Req 11 — Temperature Emergencies

The outdoors is full of thermal hazards. Scouts have died from heat stroke in summer camp and from hypothermia on autumn backpacking trips in conditions that seemed manageable. These emergencies are almost entirely preventable — and highly treatable when caught early. This requirement covers six conditions:

• 11a — Dehydration and over-hydration
• 11b — Heat cramps and muscle pain after exertion
• 11c — Heat exhaustion
• 11d — Heat stroke
• 11e — Chest pains associated with cold exposure
• 11f — Hypothermia

Requirement 11a: Dehydration and Over-Hydration

Dehydration

Water is the medium for nearly every chemical reaction in the human body. Even mild dehydration impairs physical performance and cognition. Severe dehydration can cause kidney failure, heat stroke, and death.

Signs and symptoms:

• Thirst (a late sign — you’re already mildly dehydrated by the time you feel thirsty)
• Decreased urine output; dark, concentrated urine
• Headache
• Fatigue and weakness
• Dizziness when standing
• Dry mouth and skin
• Severe: confusion, rapid heart rate, sunken eyes, no urination

First aid:

• Mild dehydration: oral fluid replacement — water, sports drinks, or broth.
• Moderate to severe: oral fluids if conscious; IV fluids in a hospital setting.
• Stop exertion in the heat; move to cool environment.

Prevention: Drink before you’re thirsty. A useful guide: clear to light yellow urine = adequate hydration. Dark yellow or amber = drink more.

Over-Hydration (Hyponatremia)

Drinking too much plain water dilutes the blood’s sodium concentration — a condition called hyponatremia. It can develop in endurance athletes and hikers who drink only water over many hours without replacing electrolytes.

Signs and symptoms: Nausea and vomiting; headache; confusion or disorientation; swelling of hands and feet; seizures (in severe cases).

First aid:

• Stop drinking plain water.
• For mild cases: consume salty food or an electrolyte drink.
• Severe cases require emergency medical treatment — do not give more water.

Prevention: Drink to thirst (not more); use sports drinks or electrolyte tablets for prolonged exertion lasting more than 2–3 hours.

Requirement 11b: Heat Cramps and Muscle Pain After Exertion

Heat Cramps

Heat cramps are painful muscle spasms caused by sodium loss through sweating, usually during or after heavy exercise in hot weather. They most commonly affect the calves, thighs, and abdomen.

Signs and symptoms: Sudden, painful muscle spasms; sweating; otherwise normal mental status.

First aid:

• Stop activity; move to a cool environment.
• Stretch and gently massage the cramped muscle.
• Drink fluid containing sodium (sports drink, lightly salted water, broth).
• Do not return to strenuous activity until cramps resolve.

Prevention: Maintain hydration with electrolyte-containing fluids during prolonged exercise; acclimatize to heat gradually before intense exertion.

Muscle Pain After Exertion (DOMS)

Delayed onset muscle soreness (DOMS) isn’t a heat condition, but this requirement asks you to address it. DOMS is microscopic muscle damage from unaccustomed exercise — it peaks 24–48 hours after the activity and resolves in 3–5 days.

Symptoms: Aching, stiff muscles; reduced strength and range of motion; worse going down stairs or with eccentric movements.

Management: Active recovery (light movement); anti-inflammatory medication; gentle stretching; time.

Requirement 11c: Heat Exhaustion

What it is: Heat exhaustion occurs when the body’s cooling system is overwhelmed — the core temperature is elevated but not yet at the critical threshold. It’s a warning that heat stroke may follow.

Signs and symptoms:

• Heavy sweating
• Pale, cool, clammy skin (sweating mechanism still working)
• Rapid, weak pulse
• Weakness, fatigue
• Nausea or vomiting
• Headache
• Dizziness, possible fainting
• Normal or slightly elevated core temperature (up to 104°F)
• Normal mental status (may be mildly confused)

First aid:

1. Move immediately to a cool environment — air conditioning, shade, near water.
2. Lay the person down with feet elevated.
3. Loosen or remove tight clothing.
4. Apply cool, wet cloths to the skin.
5. Fan the person.
6. Give cool fluids slowly if conscious and not nauseated (sports drinks preferred).
7. Monitor for progression to heat stroke.

