A 53-year-old diabetic man who has been mowing in the heat for 3 hours is confused with hot, moist skin and hypotension. What should you do?

• A. Place him in a sitting position and have him drink 1 L of water.
• B. Perform a head-to-toe assessment and look for signs of trauma.
• C. Administer one tube of oral glucose and reassess his mental status.
• D. Load him into the ambulance and begin rapid cooling interventions.

Answer: (D)

When the body’s temperature climbs and the person is confused or disoriented, the most important action is to start rapid cooling and get to hospital care quickly. This presentation—heat exposure, altered mental status, hot skin, and low blood pressure—points to a heat illness that can rapidly progress to heat stroke. The fastest way to reduce the risk of organ damage is to lower core temperature as quickly as possible, so loading him into the ambulance and initiating aggressive cooling in the field is the correct priority. This may involve removing clothing, transferring to a cooler environment, and using methods such as ice packs to the neck, armpits, and groin, or immersion in cold water if available, while you monitor him and prepare for transport.

Giving water orally isn’t appropriate when the patient is confused and may have impaired swallowing or airway protection, and it won’t reverse the dangerous hyperthermia quickly enough. A full head-to-toe assessment is important, but delaying cooling to perform it would miss the immediate life-saving intervention. Administering oral glucose won’t address the underlying heat injury or mental status change.