NEW 2025 — Recognized as a distinct medical emergency with high mortality. Aggressive early intervention required.
Steps by Cert Level
AEMT: Recognize ExDS: hyperthermia, profound agitation, diaphoresis, tachycardia, combativeness, apparent superhuman strength. Immediate notification of medical control. IV access. Active cooling measures (wet towels, fan).
PARAMEDIC: Chemical sedation IMMEDIATELY — do not delay: Ketamine 4mg/kg IM (preferred). Droperidol 5mg IM alternative. Secure airway post-sedation. NS 500mL IV bolus. 12-lead ECG — ExDS associated with dysrhythmias. Cardiac monitor throughout. High likelihood of respiratory compromise post-sedation — be ready to intubate.