Collapse at the Annual Sports Meet

This is exertional heat stroke. The two defining features are present together: a core temperature above 40 degrees Celsius (measured 40.1) and central nervous system dysfunction, shown by confusion, not recognising a familiar teacher and incoherent answers. Heat exhaustion is the closest alternative, but in heat exhaustion temperature is usually below 40 degrees, the athlete is sweaty but lucid, and complains of dizziness, headache, nausea and cramps. Confusion is the dividing line, so heat exhaustion is excluded here. Note that heavy sweating does not argue against heat stroke: in exertional heat stroke, sweating often persists because the hypothalamic set-point is intact, unlike classical heat stroke in the elderly where dry skin is typical. The pulse of 140 and rapid breathing reflect heat load and fluid loss but do not themselves decide the diagnosis. Exercise-associated hyponatraemia can also cause confusion, but usually after hours of drinking excess plain water and without temperature above 40 degrees. On these findings, heat stroke is the working diagnosis and the time-critical decision.

The principle is 'cool first, transport second, and never delay cooling'. Sequence: call the ambulance or 108 immediately while another person begins cooling; move him to deep shade and strip him to shorts; cool aggressively by the fastest available route - immersion in cold water is best, otherwise continuous cold-water dousing with fanning, ice packs at neck, axillae and groins, and wet towels changed frequently; keep cooling until temperature falls below about 39 degrees and he is more lucid, then transport with cooling continuing. Do not give oral fluids: he is confused, his swallow is unsafe, and aspiration is a real risk; intravenous fluids are a hospital decision. Do not give paracetamol or other antipyretics, which act on the hypothalamic set-point, not on environmental heat load, and can injure the liver. Do not use alcohol rubs or wrap him in blankets. If he becomes unresponsive but is breathing, place him in the recovery position. Resolution of the dispute: pouring water slowly and waiting wastes the decisive minutes, while lifting him into a car delays cooling, so ambulance dispatch plus immediate active cooling, not either teacher's plan alone.

The scenario gives the risk factors, so prevention targets each. Timing: schedule distance races before 10 am or after 4 pm; 1:45 pm in mid-May in Bengal is the hottest, most humid part of the day, when evaporative cooling is least effective. Acclimatisation: heat adaptation takes roughly 10-14 days of progressive exposure, so a boy who has only run in the early morning is unacclimatised and cannot be expected to race at 1:45 pm. Medical screening: pre-participation check for fever, recent illness, dehydration and previous heat illness; a simple checklist at entry. Water and shade: drinking stations on the route, shaded rest areas, and oral rehydration solution available, not just plain water, because prolonged sweating with plain water replacement risks hyponatraemia. Reduce distance or make it a timed run in high humidity. Train officials to recognise confusion as an emergency and to start cooling rather than argue. Keep a written heat protocol with an ambulance on standby and a tub or large ice supply at the venue.