove any athlete showing it from play immediately. Record each athlete's weight before and after endurance events if possible; a loss of about 2% body mass signals poor hydration. With only two trained teachers, assign one to the cool zone and one to field observation, and write the ambulance number and 12-minute response time into the announcement script.