Heatstroke, mortality rates of up to 80 per cent: what can be done to protect the most vulnerable

Over the last twenty years, heat-related mortality among people aged over 65 has risen by 54 per cent. Without prompt treatment, the mortality rate for classic heatstroke reaches 80 per cent, whilst that for exertional heatstroke stands at 33 per cent. These figures also form the basis for the first document – drawn up by Simeu, the Society of Emergency and Urgent Medicine – which sets out the steps required to tackle the problem.

One chapter of the Position Paper is devoted to the review of long-term treatment in older people, where daily medication acts as a factor that exacerbates harm during heatwaves. Another crucial objective is to overcome disparities in treatment, which is why Simeu is calling for the ‘Heat Protocol’ to be incorporated into the Ministry’s guidelines for the summer months, so as to address regional inconsistencies. The scientific society has reiterated its willingness to collaborate with the Ministry of Health to incorporate the contents of the ‘Heat Protocol’ into the operational ministerial guidelines for the summer months and to promote its widespread adoption nationwide. ‘The issue is not one of expertise, which is certainly present in our A&E departments,’ notes Mario Guarino, vice-president of Simeu and director of Emergency Medicine at the CTO Hospital in Naples. “The key issue is consistency. A patient suffering from heatstroke must receive the same care pathway and be treated within the same timeframes wherever they are. The document is ready, and so is our willingness to work on it together with the relevant institutions.”

The document sets out a specific operational target: a core temperature below 39 degrees within thirty minutes of diagnosis, with cooling to begin at the scene rather than on arrival at hospital. ““Heatstroke is a time-sensitive emergency, just like a heart attack or a stroke, but there is still no network in place to treat it as such,” Guarino adds. “The therapeutic objective is to bring the core body temperature below 39 degrees within thirty minutes of diagnosis. This means that cooling must begin on site, before transport, not on arrival at A&E.”

The ‘Heat Response Plan’ is structured around four operational strands. The first is a dedicated, fast-track triage process, using clinical and epidemiological criteria to identify at-risk patients early on, from the moment they first present: the elderly, frail individuals, patients with chronic conditions, and exposed workers. Secondly, standardised clinical and care protocols are required for the immediate management of heatstroke, severe dehydration and the exacerbation of pre-existing conditions. Thirdly, integration is required between the hospital network and the local healthcare network, with information flows and secure discharge pathways to primary care and home care services. Finally: the preparation and reallocation of resources during critical periods, with criteria for the emergency mobilisation of staff and observation areas in response to weather and climate alerts.

The document sets out specific standards: rectal temperature measurement as the only reliable method for determining core temperature; early active cooling, to be halted at 38.6 degrees to prevent the ‘afterdrop’ phenomenon; a ban on antipyretics; specific equipment for ambulances during the period 1 May to 30 September; annual training for 118 staff; A&E, and short-stay intensive and semi-intensive observation units, to be completed by 30 April.