heat stroke
Enable an AI agent to recognise suspected heat stroke, track thermal and neurological danger, and support timely emergency care and clinician-directed recovery.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
Researched by: Codex + Grok
Purpose and description
Enable an AI agent to recognise suspected heat stroke, track thermal and neurological danger, and support timely emergency care and clinician-directed recovery.
Heat stroke is a life-threatening failure of thermoregulation in which environmental and/or exertional heat load drives core body temperature typically to 40 °C or higher together with acute encephalopathy, and from which coagulopathy and multi-organ injury can follow if cooling is delayed.
It can be Flag a suspected episode for emergency escalation using recorded evidence and an applicable clinical protocol.; Assemble a handover containing exposure history, neurological changes, temperature methods and cooling timestamps.; Track whether cooling is occurring and highlight interruptions or missing reassessments.; Compare successive temperature and neurological observations without treating incompatible measurements as equivalent.; Link unresolved organ-injury assessments and clinician-issued activity restrictions to the episode..
Distinguishing features
Look for marked neurological dysfunction alongside heat exposure and hyperthermia; weakness or sweating alone does not establish heat stroke. [CDC Yellow Book](https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/heat-and-cold-illness-in-travelers.html)
Distinguish persistent neurological impairment from a brief heat-associated faint followed by rapid recovery when supine. [CDC Yellow Book](https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/heat-and-cold-illness-in-travelers.html)
Do not require dry skin: heat stroke can present with either dry skin or profuse sweating. [CDC NIOSH](https://www.cdc.gov/niosh/heat-stress/about/illnesses.html)
Check competing explanations for altered consciousness, particularly exercise-associated hyponatremia; serum sodium and the exposure and fluid-intake history help resolve that boundary. [CDC Yellow Book](https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/heat-and-cold-illness-in-travelers.html)
Scope
+ Evidence supporting, weakening or leaving uncertain recognition of heat stroke
+ Exertional and non-exertional heat exposure associated with the episode
+ Temperature and neurological observations with measurement context
+ Emergency escalation, cooling delivery and observed response
+ Episode-related organ injury, recovery and clinical clearance
- Heat exhaustion, heat syncope and dehydration as independent conditions
- Weather systems, heatwave forecasts and workplace heat-risk programmes
- The person's complete medical history and medication records
- Independent models of renal failure, liver failure, rhabdomyolysis and coagulopathy
- Cooling-device engineering and emergency-service operational management
Characteristics
- Recognition status
- suspected | clinician-confirmed | disputed | ruled-out Separates emergency suspicion from an attributed clinical diagnosis.
- Exposure phenotype
- exertional | non-exertional | mixed | undetermined Preserves the circumstances of heat accumulation without inferring subtype from age or fitness alone.
- Temperature observation
- °C or °F, with timestamp, anatomical site, device and cooling already received Makes temperature evidence interpretable across methods and intervention stages.
- Neurological condition
- baseline | confusion | abnormal behaviour | impaired coordination | seizure | reduced consciousness | unknown; multiple observations allowed Records the neurological evidence central to recognition and subsequent reassessment.
- Exposure-to-care intervals
- minutes or hours between estimated onset, recognition, cooling and clinical handover; uncertainty recorded Distinguishes observed times from estimates and exposes delays requiring explanation.
- Cooling delivery
- not started | active | interrupted | stopped | unknown, with method and responsible responder Connects the treatment actually delivered with subsequent observations.
- Organ-injury assessment
- linked neurological, renal, hepatic, muscular, coagulation or cardiovascular assessments Connects complications to this episode while preserving their independent clinical records.
- Recovery and exposure clearance
- under acute care | under reassessment | restricted | conditionally cleared | cleared | unknown Prevents a normal temperature observation from being treated as permission to resume heat exposure.
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 18 findings · 30 questions.
Heat-stroke recognition Evidence establishing why this episode is being treated as possible heat stroke.
Recognition must remain actionable despite incomplete observations while preserving diagnostic uncertainty.
Thermal and neurological presentation
The relationship between heat exposure, temperature observations and altered brain function.
Recognition evidence
Record the actual observations supporting suspicion, their timing and the assessor's interpretation.
