A 52-year-old female lives in a home without air conditioning. It has been hot for six days. Her skin is hot to touch, and she babbles when she speaks. Before transporting her, you should:

• A. Fan her and transport with AC on full strength
• B. Have her drink electrolytes
• C. Cover her head and face with ice soaked towels
• D. Make every effort to rapidly cool her off

Answer: (D)

Rapid cooling is the priority because this presentation fits heat stroke, a medical emergency where CNS dysfunction plus very high body temperature must be addressed immediately. The goal is to lower core temperature as fast as possible before transport. In the field, that means removing excess clothing and employing aggressive cooling—such as ice packs to the groin and armpits, or rapid evaporative cooling with water mist and fans—while you arrange transport. Giving oral electrolytes isn’t appropriate with altered mental status and won’t rapidly reduce temperature, and focusing on ice towels to the head alone is not as effective and can hinder overall cooling. So, act now to rapidly cool her off, then continue transport with continued cooling and monitoring.