An Easy-to-Use Prehospital Indicator to Determine the Severity of Suspected Heat-Related Illness: An Observational Study in the Tokyo Metropolitan Area

Abstract

Rapid hospital arrival decreases mortality risk in heat-related illnesses. We investigated an easy-to-use indicator of life-threatening severity of heat-related illnesses in a community setting to enable quick hospitalization by using data extracted from prehospital transportation records of a database from 2016 that included information on the clinical severity of suspected heat-related illnesses in patients (n = 2528) upon hospital arrival. Patient-related risk factors (adjusted odds ratio, aOR [95% confidence interval, CI]) included age, vital signs, location of the patient, and illness severity, and respiratory rate (3.34 [1.80–6.22]), heart rate (2.88 [1.57–5.29]), axillary body temperature (7.79 [4.02–15.1]), and consciousness level (38.3 [5.22–281.1]) were independent risk factors for heat-related illness severity. On-site blood pressure was not an independent factor for illness severity. Heart rate > 120 beats/min, respiratory rate > 24 breaths/min, and temperature > 38.6 °C (highest areas under the receiver operating characteristic curves [95% CI]: 0.80 [0.75–0.87]; 0.73 [0.67–0.81]; and 0.83 [0.77–0.91], respectively) predicted life-threatening illness severity. Changes in the vital signs of patients with heat-related illnesses, particularly tachycardia and tachypnea, constitute sensitive, easy-to-use indicators that facilitate rapid identification of severity by laypersons and transport of patients before aggravation to a life-threatening situation.

Keywords

• heat-related illness
• heatstroke
• prehospital care
• prevention
• severity