- What neurological changes occurred relative to the person's baseline, and who observed them? measurement
- What temperature and exposure evidence accompanied those changes, and what remained unmeasured? measurement
Diagnostic boundaries
Distinction from neighbouring heat illnesses and other causes of altered consciousness.
Competing explanations
Keep alternative and coexisting diagnoses visible rather than converting suspicion into certainty.
- What evidence distinguishes this presentation from heat exhaustion or a transient heat-associated faint? boundary
- Which competing causes, including hyponatremia, hypoglycaemia, infection or drug-related hyperthermia, have clinicians assessed or left unresolved? boundary
- Who assigned the current diagnostic status, using which criteria or protocol? provenance
Heat load and susceptibility Episode-specific circumstances contributing to heat accumulation and impaired heat loss.
The model needs an exposure account that supports subtype assessment and later prevention without assuming a single cause.
Exposure reconstruction
Environmental and exertional conditions before recognition.
Heat accumulation context
Record activity, surroundings, clothing and access to cooling with their temporal relationship to symptoms.
- What exertion, environmental heat, humidity, radiant heat or enclosing conditions preceded symptom onset, and for how long? measurement
- Which evidence supports an exertional, non-exertional, mixed or undetermined classification? definition
Episode-specific susceptibility
Relevant personal circumstances linked from other records.
Susceptibility and access to cooling
Separate documented vulnerabilities and practical barriers from assumptions about their causal importance.
- What is known about acclimatisation, recent illness, hydration, relevant medicines and previous heat illness? provenance
- Could the person stop exertion, leave the heat, obtain cooling or summon help, and what prevented these actions? boundary
Thermal and neurological course Interpretable observations of temperature and neurological condition across the episode.
A single temperature or consciousness label cannot represent the course or response to cooling.
Temperature evidence quality
Measurement method, timing and uncertainty.
Temperature series context
Keep measurement site and intervention timing attached to every reading; rectal measurement is identified as most reliable in suspected heat stroke by the [CDC Yellow Book](https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/heat-and-cold-illness-in-travelers.html).
- Where, when and with which device was each temperature measured? measurement
- Was the reading obtained before or after cooling, and was the apparent peak measured or only estimated? provenance
Neurological response
Changes in consciousness, behaviour and coordination during treatment.
Neurological trajectory
Record neurological response separately from temperature response and identify confounded assessments.
- How did consciousness, orientation, coordination and seizure activity change during and after cooling? measurement
- Which observations were limited by sedation, baseline impairment, language barriers or unavailable witnesses? boundary
Emergency cooling and handover Emergency activation, cooling delivery and continuity of care.
The record must show whether time-critical actions occurred and what responders need to continue them safely.
Emergency response
Recognition-to-action timing and responder responsibilities.
Escalation and immediate care
Suspected heat stroke calls for emergency assistance and immediate cooling. [CDC NIOSH](https://www.cdc.gov/niosh/heat-stress/about/illnesses.html)
- When were emergency services activated and cooling started, and what delays occurred? action
- Who is supervising the person and addressing airway, breathing and circulation needs within their training? action
Cooling execution
Method selection, reassessment and transfer without losing treatment history.
Cooling method and continuity
Record method, practical constraints and protocol-directed stopping criteria; cold-water immersion is emphasised for severe heat illness after initial assessment in the [WMS guideline summary](https://wms.org/magazine/1540/Heat-Illness-CPG/default.aspx).
- Which cooling method was delivered, and what access, supervision or clinical constraints affected its use? action
- Which protocol and observations governed reassessment, interruption or stopping of active cooling? action
- Were temperature methods, neurological changes and cooling intervals communicated at handover? provenance
Organ injury and recovery Episode consequences and conditions governing recovery decisions.
Thermal improvement and overall recovery are distinct states requiring separate evidence.
Complication surveillance
Clinical assessments for evolving injury beyond the temperature abnormality.
Organ-injury status
Record serial complication assessments, retaining unknown separately from absent; liver or kidney injury and abnormal bleeding can emerge after presentation. [CDC Yellow Book](https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/heat-and-cold-illness-in-travelers.html)
- What neurological, renal, hepatic, muscular, coagulation and cardiovascular assessments were performed, with what results and times? measurement
- Which suspected complications require repeat assessment or escalation under the treating team's plan? action
Recovery restrictions
Outstanding deficits, follow-up and authority for renewed activity.
