Heat stroke (>104°F + AMS) is a true emergency. Cool first, transport second.
Steps by Cert Level
ALL: Move to cool environment immediately. Remove excess clothing. Temperature > 104°F with AMS = heat stroke (not exhaustion) — begin aggressive cooling NOW.
EMT: Cooling: wet sheets + fanning, ice packs to groin/axilla/neck. Do NOT give fluids by mouth if AMS.
AEMT: IV NS cool fluids (if available). Cold IV fluid infusion (not ice cold — room temp or slightly cool).
PARAMEDIC: Continuous temperature monitoring. Benzodiazepine for shivering (shivering increases heat production). Monitor for rhabdomyolysis. Intubation if airway compromised. Stop cooling at 102°F to avoid overshoot.