Staying Safe In The Heat


“It’s so hot where we live and it seems that we have elderly people who suffer most when it gets hot and humid.  Is there anything I can do to stay cool myself and maybe even help someone who is having a heat related health problem?”


Melting in Florida

Dear Melting,

Benjamin Franklin once said “An ounce of prevention is worth a pound of cure.” This saying applies to many different health care related scenarios, heat related emergencies certainly not the least of them.

When staying safe and healthy in hot and humid weather it is important to understand what types of environments will put one at risk.

To get started, let’s take a look at how a heat index works.

A heat index combines air temperature with relative humidity as a way of determining how hot a person feels.  A person feels hotter in more humid climates because the moisture in the air does not allow one’s perspiration to carry the heat generated by the body away and evaporate as easily.  When the body cannot cool itself by perspiration and evaporation, the body’s temperature rises and one may feel less comfortable or may even lead to more serious heat related problem.

An example of what could take place in certain heat indexes are as follows:

  1. 80–90 °F  Caution — fatigue is possible with prolonged exposure and activity. Prolonged activity could result in heat cramps.
  2. 90-105 °F  Extreme Caution — heat cramps, and heat exhaustion are possible.  Prolonged exposure and activity could result in heat stroke.
  3. 105-130 °F  Danger — heat cramps, and heat exhaustion are likely; heat stroke is probable with continued activity.
  4. Over 130 °F Extreme danger — heat stroke is imminent.                                                                                                                                                                                               (Please note that these are shade values.  Exposure to direct full sunshine could increase these heat values by more than 10 degrees.) Closely paraphrased from the public domain article Heat Index on the website of the Pueblo, CO United States National Weather Service.

Most individuals can indeed acclimatize to heat which will help the body tolerate hotter conditions with less stress to the body.  This process for normal healthy individuals usually takes about 5 -7 days.  This should be done gradually and with a person maintaining good hydration.  A person is capable of sweating up to 2-3 gallons of water per day in hot conditions and cannot rely on the thirst drive in order to know when to drink.  During heavy sweating, a person should be drinking approximately 5-7 ounces every 15 minutes 20-30 ounces per hour in order to replenish lost fluids.  Valuable electrolytes such as sodium, calcium and potassium may be lost during heavy perspiration and should be replaced with proper nutrition and diet.

Those who are most vulnerable to these heat indexes include:

  • infants,
  • the elderly (often with associated heart diseases, lung diseases, kidney diseases, or who are taking medications that make them vulnerable to heat strokes),
  • athletes, and
  • outdoor workers physically exerting themselves under the sun.


Those who do not have means for escaping the heat.  Some examples of how to escape the heat include:

  1. Circulation of air by fan or ventilation,
  2. Accessing lakes, ponds or pools
  3. Air conditioning or subterranean cooling like a vegetable cellar or cool basement.
  4. In certain cases, placing ice bags under arm pits or around the neck or over other arteries like the wrists, ankles, top of head which may help in cooling core body temperatures.
  5. Cool or tepid bath water or a cool shower

If an individual does not have means of cooling and succumbs to the heat they may be suffering from heat fatigue, heat exhaustion or heat stroke.  Let’s take a look at each of these and how to treat each problem.

Definition Heat Fatigue: The signs and symptoms of heat fatigue may include heavy sweating, muscle weakness, tiredness, and impaired performance of skilled sensorimotor jobs.

Treatment:  Remove from heat, encourage water intake and good healthy nutrition and allow person to rest.  Allow person to acclimatize longer to increased heat environment.

Definition Heat Exhaustion: The signs and symptoms of heat exhaustion may include all of the above with the addition of heat cramps in legs, abdomen, back, calves and arms, headache, nausea, vomiting, dizziness, confusion and lethargy.

Treatment:  Remove from heat, encourage fluid intake, loosen clothing, poor water over persons body to soak clothing and begin cooling persons body. Monitor person for unresponsiveness, difficulty breathing or cardiac arrest.  If person is not improving with treatment or symptoms worsen, activate EMS or 911.  Heat exhaustion can become heat stroke if body temperature is not reduced.

Definition of Heat Stroke:   All of the above for heat exhaustion but usually progress to the following:

  • high body temperature
  • the absence of sweating, with hot red or flushed dry skin
  • rapid pulse
  • difficulty breathing
  • strange behavior
  • hallucinations
  • confusion
  • agitation
  • disorientation
  • seizure
  • coma

Treatment: Remove person from source of heat, loosen clothing, begin cooling the person’s body safely as soon as possible in order to lower body temperature.  Nothing should be given by mouth once the person cannot drink safely on their own.  Activate EMS/911 and support with CPR and First Aid for life saving measures.

