After listening to the SOAP report and approving the assessment and plan you check in on the other members of this trail crew. They are all tired and stressed by the heat, although none are as ill as the patient. One of the crew members has been feeling sick and has had a low-grade headache for a day. He thinks he has a “cold” and has been taking Sudafed. You’re concerned because this medication increases metabolic rate and is on the lists of drugs that can be problems in heat.
You learn the crew members have been drinking water, but the 3-4 liters daily recommended by the staff seems to be in reality 2-3 liters on average (the water has a brackish taste that no one likes). The work days are long and run from 8:00 a.m. until 6:00 p.m. It’s been warm in the evenings, the camp is noisy, and most of the crew members are sleeping poorly. You notice several of the boys have bandannas on their heads, none have long-sleeved shirts or wide-brimmed hats, and they all are red and bronzed from lots of sun exposure.
You decide to meet with your crew leaders and make some changes to manage this heat stress. First, you give everyone a rest day tomorrow and take them to a lake where they can swim and be cool. You can’t improve the water source so you try some drink mixes to entice the crew members to drink more fluid. You change the work schedule to early morning and evening shifts and make people rest in the shade in the heat of the day. And you tell them to wear loose, long-sleeved cotton shirts and hats to keep the sun at bay. Then you review strategies for preventing heat illness, predisposing factors, and the subtle signs and symptoms of heat stress.