DISASTER MEDICINE No. 1 •2026

https://doi.org/10.33266/2070-1004-2026-1

Review article

Heat Illness: a Review of Current First Aid Guidelines

Birkun A.A. 1,2

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1 Medical Institute named after S.I.Georgievskiy of V.I.Vernadskiy Crimean Federal University, Simferopol, Russian Federation

2 Crimean Republican Center of Disaster Medicine and Emergency Medical Services, Simferopol, Russian Federation

UDC 616-001.16:614.88(048.8)

P. 66-73

 

Summary. The purpose of this study was to review international scientific evidence and practical recommendations on first aid (FA) for heat illness.
Materials and methods of research. In June 2025, a search was conducted for scientific articles on the topic of providing FA for heat illness, as well as international and national guidelines on FA containing provisions concerning heat illness. The search was carried out without restrictions on the year of publication in Russian and English across the eLIBRARY.RU, PubMed, and Google Scholar databases, as well as using the Google search engine.
Research results and their analysis. The article presents an overview of modern principles and methods of providing FA in various forms of heat illness, including heat cramps of skeletal muscles, heat oedema of the extremities, heat syncope, heat exhaustion and life-threatening heat stroke. The methods of passive and active cooling of the body (including immersion and dousing of the body with ice-cold, cold or cool water, immersion of hands and feet in cold water, application of ice packs, ice sheets or towels, fanning, evaporative cooling), approaches to thermometry, and hydration are considered. Attention is paid to the issue of normative and legal regulation of the provision of FA for heat illness. The predicted increase in the number and intensity of heat waves determines the need to form a unified, effective organizational basis for the provision of FA in heat illness. The priority task is to develop and approve lists and sequences of measures to provide FA in case of heat illness, taking into account the best evidence-based principles and methods.

Key words: emergency care, first aid, heat cramps, heat exhaustion, heat illness, heat syncope, heat stroke, hyperthermia, overheating, sunstroke

For citation: Birkun A.A. Heat Illness: a Review of Current First Aid Guidelines. Meditsina Katastrof = Disaster Medicine. 2026;1:66-73 (In Russ.). doi: 10.33266/2070-1004-2026-1-66-73

 