So, next time you’re planning a trip out into hot conditions, take a moment to check the heat index and formulate a plan for protecting, preventing and treating yourself and others who might fall to heat related emergencies.  Oh, and if you know someone who may be vulnerable to hot weather, see if you have an extra fan, or maybe even give them some tips on how to cool down right in their own home.  You could just find that you have some rescue hero in you too.

Shock and the Capillary Refill Test

In this RoyOnRescue Video Blog, a student had emailed Roy a question about explaining the Capillary Refill Test and how it may relate to determining if someone is suffering from shock.
Be sure to watch this episode of RoyOnRescue and learn a new trick that could either tell you if someone is going into shock, or that their hands are simply cold.
There are three main reasons why a person may have more than a 2 second capillary refill time:
1. Shock
2. Peripheral Vascular Disease
3. Hypothermia or cold hands
This slow capillary refill time of more than 2 seconds should only be an indication that we should check for other problems. Please don’t assume simply because someone has a slow cap. refill that they are going into shock. It is simply a quick and easy test to help point a first aider in the right direction and to tell us we should check for other issues.

Knitting Needles and Puncture Wounds?

Knitting Needles can be the source of warm mittens, cozy scarves and comforting winter sweaters.  They can also become sharp pointed weapons or injury causing spikes when fallen upon or when they are thrust into the face, neck, chest or abdomen due to a car accident or accidentally falling onto them.  In this RoyOnRescue episode, we take a look at the hidden danger of sharp pointed objects that usually remain harmless but when not respected and carried safely, they could cause great harm.  Learn about the dangers of pointed objects and how to keep knitting needles a source of pleasure not pain.

Giving CPR to People With Bleeding Chest Injuries

I received an email that I think we can all benefit from.

It read…

“Since most of the first aid measures for a no pulse, no breathing situation is immediate CPR, is it alright to do CPR if the victim has a wound on the chest that is bleeding profusely? This is not that I have seen this situation, but I like to think that if it happens I would know what to do!”
C. H.

That’s a great question C.   Sometimes it’s easy to get distracted by a serious traumatic injury and forget the basics and what needs to be done first in order to try and save the person’s life.  Or, we can look at a complicating injury such as a chest wound and think,  How am I going to do CPR on this person, there chest has a serious bleeding wound right where I’m going to give my compressions?

In this episode of RoyOnRescue we are going to look a proper treatment plan if we ever came across a person who had a serious chest injury and needed CPR.

Asthma Attack and No Medication!

One of the scariest feelings is not being able to breath.  This is exactly what is happening during a severe asthma attack.  I received an email from a person who stated that they have been trained in CPR and First Aid multiple times and though it covers the basics of asthma it never really talks about what to do in depth.  They gave me a scenario where a person may be having an asthma attack and EMS is quite some ways away.  What’s worse, there isn’t any medication for the asthma attack!  Now what?

In this episode we take a look at what asthma is, and how we can confidently handle it even if there isn’t any medications and EMS/911 is delayed.

Asthma Guide
Asthma Symptoms Training (Allergic Reactions)

Is Milk or Water Better For Treating Dehydration?

I received an email today asking if milk would be just as effective as water for rehydrating a two year old after they’ve been in the heat and lost fluids.   The research I found was eye-opening.

Here’s my reply to the email. The name and personal information was deleted for personal privacy.

Thank you for your question.

My original hunch that water is still the best home remedy for replenishing vital lost fluids still seems to be the general consensus for most medical professionals(Source).  But there is an interesting study that was done in the UK where skim-milk was used for re-hydration and the study revealed that based on urine output, the skim milk may have been better absorbed than any other liquid.(Source)

There was a study that showed that milk did not replace fluids as well as water because of the fat content found in all milk.  Probably why the above study calls for skim milk instead of 2% or Whole Milk.  Skim is the lowest fat content of all the options.

Let’s take a look at what the study found.

“It is likely that the presence of sodium along with a relatively large quantity of potassium (approximately 45 mmol/l) in milk accounts for the effectiveness of milk at restoring fluid balance following exercise-induced dehydration,” they said.

