In a heat-related illness with altered mental status, which action is most appropriate before transport?

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

Answer: (C)

Rapid cooling is the priority when a heat-related illness presents with altered mental status, because this scenario often indicates heat stroke with risk of brain injury and organ damage. The immediate goal is to bring the body's temperature down as quickly as possible before transport. Use active cooling right away—evaporative cooling by spraying water and fanning, or applying ice packs to areas with large vessels like the groin, armpits, and neck if available—while monitoring the patient and staying safe. This approach directly reduces core temperature and addresses the life-threatening aspect of heat stroke.

Waving with a fan and blasting air conditioning alone doesn’t normalize core temperature fast enough in a patient with AMS. Having the patient drink electrolytes isn’t appropriate when mental status is impaired due to the risk of choking or aspiration, and it doesn’t address overheating. Focusing cooling on the head with ice-soaked towels misses the more effective whole-body cooling and can be uncomfortable or impractical in the field.