СПИСОК ИСТОЧНИКОВ / REFERENCES

  1. Bunting E.L., Tolmanov V., Keellings D. What is a Heat Wave: A Survey and Literature Synthesis of Heat Wave Definitions Across the United States. PLOS Climate. 2024;3;9:e0000468.
  2. Zhao Q., Guo Y., Ye T., et al. Global, Regional, and National Burden of Mortality Associated with Non-Optimal Ambient Temperatures from 2000 to 2019: a Three-Stage Modelling Study. Lancet Planet. Health. 2021;5;7:e415– e425.
  3. Mason H., King J.C., Peden A.E., Franklin R.C. Systematic Review of the Impact of Heatwaves on Health Service Demand in Australia. BMC Health Serv. Res. 2022;22;1:960.
  4. Hosseinzadeh A., Aghababaeian H., Ostadtaghizadeh A., et al. Pre-Hospital Emergency Medical Dispatches Following Heat Waves: a Systematic Review Study and Meta-Analysis. J. Therm. Biol. 2025;129:104086.
  5. Robine J.M., Cheung S.L.K., Le Roy S., et al. Death Toll Exceeded 70,000 in Europe during the Summer of 2003. C. R. Biol. 2008;331;2:171–178.
  6. Knowlton K., Rotkin-Ellman M., Geballe L., et al. Six Climate Change-Related Events in the United States Accounted for about $14 Billion in Lost Lives and Health Costs. Health Aff. (Millwood). 2011;30;11:2167–2176.
  7. Maksimenko M., Timonin S., Shartova N., Varentsov M. Urban–Rural Differences in Mortality during the 2010 Heatwave in European Russia. Vienna Yearbook of Population Research. 2024;2024:1–23.
  8. Hayashida K., Shimizu K., Yokota H. Severe Heatwave in Japan. Acute Med. Surg. 2019;6;2:206–207.
  9. Domeisen D.I.V., Eltahir E.A.B., Fischer E.M., et al. Prediction and Projection of Heatwaves. Nat. Rev. Earth Environ. 2023;4;1:36–50.
  10. Sheludkov A., Vinogradova V. Population Exposure to Heat Waves in Russian Regions According to Climate Change Scenarios for the Mid-21 Century. GeoJournal. 2024;89;2:47.
  11. Eifling K.P., Gaudio F.G., Dumke C., et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness Environ. Med. 2024;35;1_suppl:112S–127S.
  12. Sorensen C., Hess J. Treatment and Prevention of Heat-Related Illness. N. Engl. J. Med. 2022;387;15:1404–1413.
  13. Byrne C., Lee J.K.W., Chew S.A.N., et al. Continuous Thermoregulatory Responses to Mass-Participation Distance Running in Heat. Med. Sci. Sports Exerc. 2006;38;5:803–810.
  14. Douma M.J., Aves T., Allan K.S., et al. First aid Cooling Techniques for Heat Stroke and Exertional Hyperthermia: a Systematic Review and Meta-Analysis. Resuscitation. 2020;148:173–190.
  15. Leon L.R., Helwig B.G. Heat Stroke: Role of the Systemic Inflammatory Response. J. Appl. Physiol. (1985). 2010;109;6:1980–1988.
  16. Romanello M., McGushin A., Di Napoli C., et al. The 2021 Report of the Lancet Countdown on Health and Climate Change: Code Red for a Healthy Future. Lancet. 2021;398;10311:1619–1662.
  17. Epstein Y., Yanovich R. Heatstroke. N. Engl. J. Med. 2019;380;25:2449–2459.
  18. Roberts W.O., Armstrong L.E., Sawka M.N., et al. ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity. Curr. Sports Med. Rep. 2023;22;4:134–149.
  19. Yezli S., Yassin Y., Ghallab S., et al. Classic Heat Stroke in a Desert Climate: a Systematic Review of 2632 Cases. J. Intern. Med. 2023;294;1:7–20.
  20. Lim C.L. Heat Sepsis Precedes Heat Toxicity in the Pathophysiology of Heat Stroke – a New Paradigm on an Ancient Disease. Antioxidants (Basel). 2018;7;11:149.
  21. Argaud L., Ferry T., Le Q.H., et al. Short- and Long-Term Outcomes of Heatstroke Following the 2003 Heat Wave in Lyon, France. Arch. Intern. Med. 2007;167;20:2177–2183.
  22. Kanda J., Nakahara S., Nakamura S., et al. Association between Active Cooling and Lower Mortality among Patients with Heat Stroke and Heat Exhaustion. PLoS One. 2021;16;11:e0259441.
  23. Filep E.M., Murata Y., Endres B.D., et al. Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review. Medicina (Kaunas). 2020;56;11:589.
  24. Гамбурцев А.Г., Сигачёв А.В. Динамика вызовов скорой помощи Москвы за последние пять лет // Вестник Российской академии наук. 2012. Т.82. № 5. С. 415–424. [Gamburtsev A.G., Sigachov A.V. Dynamics of Ambulance Calls in Moscow over the Past Five Years. Vestnik Rossiyskoy Akademii Nauk = Herald of the Russian Academy of Sciences. 2012;82;5:415–424 (In Russ.)].
  25. Smith D.J., Ferranti E.P., Hertzberg V.S., Mac V. Knowledge of Heat-Related Illness First Aid and Self-Reported Hydration and Heat-Related Illness Symptoms in Migrant Farmworkers. Workplace Health Saf. 2021;69;1:15–21.
  26. Razzak J.A., Agrawal P., Chand Z., et al. Impact of Community Education on Heat-Related Health Outcomes and Heat Literacy among Low-Income Communities in Karachi, Pakistan: a Randomised Controlled Trial. BMJ Glob. Health. 2022;7;1:e006845.
