How can heat stroke be differentiated from heat exhaustion during EMS assessment?

• A. Heat stroke presents with excessive sweating and cool skin, which distinguishes it from heat exhaustion.
• B. Heat stroke presents with altered mental status and hot, dry skin; heat exhaustion features normal or moist skin and no CNS dysfunction.
• C. Heat exhaustion is always more dangerous than heat stroke.
• D. Heat stroke occurs only with fever above 38.5°C (101.3°F).

Answer: (B)

The main idea is that telling heat stroke apart from heat exhaustion relies on how the body’s cooling system is working and how the person is behaving mentally. Heat stroke is a thermoregulatory failure and typically shows altered mental status (confusion, agitation, seizures, or coma) with hot, dry skin because sweating has stopped. In contrast, heat exhaustion usually leaves the CNS functioning relatively normally, and the skin is moist or cool to the touch because sweating is still present.

So, if you see someone with confusion or unconsciousness and very hot, dry skin, assume heat stroke and treat as an emergency with rapid cooling and immediate transport. If the person is still alert, oriented, dizzy, nauseated, and has sweaty, moist skin, heat exhaustion is more likely. Fever isn’t the defining feature here, and heat exhaustion isn’t necessarily more dangerous—heat stroke is.