Environmental Heat Conditional Protocol Summary

This protocol has been developed by the medical staff to reflect standing orders for care of athlete’s experiencing signs and symptoms of exertional heat illness.  This protocol is a summary drawn from the team’s comprehensive emergency action plan, and is intended to summarize the medical team’s preparation for and initial response to the identified condition.  This protocol summary is intended to serve only as a guideline.  The following procedures are not intended to substitute for prudent autonomous medical decision-making required during actual care and management of a sick or injured individual.  Please see the comprehensive emergency action plan for a formal write-up and reference material.  

Preparation and Readiness Planner

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Emergency Management Checklist

BLS Supplies   ALS  Considerations   Protocol Specific Supplies
  • AED
  • BVM ventilator
  • Seal Quick™ resuscitator mask
  • Magill forcepts
  • Suction pump
  • Oxygen
  • Non-rebreather mask
  • Heart rate / blood pressure monitor
  • Pulse-oximeter
  • Latex free gloves

Cool First, Transport Second!

  • Athlete should not be taken out of cold water immersion until rectal temperature falls to 102°F
  • Cooling tub / tarp;
  • Water & ice source;
  • Cooling fans;
  • Ice towels;
  • Heat Illness Emergency Kit, including:
    • Scissors
    • Rectal thermometer and probes
    • KY jelly
    • Nylon tape / duct tape
    • Extra batteries
    • Ziploc bags
    • Tarp
    • Sheet
    • Towels
    • Gatorade
  • Heat Kit Con’t
    • Water
    • Flexible straws
    • Gatorlytes
    • Bars / Energy Chews
    • IV bags / set‐up (2)
    • IV push
    • CWI Cooling rates chart (laminated)
    • “Hyperthermia Code” Card
    • Sharpie
    • Note pad
    • Pen(s)


Management Algorithm

Critical Content Overview
Heat Index
Risk Level
Prevention Measures
< 65° F
Individual predisposing factors may influence potential for onset of heat illness.
66° – 73° F
Risk level will increase as physical activity continues or intensity increases.  Consume about 12-24 oz of water per hour.  Rest about 1o min every hour.
73° – 82° F
Moderate / High
Alert all participants to the potential risk, particularly those who might be a greater risk. Consume about 12-24 oz water per hour.  Rest about 10 min every hour for light workouts and 20 min per hour for more intense workouts.
82° – 99° F
Consider rescheduling or delaying event; schedule additional rest and hydration breaks; limit or restrict activity for high risk athletes; vigilant surveillance. Consume about 36-48 oz water per hour.  Rest at least 20 min per hour.
>99° F
Consider rescheduling event until risk level is lower; allow participants addition time to hydrate and eat prior to beginning event; restrict activity for high risk participants; schedule additional rest and hydration breaks; vigilant surveillance. Consume about 36-48 oz water per hour.  Rest at least 40 min per hour.


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