“The results suggest that milk is more effective at replacing sweat losses and maintaining euhydration than plain water or a commercially available sports drink following exercise-induced dehydration by approximately two per cent of initial body mass,” added the researchers.

“Given that hypohydration results in an increase in cardiovascular and thermoregulatory strain, and a reduction in exercise capacity in the heat, it is important to ensure that fluid losses accrued during exercise are replaced prior to the performance of a subsequent exercise bout,” they concluded.

Commenting on the research, Judith Bryans, director of The Dairy Council, said: “This study joins the growing volume of literature which suggests that skimmed milk is a natural and effective post exercise recovery aid. Drinking milk is not only a valuable way to re-hydrate the body but also provides an excellent source of energy, protein and a vast array of different vitamins and minerals essential to the good health of hardworking sportspeople and the population as a whole.”

In the UK, semi-skimmed, or half-fat milk, now accounts for 60 per cent of total milk sales. Skimmed milk is also growing in popularity, now accounting for a further 14 per cent of the total.

Source: British Journal of Nutrition
Volume 98, Pages 173-180
“Milk as an effective post-exercise rehydration drink”
Authors: S.M. Shirreffs, P. Watson, R.J. Maughan
What’s important to remember in all of this is that unless there is a situation where prevention is not possible, like being lost in the wilderness,  a plane crash, a disaster,  etc… prevention is the way to combat most of the de-hydration problems.  The goal is to have persons drink at least 8-12oz. of hydrating fluid every hour during hot temperatures and during exertion and replace what we lose whenever needed.

In order to recognize the symptoms of dehydration we should probably take a look at some of the symptoms.

Mild to moderate dehydration is likely to cause:

* Dry, sticky mouth
* Sleepiness or tiredness — children are likely to be less active than usual
* Thirst
* Decreased urine output — fewer than six wet diapers a day for infants and eight hours or more without urination for older children and teens
* Few or no tears when crying
* Muscle weakness
* Headache
* Dizziness or lightheadedness

Severe dehydration, a medical emergency, can cause:

* Extreme thirst
* Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
* Very dry mouth, skin and mucous membranes
* Lack of sweating
* Little or no urination — any urine that is produced will be dark yellow or amber
* Sunken eyes
* Shriveled and dry skin that lacks elasticity and doesn’t “bounce back” when pinched into a fold
* In infants, sunken fontanels — the soft spots on the top of a baby’s head
* Low blood pressure
* Rapid heartbeat
* Fever
* In the most serious cases, delirium or unconsciousness

Unfortunately, thirst isn’t always a reliable gauge of the body’s need for water, especially in children and older adults. A better barometer is the color of your urine: Clear or light-colored urine means you’re well hydrated, whereas a dark yellow or amber color usually signals dehydration.

Treating severe dehydration
Children and adults who are severely dehydrated should be treated by emergency personnel arriving in an ambulance or in a hospital emergency room, where they can receive salts and fluids through a vein (intravenously) rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do — something that’s essential in life-threatening situations.

Now that we know what dehydration looks like and the best way to treat it is to prevent it, how much water might be needed to prevent dehydration?

Let’s take a look.

Different Bodies, Different Needs
There are a multitude of factors that impact a person’s individual fluid needs – from concrete factors like age, weight, height, and genetic make-up, to more variable aspects like overall health, and environmental conditions. Given these differences, it is not hard to believe that each of us may have our own personal fluid requirement. So, while some people may in fact need eight glasses of water every day, chances are most do not. But, brace yourself – there is a very good chance that some of us actually need even more.

Eight is Just an Estimate
So, if eight isn’t the magic number for water needs, how do we actually know what we should be drinking? Unfortunately, there isn’t an easy answer. This is likely why the “8 x 8 rule” has been so popular simply because it made an otherwise complicated issue a little easier to manage. However, after careful review of the scientific literature, researchers from the University of Pennsylvania recently determined that there was no real basis for such a general recommendation. Regardless, given the fact that the average adult loses around 10 cups of water daily through their breath, sweat, feces, and urine, along with the estimate that most people meet 20% of their fluid needs through food; drinking 8 cups of water seems to be a pretty reasonable guideline. Still, it is just that – a guideline. Additional guidelines established by the Institute of Medicine take into account all beverages (including juices, coffee, tea, etc.) and suggest that men should drink approximately 13 cups of total fluid and women should drink around 9 cups of total fluid every day. Wow! And you were overwhelmed by 8?

