Quick Chart
  • Heat stroke is an excessive elevation of core body temperature above the normal range due to failure of thermoregulation
  • Heat stroke can be induced by:
    • Environmental factors, such as excessive heat absorption, hot and humid climates, excessive physical exertion
    • Intrinsic factors, such as metabolic reactions, drugs, infection
  • Heat stroke should be suspected if symptoms do not dissipate when the affected person lies down and rests
 Clinical Presentation
  • Signs of an altered mental state or consciousness, including but not limited to, inability to co-ordinate movement, slurred speech, coma or seizure, in circumstances or settings potentially conducive to hyperthermia.
 Exclusion Criteria
Exclusion Criteria
 Risk Assessment
  • Consider using any facilities that are on scene (i.e. ice bath if available) to help rapidly cool the patient before transporting to hospital. (Immerse the patient up to their neck in the ice bath for up to 15 minutes).
  • In the initial stages of heat stroke, CNS dysfunction is observed. These are the first signs of thermoregulatory failure.
  • Improvements in the patients conscious state is the most promising sign that active cooling is working but may happen slowly.
  • The very young and very old are more prone to heat induced illness.
  • Tympanic temperature readings may not provide a true representation of a patient’s core body temperature in heat extremes.
  • Assess patients left in cars for heat induced illness.
  • Cardiac dysfunction and tachyarrhythmias generally resolve with cooling.
Primary Care
  • Primary Survey
    • When safe to do so, move the patient into a cool environment or shade.
    • Position patient supine if appropriate
  • Vital Sign Survey
    • Closely monitor patients temperature and BGL 
  • Consider Oxygen if indicated as per CPG
  • Provide water to drink if fully conscious
  • Apply critical treatment points:
    • STRIP clothing off patient.
    • SOAK or spray the patient with tepid water.
    • FAN the patient to promote heat loss.
    • IMMERSE the patient in an ice bath if available. If unavailable, apply ice packs to neck, groin and armpits.
    • COVER the patient with wet cold cloths and continue to fan.
    • Consider delaying transport to ensure the patient is adequately cooled (approximately 15 minutes).
    • Consider antiemetics.
    • Continue cooling the patient during transport to hospital.
    Intermediate Care
    • Apply cardiac monitor if trained and authorised
    • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
    • Transport Priority 1 if patient time critical, pre-notifying receiving facility
    Advanced Care
    • Apply cardiac monitoring
    • Establish vascular access
    • Consider fluid therapy (administering cool IV fluids if possible)
    • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
    • Transport Priority 1 if patient time critical, pre-notifying receiving facility
    Critical & Extended Care
    • As per Advanced Care guidelines
     Additional Information
    • Seizures are common in patients with heat stroke, manage as per Seizures CPG while active cooling occurs.
    Key Terms & Links
    Extended Care:
    Colour assist:


    Document Control

    Clinical Services

    Responsible Manager
    Head of Clinical Services


    Published Date

    Review Date

    Clinical Resources Website

    St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.

    Other users – Terms of Use

    The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.

    St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.

    St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website. 

    No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au

    Where links are provided to resources on external websites, St John WA:

    • Gives no assurances about the quality, accuracy or relevance of material on any linked site;
    • Accepts no legal responsibility regarding the accuracy and reliability of external material; and
    • Does not endorse any material, associated organisation, product or service on other sites.

    Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.

    To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).


    Please read this cookie policy carefully before using Clinical Resources from St John WA.

    The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.

    Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.

    If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.

    St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

    Terms of Use | Privacy Policy | Copyright Statement & Disclaimer