BC Emergency Health Services has revised its guidelines for treating heat exhaustion, calling on ambulance paramedics to immediately immerse patients in cold water before transporting them to hospital.
Ambulance paramedic Sara Kendall authored the new hyperthermia treatment guidelines, released last month, after realizing they were out of sync with international medical consensus.
“I realized that our treatment guidelines were out of date — they were wrong,” said Kendall.
The new guidelines begin with a warning to first responders that the frequency and intensity of extreme heat events will grow “as climate destruction worsens these phenomena.”
At 40 C, the human body starts to cook — you begin to lose cells in your brain, liver and blood vessels.
“That will send somebody into multi-system organ failure really fast,” said Kendall, who is also trained as a medical doctor though not yet certified in Canada.
While the early signs of hyperthermia, like heat cramps and nausea, call for oral electrolytes and rest in a well-ventilated or shady place, heat exhaustion or heat stroke requires immediate cooling.
Instead of transporting a patient with full-blown hyperthermia to hospital, the new BCEHS guidelines call on emergency medical personnel to remove all clothing from their patient and immediately immerse their entire body in a lake, swimming pool or ocean. If a home, the guidelines recommend full-body immersion in a cold water bath with ice.
Other options include sitting the patient down under a high-flow cold water shower, or in an outdoor situation, Kendall recommended lifting the ends up of a tarp and sloshing a patient around in a mix of cold water and ice — “like a slushy.”
If paramedics have access to water on scene, that means spending a minimum of 10 to 15 minutes trying to cool the patient before moving them.
“It’s the exact same treatment whether you're a highly trained critical care paramedic, emergency doc or a person with their friend at home,” said Kendall.
Kendall says updated guidelines lean on medical consensus built through clinical experience in places like India and the United States, where heat waves are more common.
She hopes that one day ambulances in B.C. will have coolers of ice to help cool patients on scene.
And while Kendall says she recognizes it takes time to make those kinds of infrastructure upgrades — especially when a region is only now adjusting to the realities of longer and more powerful heat waves — getting out the right kind of medical advice to the public can happen now.
Public needs to know what to do
Kendall said she’s “devastated” the province hasn't adjusted their public messaging to reflect medical consensus around the treatment of heat exhaustion.
As the new guidelines filter down to her ambulance paramedic colleagues, Kendall says public officials like Health Minister Adrian Dix and Provincial Health Officer Dr. Bonnie Henry need to step up and be direct with the public on how to treat heat illness.
“Use the television and use the radio and tell the people what they need to know, which is basically just go get yourself into water and that will save everyone's lives,” she said.
In a recently released guide on how to do in-person and remote health checks during extreme heat events, advice on how to cool a person experiencing severe heat-related illness is limited to applying cold towels and ice packs to the body.
Taking a cool shower or bath to reduce body temperature only appears at the end of the document, a complete reversal of the priorities given to paramedics.
The guide was among several resources shared last month by the BC Centre for Disease Control to help the public navigate an extreme heat event.
“It’s one thing for a paramedic to know what they're doing or an ER doc to know what they're doing. But the problem with the heat wave is that it's affecting every member of the population simultaneously,” said Kendall. “Even if we were the best staff service in the world (which everybody knows we're not), we still wouldn't be able to know who and in what apartment building (people are) dying.
"We need community, we need each other.”
'Transport is sometimes the best treatment'
Jennifer Baumbusch, a professor in School of Nursing at the University of British Columbia researching the effects of extreme temperatures on older adults, says she agrees full-body cold water immersion should receive more public attention.
She says it makes sense for a support person to call 911 and then, while they’re waiting for an ambulance, help someone with severe heat illness into a bath of cold water.
“When we look at the infographics that are out, it really starts with the least invasive interventions, and kind of at the bottom, it's almost like a little footnote, that, ‘get yourself into the really cold bath if you're experiencing severe heat-related illness,” she said.
“We need a way to kind of pop that up and get closer to the top.”
But Baumbusch also worries that messaging could be dangerous if people are alone and try to get into a cold bath — heat illness can cause someone to pass out, at which point the risk of drowning becomes real.
She says during a medical emergency, prioritizing a cold bath could delay a call to emergency services.
“That's why really needs to be clear: Contact emergency services. Get into the cold bath,” said Baumbusch
But first, she said, “We need to regrow confidence in our emergency services, and that was really wiped out last year during the heat dome.”
Not everyone agrees that the new BCEHS guidelines should be widely adopted by ambulance paramedics.
Ian Tait, an ambulance paramedic from Chilliwack, B.C., said he had never heard of the updated hyperthermia guidelines until they were pointed out by this reporter.
“It hasn't been disseminated to the crews, or the crews have seen it and are completely ignoring it because it's nonsense,” he said.
Tait, who says he “witnessed the collapse” B.C.’s emergency health system during last year’s heat dome, was skeptical that the updated guidelines could be realistically followed.
“If a little old lady collapses in front of the bank, [BCEHS guidelines] realize I’m not going to hose her down with a hose and a tarp on the sidewalk, especially if the hospital's six minutes away,” he said.
“Sitting on scene a lot of the time is a delay of a definitive care… transport sometimes is the best treatment.”
Submersion requires 'medical training'
Glacier Media asked the Ministry of Health whether it will be updating its public messaging to reflect the changes made in the BCEHS guidelines.
In an email, a spokesperson for the Ministry of Health said submersing a patient suffering severe heat stroke “requires medical training and teamwork to ensure safety.”
That’s why the ministry directs the average British Columbian to wellness checks to ensure the health of friends, neighbours and family, he said.
“In these events, it is recommended that members of the general public call 911 and provide other helpful cooling measures, such as the use of wet towels and/or ice packs,” wrote the spokesperson.
“If someone is suffering from mild to moderate heat-related illness such as heat exhaustion, taking cool baths, if they are able, is one of many ways to cool down.”