When to call 911: If symptoms don’t improve within 30 minutes, if vomiting prevents fluid intake, or if mental status changes — call immediately.

Requirement 11d: Heat Stroke

What it is: Heat stroke is a life-threatening emergency. The body’s thermoregulation has failed completely. Core temperature exceeds 104°F (40°C), and the brain and other organs are being damaged by the heat.

There are two forms:

• Classic heat stroke: Occurs in elderly or medically compromised individuals during environmental heat waves. Skin is typically hot and dry (sweating mechanism may have failed).
• Exertional heat stroke: Occurs in young, physically active people exercising intensely in the heat. Skin may still be sweating.

Signs and symptoms:

• Hot skin (may be dry OR sweating)
• Core temperature above 104°F
• Altered mental status — confusion, irrational behavior, combativeness, or loss of consciousness (this is the key difference from heat exhaustion)
• Rapid, strong pulse
• Possible seizures

First aid:

1. Call 911 immediately.
2. Begin cooling immediately — every minute matters. The faster you lower core temperature, the less organ damage occurs.
3. Best method: Cold water immersion — if available, immerse the patient in cold water up to the neck, stirring the water. This is the most effective cooling method.
4. If immersion isn’t possible: apply ice packs to the neck, armpits, and groin (where major blood vessels are close to the surface); pour cold water over the body; fan aggressively.
5. Do not give fluids to an altered-level-of-consciousness patient.

Requirement 11e: Chest Pains Associated with Cold Exposure

What it is: Cold air and cold temperatures increase the workload on the heart. Coronary arteries can constrict in cold, reducing blood flow to the heart muscle. For people with underlying heart disease (including undiagnosed heart disease), this can trigger a heart attack. Even shoveling snow — a familiar winter activity — kills thousands of Americans each year.

Signs and symptoms: Chest pain, pressure, or tightness that comes on during exertion in cold weather; shortness of breath; radiation to the arm or jaw; cold sweats; possible collapse.

First aid:

• Stop the activity immediately; move to warmth.
• If symptoms suggest heart attack: call 911; have the person rest in a position of comfort; consider aspirin (see Req 7b).
• Begin CPR if they lose consciousness and stop breathing.

Prevention: Warm up gradually before outdoor exertion in cold weather; know if you or group members have cardiac risk factors; pace yourself with snow shoveling; take breaks.

Requirement 11f: Hypothermia

What it is: Hypothermia occurs when core body temperature drops below 95°F (35°C). The body’s heat-generating mechanisms — shivering, vasoconstriction, increased metabolic rate — are overwhelmed by heat loss. Mild hypothermia is uncomfortable; severe hypothermia is fatal.

Most wilderness hypothermia is not from extreme cold — it results from being wet (from rain, sweat, or immersion), cold, and windy. A Scout who gets soaked and stops moving can develop hypothermia in temperatures well above freezing.

Stages:

The “umbles”: Memory aid for hypothermia progression — the patient tumbles (loss of coordination), grumbles (irritability), stumbles (ataxia), mumbles (slurred speech).

First aid:

1. Stop heat loss first: Get the person out of wind, rain, and wet clothes. Cover with dry insulation (sleeping bag, emergency blanket, dry clothing).
2. Handle gently: A hypothermic heart is irritable — rough handling can trigger fatal arrhythmias.
3. Rewarm gradually: body-to-body warmth in a sleeping bag, warm (not hot) packs to the neck/armpits/groin.
4. Give warm, sweet fluids if conscious and able to swallow.
5. Do NOT rub the extremities vigorously — this drives cold blood to the core.
6. For moderate or severe hypothermia: do not assume dead. Begin CPR if no pulse (even in moderate hypothermia the pulse may be very weak). Continue until rewarmed. “You’re not dead until you’re warm and dead” is a real guideline.

You’ve covered the full range of environmental threats. Next, you’ll tackle a less visible but equally real category of emergencies: mental health and stress reactions.