Physician Directed Prehospital Treatment in Psychostimulant Induced Hyperthermia: A Case Series
Abstract
Abstract Objective Psychostimulant induced hyperthermia is a high mortality condition encountered at mass gatherings such as music festivals. Early, rapid resuscitation and cooling may improve outcomes. This case series describes the use and patient outcomes of a physician directed medical resuscitation guideline including on-scene sedation, intubation, and ice-water submersion in the prehospital setting, followed by transport to non-specialized emergency departments (EDs). Methods We performed a retrospective chart review of hyperthermia cases treated at electronic dance music festivals by physician-led prehospital resuscitation teams using ice-water bath submersion. Initial prehospital and ED core body temperatures were recorded as were initial ED vital signs, laboratory values, imaging studies, and hospital outcome. Results Twenty-one cases of hyperthermia were identified that were treated using emergency resuscitation and ice-water submersion. All were presumed to have involved the recreational use of psychostimulant drugs. Median initial rectal temperature was 42.2 °C (107.9 °F) (IQR 41.8–42.4 °C). All patients underwent sedation, intubation, and attempted cooling per the event-medicine specific guideline. Eighteen patients were cooled using ice-water submersion and on arrival to the ED the measured mean core temperature was 35.89 °C (96.65 °F) (SD 2.39 °C). Three patients did not complete the cooling process as they developed cardiac arrest before or during cooling,…
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