Recovery and clearance evidence
Track symptom resolution, unresolved injury and explicit clinician-issued conditions for return to exertion or heat exposure.
- What symptoms, functional limitations or abnormal assessments remain unresolved? measurement
- Who authorised return to activity, with which restrictions, reassessment requirements and supporting evidence? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Kinds and varieties
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Classic (non-exertional) heat stroke: passive overheating, typically in older, very young, or chronically ill people during heat waves, often with little recent heavy exercise
- Exertional heat stroke: collapse during or soon after strenuous work or sport, typically in younger workers, soldiers, or athletes, often while still sweating
- Mixed-type heat stroke: modest activity plus high ambient heat in a vulnerable person, distinguished in Japanese emergency classification rather than as a separate pathophysiology
- Which of these kinds and varieties hold for the sense of heat stroke this model covers, and on what evidence? provenance
Identifiers and schemes
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Wikidata - Q337554 - Item for heat stroke as a medical condition
- ICD-10 - T67.0 - Heatstroke and sunstroke, under Effects of heat and light
- ICD-10-CM - T67.0xx - US clinical modification; 7th-character encounter extension required (e.g. T67.01XA / T67.02XA in later revisions that split exertional vs nonexertional)
- ICD-11 - NF01 - Heatstroke, under Effects of heat
- MeSH - D018883 - Heat Stroke
- SNOMED CT - 39871006 - Heat stroke (disorder); confirm against the current SNOMED release before use as a binding code
- Which of these identifiers and schemes hold for the sense of heat stroke this model covers, and on what evidence? provenance
Standards and regulation
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- ISO 7243:2017 WBGT heat-stress assessment - International Organization for Standardization
- ISO 7933 predicted heat strain - International Organization for Standardization
- ACGIH Threshold Limit Values for heat stress and strain - American Conference of Governmental Industrial Hygienists
- NIOSH Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments (2016-106) - CDC/NIOSH
- OSHA General Duty Clause (and the proposed federal Heat Injury and Illness Prevention standard) - U.S. Occupational Safety and Health Administration
- California Code of Regulations Title 8, section 3395 Heat Illness Prevention - Cal/OSHA
- NATA Position Statement: Exertional Heat Illnesses - National Athletic Trainers' Association
- Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness - Wilderness Medical Society
- WHO guidance on heat-health action plans - World Health Organization
- Which of these standards and regulation hold for the sense of heat stroke this model covers, and on what evidence? provenance
Real-world use
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Emergency-department diagnosis and cooling during urban heat waves, especially in older people in poorly cooled housing
- Sideline collapse at endurance events and team practices, with on-site rectal temperature and cold-water immersion before transport
- Military training and selection courses in hot climates, a long-standing source of exertional cases
- Occupational illness in agriculture, construction, warehouses, kitchens, and foundries
- Mass-gathering medicine, including Hajj pilgrimage and summer marathons
- Public-health surveillance of heat-related emergency visits and excess mortality under heat alerts
- Medicolegal attribution of heat-related death when core temperature was not recorded in life
- Which of these real-world use hold for the sense of heat stroke this model covers, and on what evidence? provenance
Typical measurements
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Core body temperature (rectal preferred at collapse) - typically ≥40.0 to about 44, occasionally higher in fatal cases - °C
- Cooling rate under cold-water immersion - about 0.15 to 0.35 - °C/min
- Wet-bulb globe temperature at which strenuous activity is commonly restricted - about 28 to 32, depending on clothing and acclimatization - °C WBGT
- Glasgow Coma Scale at presentation - 3 to 14; severe cases often ≤12 - GCS points
- Serum creatine kinase in exertional cases with rhabdomyolysis - hundreds to greater than 10 000 - U/L
- Serum alanine/aspartate aminotransferase in hepatic injury - hundreds to several thousand - U/L
- Which of these typical measurements hold for the sense of heat stroke this model covers, and on what evidence? provenance
Failure modes and hazards
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Delayed recognition or delayed cooling, the main modifiable driver of death and lasting brain injury
- Disseminated intravascular coagulation and uncontrolled bleeding
