Environmental

Heat exhaustion at summer music festival

Foundation

Adult · 35yr · female

Patient Information

Dispatch	A 35YO female has been brought to the FAP by friends. She is dizzy, sweaty, and feels like she is going to pass out. (Sophie Meredith)
Patient	Sophie Meredith — 35yr (65kg)
Incident History	Pt has been at an outdoor music festival since 10am. It is now 2pm and approx 36°C. She has been dancing and drinking alcohol. Friends say she complained of a headache and nausea then started to look pale and unsteady.
Emergency Contact	Claire Meredith (Sister) — 0412 774 053

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstructions. Nil airway swelling or stridor.
Breathing	Slightly increased respiratory rate. Nil audible wheeze or crackles. Able to speak in full sentences.
Circulation	Rapid and weak radial pulse. Skin pale, cool and diaphoretic. No external bleeding.
Disability	GCS 15 (E4V5M6). Oriented to time, place and person. Complaining of headache and dizziness.
Exposure	No rashes or visible injuries. Skin is pale and clammy. No evidence of sunburn.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Nil	22	112	98/64	3s	15	4 4 ++	38.2	4.8 mmol/L	4
10 mins	99% (RA)	Nil	18	96	108/70	<2s	15	4 4 ++	37.6	4.8 mmol/L	2

History Taking

Treatment Response

Diagnosis

This patient is suffering from heat exhaustion secondary to prolonged exertion in a hot environment with inadequate fluid intake and alcohol consumption.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not move the patient to a cool/shaded area within the FAP promptly, the facilitator should advise that the patient says she feels worse and her skin is becoming hot and dry — prompt reassessment of temperature.)
! (If the trainee does not encourage oral fluids for the conscious patient, the patient's heart rate remains elevated at 10 minutes and she reports increasing dizziness.)
! (If the trainee does not reassess GCS and temperature at 10 minutes, the facilitator should state the patient is becoming more confused and irritable — prompt consideration of heat stroke progression.)
! (If cooling measures — removing excess clothing, applying cool water, fanning — are not initiated, the patient's temperature rises to 38.8°C at 10 minutes and GCS drops to 14.)

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — confirm patent airway, adequate breathing, and circulation.
3. Move patient immediately to a cool, shaded environment within or near the FAP.
4. Position patient supine with legs slightly elevated if tolerated (to assist venous return given symptomatic hypotension) — reassess tolerance.
5. Perform Vital Sign Survey — GCS, SpO2, RR, BP, HR, CRT, BGL, temperature.
6. Obtain IMISTAMBO-style history from patient and friends.
7. Initiate active cooling: STRIP — remove excess clothing (jacket, outer layers). SOAK — apply cool/tepid water to skin (spray bottle or damp cloths to neck, armpits, groin). FAN — use available fan or hand fanning to promote heat loss via evaporation. COVER — apply wet cool cloths and continue fanning.
8. Provide oral fluids (water or electrolyte drink) as patient is GCS 15 and fully conscious — encourage slow sips.
9. Monitor patient continuously — repeat full observations at 10 minutes, including temperature and GCS.
10. Reassess temperature at 10 minutes — if temperature rises and/or GCS deteriorates, escalate to suspected heat stroke management as per Heat Stroke CPG.
11. Do NOT administer Ondansetron at this time — nausea is mild and patient is not actively vomiting; reassess if vomiting commences.
12. Consider requesting ambulance transfer if patient does not improve within 15–20 minutes, GCS deteriorates, temperature exceeds 40°C, or patient develops altered conscious state consistent with heat stroke.
13. Scenario ends on arrival of ambulance and IMISTAMBO handover.
14. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Heat Stroke

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Signs/Symptoms	Headache, dizziness, nausea, feeling weak and faint. Heavy sweating.
Allergies	Nil known drug allergies.
Medications	Oral contraceptive pill. No other regular medications.
Pertinent History	Nil significant past medical history. Non-smoker. Social drinker.
Last Oral Intake	Last ate a small meal at approximately 8am. Has been drinking alcohol (approx 3–4 standard drinks) and limited water since arriving at the festival.
Events Leading	Patient had been standing in direct sunlight and dancing for several hours in 36°C heat. She had not been drinking adequate water throughout the day.
Treatment Prior	Friends gave her one glass of water approximately 10 minutes ago.

Onset	Gradual onset over the past hour. Symptoms worsened in the last 20 minutes.
Pain	Throbbing headache frontal region.
Quality	Constant dull ache in head. Generalised weakness and fatigue.
Radiates	Nil
Severity	4/10