Two Casualties on the Trek: Heat Stroke or Heat Exhaustion at Kilometre Six
Fourteen cadets and one instructor are on an 8-km trek from camp, started at 11:00 on a day when the district has recorded 39 degrees Celsius. At kilometre six, Cadet Ravi, 16, is confused, unsteady and answers questions slowly. His skin is hot and dry, he has stopped sweating, his pulse is about 120 and his skin is burning to touch. Ten metres away, Cadet Priya is sweating heavily, pale, cramped in both calves and complaining of dizziness. The group has about two litres of water left, one small first-aid pouch with ORS sachets, no stretcher, no mobile network at this point, the camp two kilometres behind and a road head four kilometres ahead where a vehicle can reach. The rest of the group is frightened and several cadets want to pour all the remaining water over Ravi and carry on walking to the road head.
1. Which casualty is the priority and what is the reasoning behind that decision?
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Ravi is the priority, and the signs decide it, not seniority or noise.
| Sign | Ravi | Priya |
|---|---|---|
| Sweating | stopped, skin hot and dry | heavy, skin pale |
| Mental state | confused, slow answers | alert |
| Temperature | burning to touch, likely above 40 C | near normal |
| Likely condition | heat stroke | heat exhaustion with cramps |
Heat stroke is a failure of the body's cooling with altered mental state; untreated it can progress to organ damage within an hour, so it is a time-critical emergency. Heat exhaustion with cramps is serious but responds to shade, rest, salt and fluids. Priya still needs treatment - shade, sitting with legs raised, sips of ORS - but she can be managed by two cadets while the instructor concentrates on Ravi.
Reasoning: the confusion plus the absence of sweating is the discriminator. A cadet who is merely exhausted can still tell you his name; one who cannot may die on the track.
2. Using only two litres of water, an ORS pouch and the clothing the group is wearing, what cooling steps would you take and in what order?
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Order matters because the first ten minutes decide the outcome.
- Move Ravi to shade and lay him flat; strip him to the waist and loosen the rest. Shade alone reduces heat load at once and costs no water.
- Wet, do not drench: soak cloths and apply to the neck, armpits and groin - the areas of high blood flow - and fan him continuously with a shirt or notebook. Evaporation plus fanning cools far more than pouring water over the whole body, which wastes a scarce supply.
- Keep 300-400 ml of water reserved for drinking. Ravi is confused, so give nothing by mouth; a confused casualty cannot protect his airway. ORS is for Priya, one sachet in the available water, sipped, not gulped.
- Reassess every ten minutes: if Ravi becomes alert, allow small sips.
Reasoning: evaporative cooling is the technique that works with little water; giving fluid to a confused casualty is the mistake that turns heat stroke into choking. Cold water immersion would be ideal but is impossible here, so emulate it at the neck, armpits and groin.
3. Should the group move Ravi to the road head, and how should the evacuation be organised?
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Do not carry a heat-stroke casualty four kilometres in the sun on foot - the carry itself adds heat and the delay is the danger.
- Split the group: two cadets are sent back the two kilometres to camp at a fast walk to bring the instructor's vehicle, a stretcher and more water; they go in pairs, with a clear message written down (casualty, place, time, condition).
- Continue cooling on site while waiting; cooling is treatment, not a prelude to it.
- Move only to the nearest shade or shelter, a few hundred metres at most, using an improvised stretcher of shirts and two lathi-length branches if it must be done.
- Priya walks with two cadets, slowly, after rest and ORS; she must not be left alone or hurried.
- Someone stays with Ravi at all times and keeps the ten-minute observations, so the handover to the medical officer is factual.
Reasoning: the fastest route to a hospital is not always the fastest route to a vehicle. Cooling on site while transport comes is the plan that uses the two available kilometres in the group's favour.