- Rhabdomyolysis, hyperkalemia, and acute kidney injury, especially in exertional cases
- Acute liver failure
- Seizure, coma, and permanent neurologic injury
- Aspiration, acute respiratory failure, and cardiovascular collapse
- Rebound hyperthermia after incomplete cooling
- Death; untreated or late-cooled classic heat stroke has historically carried high case fatality
- Which of these failure modes and hazards hold for the sense of heat stroke this model covers, and on what evidence? provenance
Regional variation
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- English usage splits heat stroke / heatstroke; ICD still pairs heatstroke with sunstroke
- Japanese 熱中症 (netchūshō) names a graded spectrum of heat illness; heat stroke maps only to the severe end with CNS or organ failure, not to the whole category
- Classic heat stroke dominates European heat-wave epidemiology; exertional heat stroke dominates North American sports and military literature
- Environmental triggering indices differ: U.S. public alerts often use heat index, Canada humidex, occupational and sports medicine WBGT
- Large case series from the Hajj in Saudi Arabia; South Asian summer practice includes dedicated heat-stroke wards and national disaster-management heat guidance
- U.S. sports medicine often cools first and transports second; some emergency-medical systems still prioritize immediate hospital transport
- Which of these regional variation hold for the sense of heat stroke this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Heat exhaustion - Mental status remains essentially intact and core temperature is usually below 40 °C; treat as a continuum, not a hard laboratory cut
- Heat syncope - Brief postural loss of consciousness with rapid recovery and without marked hyperthermia or lasting encephalopathy
- Exertional hyponatremia - Endurance-event collapse with normal or low core temperature and low serum sodium, not extreme hyperthermia
- Sepsis or other febrile infection - Infectious source and inflammatory signs without a decisive environmental or exertional heat load; the two can coexist in heat waves
- Stroke (cerebrovascular accident) - Focal neurologic deficit without extreme core hyperthermia as the primary finding
- Malignant hyperthermia - Triggered by halogenated anesthetics or succinylcholine in a genetically susceptible patient, not by ambient or exertional heat
- Neuroleptic malignant syndrome - Days-long onset after dopamine-antagonist exposure, with rigidity, rather than acute environmental heat load
- Serotonin syndrome - Serotonergic drug exposure with hyperreflexia and clonus; heat stroke lacks that toxidrome unless drugs are also involved
- Which of these neighbouring kinds and how to tell them apart hold for the sense of heat stroke this model covers, and on what evidence? provenance
Sources
- Heat Stroke - The New England Journal of Medicine (Massachusetts Medical Society) - Specialist definition, classic versus exertional distinction, core-temperature and CNS criteria, multi-organ complications, and the primacy of rapid cooling
- Classic and exertional heatstroke - Nature Reviews Disease Primers (Springer Nature) - Current disease-primer account of the two main clinical kinds, mechanisms, organ injury, and management
- National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses - Journal of Athletic Training (NATA) - Field recognition of exertional heat stroke, rectal-temperature practice, cold-water immersion, and separation from heat exhaustion and exertional hyponatremia
- Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments - CDC/NIOSH (DHHS Publication 2016-106) - Occupational encounter, WBGT-based exposure assessment, and workplace heat-illness prevention practice
- ISO 7243:2017 Ergonomics of the thermal environment - Assessment of heat stress using the WBGT index - International Organization for Standardization - The principal international method for measuring environmental heat stress that precipitates occupational heat stroke
- ICD-10 code T67.0 Heatstroke and sunstroke; ICD-11 code NF01 Heatstroke - World Health Organization - Standard diagnostic identifiers and the residual ICD grouping of heatstroke with sunstroke
What the second pass must settle
- Which diagnostic criteria should govern each intended setting, particularly when cooling preceded measurement or reliable core temperature is unavailable?
- How should the model represent variation between guidelines in the neurological boundary separating heat exhaustion from heat stroke?
- Which cooling methods, reassessment intervals and stopping criteria are supported for the intended populations and responder capabilities?
- Which serial organ-injury assessments and observation periods are justified for different presentations and treatment responses?
- What evidence and professional authority should be required for return to exertion or heat exposure after an episode?