Your Body Will Tell You What You Need
It is all a bit confusing. But, the good news is that your body does provide some clear indicators of what is best for you. Thirst is an obvious sign that your body needs more fluids, and a clear warning that you need to drink. But it isn’t always the most sensitive indicator, especially for older adults whose thirst mechanisms are not as sharp. This means that some older individuals don’t truly become thirsty until they are near dehydration. This can be dangerous because it is easier to prevent dehydration, than to try to catch up on fluids when you are already running low. A better means of assessing your fluid intake is through the color of your urine, with clear or pale yellow urine indicating a healthy fluid balance, and dark yellow or amber urine indicating dehydration. Another way of assessing your hydration status is simply by how you feel. Thirst, dizziness, confusion, fatigue, fever, and dry mouth are all symptoms of dehydration.

Water Works Wonders
You might be thinking, “What’s the big deal?” This seems to be a common response for most people, as we often take water for granted. That is of course until we are at a ball game or an amusement park, feeling parched, and our only option is to buy a four dollar bottle of water. Then, we realize just how valuable water can be! But, its value goes well beyond the amount that we shell out per bottle. The real wonder comes from all of the essential roles that water plays in the body including aiding with digestion, elimination, blood flow, and temperature regulation just to name a few. If you are not well hydrated, your body can’t work as efficiently, and you simply won’t be at your best.

Tips for Meeting Your Daily Water Needs
Although determining your fluid needs can be a bit of a challenge, actually meeting them doesn’t have to be. Here are a few tips:

* Fill a pitcher with 6-9 cups of water (based on you own personal needs) every night before going to bed and put it in the fridge to chill. When you wake up, start you day with a big glass of cold water, and continue drinking from the pitcher throughout the day until it is gone.
* Add slices of citrus fruit to your water (lemon, lime or orange) to give it a little extra flavor with no extra calories.
* Eat juicy foods like fruits and vegetables including melon, grapes, tomatoes, lettuce, and squash.
* Dilute juices and soda with 25% water, gradually increasing to 50% water as your taste buds adjust.
* Cool off beverages like coffee, lemonade, or tea with lots of ice cubes.
* Limit alcoholic beverages because they are diuretics and actually increase your fluid needs.

When the heat is on, make water your first choice. Instead of worrying about how many cups you should be getting, pay more attention to how you feel. By drinking regularly and staying ahead of thirst, you are sure to get the amount that is just right for you, no debate about it.

* Dan Negoianu and Stanley Goldfarb. Just Add Water. J Am Soc Nephrol. 2008; 19: 1041-1043.

* Mayo Clinic Staff. Water: How much should you drink every day? April 19, 2008. retrieved 7/21/08 LINK

* Mayo Clinic Staff. Dehydration. Jan. 3, 2007. retrieved 7/21/08 LINK

Well John,  I hope this helps.  As we move into the warmer months I’m sure that we will all need to remember some these tips on recognizing, treating and preventing dehydration.  And by the sounds of it, if you want to give your two year old skim milk because they like it more, and then follow that up with water, it appears that some research actually allows for that too!

Thanks for the great question and go fourth and rescue!

Best wishes,


Heat Exhaustion vs. Heat Stroke

In this RoyOnRescue, I reply to a question a student emailed me about how to recognize heat exhaustion and heat stroke and how to treat both.   If you ever wondered if a person was just “over heated” or if they might be in danger of suffering a life threatening heat stroke, you will want to watch this video blog reply.

In some parts of the country it doesn’t feel very hot but don’t be fooled…Summer is just around the corner.  Be ready and don’t allow you or someone you love to become a victim of Heat Stroke!

How to Deal With Death When CPR Doesn’t “Work”

This response was written after receiving an email from a person, who has a cousin that is a trained CPR provider and attempted to save their own father’s life with CPR but their father remained dead despite their efforts.  This person felt badly and didn’t know what to say to their cousin to help them not feel guilty or that their father’s death was in some way the rescuer’s fault.  I responded to them, and afterward, felt that my response may be helpful to others who have suffered or are suffering or asking themselves the question, “Was there more I could have done?”.   I hope that this response will be of help to anyone who may have feelings of failure or guilt as a result of their cpr efforts not ending in the survival of the patient.

Student’s Email Question:

(Paraphrased to protect students identity)

“My cousin has recently lost his dad and he is a trained CPR provider.  He tried CPR on him but it didn’t work. I was wondering if you had a way you deal with death if you could not save them. I just don’t know what to say to him or how to help him.  I’m the only one he is talking to and trusts. So not knowing how to help him bothers me.  If you would email me back that would be great.”

