Physician Directed Prehospital Treatment in Psychostimulant Induced Hyperthermia: A Case Series

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).

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.

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, necessitating removal from the submersion tank, cardiopulmonary resuscitation (CPR), acute resuscitation led by the physician, and transport to the closest hospital. On arrival to the ED, mean rectal temperature was 35.89 °C (96.65 °F) (SD: 2.39 °C). Of the 21 patients that met study inclusion, 19 survived to hospital admission, of which 18 were discharged from the hospital neurologically intact.

A prehospital physician-directed guideline, including ice-water submersion after sedation and intubation, was used in mass gatherings to reduce body temperature in patients with psychostimulant induced hyperthermia. In this case series, we present the largest series of patients treated by physician directed guideline in the out-of-hospital environment at music festivals. Our outcomes suggest that a physician-directed guideline incorporating ice-water immersion on site before transfer to an emergency department can be used to decrease the mortality risk of psychostimulant induced hyperthermia in the prehospital setting.