Forty minutes on hot asphalt
It is the annual sports day, 1:30 p.m., 38 °C on the school ground with high humidity. The Class 9 march-past squad has been standing at attention on asphalt for 40 minutes waiting for the chief guest. A girl of 14 sits down suddenly, complains of headache and nausea, and then becomes irritable and confused, answering questions slowly. Her skin is hot and dry, her face flushed, and she has stopped sweating although the rest of the squad is drenched. You are the student first-aider on duty. Her class teacher says she is 'just dehydrated'. A teammate wants to pour a bottle of orange juice into her mouth, and another keeps telling her to get up and walk to the shade. A thermometer from the medical room reads 40.2 °C; her pulse is 130 and thready.
1. Classify her condition. Contrast heat exhaustion with heat stroke using the signs in front of you.
Read the worked answer
This is heat stroke until proved otherwise - not heat exhaustion.
| Feature | Heat exhaustion | Heat stroke | What this girl shows |
|---|---|---|---|
| Core temperature | Usually below 40 °C | 40 °C or above | 40.2 °C |
| Mental state | Alert, weak, dizzy | Confusion, irritability, poor answers, collapse | Confused and irritable |
| Skin | Pale, clammy, sweating | Hot; sweating may have stopped | Hot, dry, flushed |
| Pulse | Rapid but steady | Rapid, weak, thready | 130, thready |
The decisive point is not the temperature alone - it is the change in mental state. A child who is confused and answering slowly after heat exposure has central nervous system involvement, and that is the definition of heat stroke, which is a life-threatening emergency. The absence of sweating is a warning, not reassurance: it means the cooling mechanism has failed.
The teacher's 'just dehydrated' reading is dangerous because dehydration is a cause, not the diagnosis. A dehydrated but alert child who is sweating is a different patient from this one.
2. Set out your immediate management in order, and say what you would stop the bystanders from doing.
Read the worked answer
Priority order - cool first, argue later.
- Call for emergency help (108) immediately and send a named person to phone, then report back. Do not wait to see if she improves.
- Move her to deep shade and lie her down, removing helmet/extra clothing and loosening the uniform. Do not make her walk; walking a confused, hypotensive child can cause collapse.
- Cool actively and at once. Pour cool water over her, fan her continuously, and place ice packs or cold wet cloths at the neck, armpits and groin, where big vessels lie close to the skin. If a tub or large water source is available, immersion is the fastest method. Continue cooling until she is more alert.
- Do not give anything by mouth. She is confused, so swallowing is unsafe and there is a risk of choking and aspiration. The orange juice must be stopped, gently but firmly, and explained to the teammate.
- Position and monitor. If she becomes drowsy but is breathing, place her in the recovery position; check breathing and response continuously and be ready to start CPR if she stops breathing.
- Keep the crowd back for air movement and dignity, and record the time, temperature, pulse and what you did, for the hospital.
- Hospital transfer even if she seems better. Cooling on the field is first aid, not treatment.
What to stop: forcing fluids, making her walk, crowding around, and any suggestion to 'let her sit and then rejoin the march past'.
3. What should the school change so that this does not repeat at next year's sports day?
Read the worked answer
Treat the event, then treat the system.
- Timing and surface. March pasts and long standing events should be scheduled before 11 a.m. or after 4 p.m., and should not be held on asphalt in peak heat. Provide shade and seating for waiting squads instead of 40 minutes at attention.
- Shorten standing time and rotate squads; a five-minute rest in shade every 15–20 minutes with water available.
- Acclimatisation. Students pulled into sudden outdoor exertion need 7–14 days of gradual exposure; one rehearsal the day before is not acclimatisation.
- Fluids and electrolytes. Water stations at every field, ORS sachets in the medical room, and a rule that students carry a bottle. Thirst is a late signal.
- Buddy system and staff watching for early signs: dizziness, headache, nausea, stopping sweating, confusion. The first-aider should be a student trained in this, backed by an adult.
- Clothing: light-coloured, loose uniforms; caps for outdoor events.
- A written emergency plan: who calls 108, who fetches the medical kit and ice, who controls the crowd, where the vehicle meets the ground. Rehearse it once.
- Brief the teachers that 'just dehydrated' is not a diagnosis, and that any child with altered behaviour in heat is evacuated and cooled.
The exam-ready reasoning: heat stroke is prevented by scheduling and hydration, not by willpower.