Dear Student,
One of the most important things to remember when providing CPR to anyone let alone a loved one, is that people who need CPR are already in a state of death.    When the person is not breathing and they don’t have a pulse strong enough to detect  with obvious signs of life, they are clinically dead.  From the point of clinical death, they are only a short distance from biological death, which is permanent.

One way of looking at the success of CPR, regardless of the outcome, helps me and I believe helps my students to be much more at peace with themselves.  The fact that your cousin’s Dad did not survive cardiac arrest has very little to do with the CPR given to him.  It’s important to remember that CPR, in and of itself does not save anyone’s life directly.  CPR is designed to “Buy Time”.  CPR only provides about 25% of the oxygen circulation that is required for someone to stay alive biologically.  CPR was never designed to be life support viewed as a way to keep people alive indefinitely, but rather to slow down the process of clinical death to biological death.  This is to provide a chance to intercept the patient with electrical therapy, advanced therapy and medications combined with CPR and time to fix the underlying problem which caused the person to die in the first place.

In my opinion what your cousin did, is give his Dad the best chance of survival possible if he was indeed going to survive.  Let’s look at clinical death as a heavy iron gate that is slowly dropping to the ground, and once closed the person is biologically or permanently dead.  CPR is like arms holding the heavy gate of possible survival open a bit longer.  Again, not stopping the progression of clinical death to biological death, but slowing it down so that if there is a chance of survival, they would have the greatest opportunity of slipping back through the gate available.  Eventually, the gate is going to close even if CPR is perfect.  As I said earlier, CPR in and of  itself is not enough to keep the human body alive.  But if the person is going to survive and the person needs more time, CPR buys the precious time required to make this a reality.

Now, it’s  important to remember a simple but powerful truth.  Everyone dies.  I have had patients that had everything go right in order for them to survive a cardiac arrest and they still remained dead despite our rescue efforts.   That day was their day to die and nothing that the cpr providers, paramedics, nurses or doctors did changed the outcome.  The CPR helped keep them viable long enough for the rescue and medical team to try and fix the underlying problem but the person remained dead.  I had to realize that as a professional rescuer and paramedic, everyone has a day to die.   It’s not my job to save everyone but it is my job to give everyone the best chance of  survival possible.  When I provided care to cardiac arrest patients, I provided care to them as if they were suppose to survive and didn’t give up hope unless they proved to me otherwise by not surviving.  It may be frustrating but we  just cannot know what day is the day a person is going to live or die until the outcome is evident.

I’m quite sure that no matter what I say, your cousin is really missing his Dad.  I don’t think there is any amount of explanation of science, death, dying and CPR that’s going to change that.   One thing I do know about what your cousin did the day he provided CPR for his Dad though, he showed others and his Dad how much he loved him.  How much he really cared.  Your cousin gave his Dad his own strength when his Dad didn’t have any of his own.  In my opionion, that’s one of the most loving and unselfish ways to tell a daddy goodbye.

May God bless your cousin and all hurting friends and family during these difficult times.


Roy Shaw, ProCPR, LLC

Roy Shaw

Surviving A Flood

Flooding causes many problems with people who experience them.  From drowning to hypothermia and fractures to contaminated drinking water.  In this episode, Roy talks about the massive flooding that has affected the Tennessee region and what types of injuries and illness floods can bring.

ABC News and Video of Tennessee Flood

RoyOnRescue Personal Message to Rescue Three Team

Hello Rescue Three and everyone who volunteers in order to form a life saving team of rescuers for the racers of the California high desert region.   I wanted to send a video reply to tell all of you how proud I am of your commitment to the racers and the welfare of everyone who participates in off-road sports.  It sounds like your team was founded back around 1976 and I’m sure that the founders are proud of the tradition you’re upholding.

I was made aware of your rescue team because of a question asked about Snake Bites and long response times due to rough terrain.   This was a great question and I believe that many other rescuers will benefit in some way from the information that was obtained by doing a blog on that topic.

In sending a video message reply in hopes that technology will bridge the distance gap and create a more face to face relationship for rescuers around the world.  I hope you find this video message a bit more personal and connecting.

Best wishes and keep up the great work.

Roy Shaw, EMT-Paramedic

Rescue Three Team Picture