  27. Рябова И., Соболевская Т., Нежкина Н. и др. Оценка компетентности учителей города Москвы в вопросах оказания первой помощи обучающимся // Вестник МГПУ. Серия: Педагогика и психология. 2017. Т.40. № 2. С. 24–37 [Ryabova I.V., Sobolevskaya T.A., Nezhkina N.N., et al. Assessment of Competence of Teachers of Moscow in the Issues of Provision of First Aid to Students. Vestnik MGPU. Seriya: Pedagogika i Psikhologiya = MCU Journal of Pedagogy and Psychology. 2017;40;2:24–37 (In Russ.)].
  28. Hewett Brumberg E.K., Douma M.J., Alibertis K., et al. American Heart Association and American Red Cross Guidelines for First Aid. Circulation. 2024;150;24:e519– e579.
  29. Pellegrino J.L., Charlton N.P., Carlson J.N., et al. American Heart Association and American Red Cross Focused Update for First Aid. Circulation. 2020;142;17:e287–e303.
  30. Eichner E.R. The Role of Sodium in ‘Heat Cramping’. Sports Med. 2007;37;4–5:368–370.
  31. Zarisfi F., Pek J.H., Oh J.H.H., et al. Singapore First Aid Guidelines 2021. Singapore Med. J. 2021;62;8:427–432.
  32. Lugo-Amador N.M., Rothenhaus T., Moyer P. Heat-Related Illness. Emerg. Med. Clin. North Am. 2004;22;2:315–327.
  33. Wyckoff M.H., Greif R., Morley P.T., et al. International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2022;146;25:e483–e557.
  34. Singletary E.M., Zideman D.A., Bendall J.C., et al. International Consensus on First Aid Science with Treatment Recommendations. Circulation. 2020;142;16_suppl_1:S284–S334.
  35. Olasveengen T.M., Semeraro F., Ristagno G., et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation. 2021;161:98–114.
  36. Panchal A.R., Bartos J.A., Cabañas J.G., et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142;16_suppl_2:S366–S468.
  37. Zideman D.A., Singletary E.M., Borra V., et al. European Resuscitation Council Guidelines 2021: First aid. Resuscitation. 2021;161:270–290.
  38. McDermott B.P., Casa D.J., Ganio M.S., et al. Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: a Systematic Review. J. Athl. Train. 2009;44;1:84–93.
  39. Casa D.J., McDermott B.P., Lee E.C., et al. Cold Water Immersion: the Gold Standard for Exertional Heatstroke Treatment. Exerc. Sport Sci. Rev. 2007;35;3:141–149.
  40. Cong S., Zheng G., Liang X., et al. Pre-Hospital Cooling in Community-Acquired Heat Stroke (CAHS): Evidence, Challenges, And Strategies. Eur. J. Med. Res. 2025;30;1:472.
  41. Ito C., Takahashi I., Kasuya M., et al. Safety and Efficacy of Cold-Water Immersion in the Treatment of Older Patients with Heat Stroke: a Case Series. Acute Med. Surg. 2021;8;1:e635.
  42. Hosokawa Y., Adams W.M., Belval L.N., et al. Tarp-Assisted Cooling as a Method of Whole-Body Cooling in Hyperthermic Individuals. Ann. Emerg. Med. 2017;69;3:347–352.
  43. Kim D.A., Lindquist B.D., Shen S.H., et al. A Body Bag Can Save Your Life: a Novel Method of Cold Water Immersion for Heat Stroke Treatment. J. Am. Coll. Emerg. Physicians Open. 2020;1;1:49–52.
  44. Comp G., Pugsley P., Sklar D., et al. Heat Stroke Management Updates: a Description of the Development of a Novel In-Emergency Department Cold-Water Immersion Protocol and Guide for Implementation. Ann. Emerg. Med. 2025;85;1:43–52.
  45. Phan S., Lissoway J., Lipman G.S. Chemical Cold Packs May Provide Insufficient Enthalpy Change for Treatment of Hyperthermia. Wilderness Environ. Med. 2013;24;1:37–41.
  46. Lissoway J.B., Lipman G.S., Grahn D.A., et al. Novel Application of Chemical Cold Packs for Treatment of Exercise-Induced Hyperthermia: a Randomized Controlled Trial. Wilderness Environ. Med. 2015;26;2:173–179.
  47. Биркун А., Григорьев П., Миннуллин И. и др. Принципы и методы дистанционного консультирования исполнителей первой помощи на месте происшествия специалистами скорой медицинской помощи: Метод. рекомендации / Под ред. Багненко С.Ф., Дежурного Л.И. М.: НТ Центральный НИИ организации и информатизации здравоохранения МЗ РФ, 2024. 60 с. [Birkun A.A., Grigor’yev P.R., Minnullin I.P., et al. Printsipy i Metody Distantsionnogo Konsul’tirovaniya Ispolniteley Pervoy Pomoshchi na Meste Proisshestviya Spetsialistami Skoroy Meditsinskoy Pomoshchi = Principles and Methods of Remote Consultation of First Aid Providers at the Scene of an Incident by Emergency Medical Specialists. Ed. S.F.Bagnenko, L.I.Dezhurnyy. Methodological Recommendations. Moscow, NT i Tsentral’nyy NII Organizatsii i Informatizatsii Zdravookhraneniya MZ RF Publ., 2024. 60 p. (In Russ.)].

 

The material was received 30.07.25; the article after peer review procedure 16.02.26; the Editorial Board accepted the article for publication 16.03.26