Collapse at the 1,600 m run: two casualties, one ambulance
A district police recruitment camp near Bhopal begins its 1,600 m run at 13:20 on 21 May. Dry-bulb temperature is 41°C, relative humidity 35%, and the track has no shade. A 22-year-old male candidate who travelled 300 km by bus the previous night and has eaten nothing since morning collapses 60 m before the finish. He is confused, his skin is hot and dry, axillary temperature is 40.6°C, pulse 132 per minute, and his batchmates say he 'stopped sweating'. About ten minutes later another candidate who has finished the run complains of painful cramps in both calves; he is sweating heavily and is fully alert. Around 300 candidates are still waiting for their turn. The camp has one ambulance, two stretchers, drinking water and ORS sachets, but no ice.
1. Name the two conditions and explain, using thermoregulation, why the first is a medical emergency and the second is not.
Read the worked answer
The first candidate has heat stroke - core temperature above 40°C with central nervous system dysfunction (confusion) after exertion. The second has heat cramps, a salt-and-water depletion problem in muscles after heavy sweating, with a fully alert patient.
The science: the hypothalamus sets a target temperature and the body sheds heat mainly by evaporating sweat. In heat stroke that evaporation route fails - high ambient temperature, dehydration from a long bus journey, an empty stomach and lack of acclimatisation mean sweat production cannot keep pace with heat gain, so core temperature climbs past the point where cells and clotting factors are damaged. Confusion is the red flag: it shows the brain itself is overheating, and this can progress to organ failure and death within minutes. Dry skin is a classic sign but its absence does not rule out heat stroke. Heat cramps, by contrast, reflect electrolyte loss in muscles with the thermostat still coping; the patient is conscious and his temperature is near normal, so the risk is distress and rhabdomyolysis, not collapse.
2. Set out the first-aid sequence for the collapsed candidate, with the reason for each step, and name two actions you must stop.
Read the worked answer
- Airway, breathing, circulation and move him to shade at once: the clock that matters is the time spent above 40°C, not the time since collapse.
- Cool aggressively and immediately. Remove clothing, pour water over him, fan him, and place wet cloths at the neck, armpits and groin - the large vessels there let cooled blood return to the core. No ice is available, so water plus moving air (the ambulance fan or a shade-net fan) is the substitute; evaporation still works even at 41°C if air is moved across wet skin.
- Do not give oral fluids: a confused patient cannot protect his airway and will aspirate. Fluids, if needed, go intravenously once the paramedic is there.
- Monitor and evacuate - record temperature, pulse and consciousness every few minutes and hand over the timings to the hospital.
Stop: covering him with a blanket or shirt, and giving paracetamol or any antipyretic. Antipyretics act on the hypothalamic set point in fever; in heat stroke the set point is normal and the drug will not help, but can add liver injury. Also stop bystanders from crowding and from massaging him with alcohol.
3. As the officer in charge of the camp, what do you change for the remaining 300 candidates, and why?
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Stop the 13:20 batch and move the remaining runs to before 09:00 next day. Justification: the heat load is a product of temperature, humidity and solar radiation, and the 41°C afternoon with no shade is the worst window; morning slots cut radiant load drastically at no cost to the test's validity, because every candidate runs under the same conditions.
Alongside that: (i) stagger starts into smaller batches with shade and water at the start and finish so a collapse is seen within seconds; (ii) give ORS, not plain water alone, before and after the run - plain water dilutes sodium and can bring on the cramps seen in the second candidate; (iii) screen every candidate at the desk for overnight travel, illness, fasting and recent fever, and let the medical officer defer them, since the first casualty's risk factors were all visible at registration; (iv) brief the 300 waiting candidates on early warning signs - dizziness, confusion, stopping sweating - and give them the authority to sit down; (v) keep the ambulance positioned at the track, not at the gate. Record all of it in the camp diary.