Episode 12: Sunburn and Sunstroke

First Aid Unboxed Podcast: Sun Safety, Heat Exhaustion and Heat Stroke

Mark:
Hi everybody and welcome back to First Aid Unbox. This is the podcast that demystifies everyday first aid for you, and the person behind all this is Louise Madeley from Madeleys First Aid Plus. Hi Louise. How are you?

Louise:
I'm very well, thanks.

Mark:
Good, good to speak to you again.

Louise:
Likewise.

Mark:
Uh, we're now on episode 12.
We've had a fantastic reaction. To the ones we've already put out there. So thank you everybody who's listened and downloaded and got in contact. Uh, lovely to hear from you all. Thank you very much indeed.
Right. Then, should we dive straight into it?

Louise:
Yes. Let's.

Mark:
okay. Right. What are we gonna be talking about today then?

Hidden Dangers of the Sun in the UK

Louise:
We're talking about the sun, believe it or not, in this country, and the dangers of, well, we've had plenty of it in the last few weeks, haven't we?

Mark:
We have indeed. Yeah. Okay. Tell me about the sun and the dangers of it.

Louise:
They're more hidden dangers in this country. We go abroad and we are going to, where it's sunny, where it's hot, it's etc, and we think about it.

Mark:
We expect there to be sun, don't we?

Louise:
Absolutely. Yeah, we all do and that's great, but what's forgotten is when you're in this country and you're working and you're doing all your usual things and the sun. Is potentially quite dangerous. Even when it's cloudy, particularly by the seaside for example.
It's, it's surprising just how dangerous that sun can be. I mean, it's great. We love a bit of sunshine, boosts our mood. You get vitamin D makes everything feel a bit brighter and we want to be out in it as much as possible, but prolonged exposure. Not just to high temperatures, it's those UV rays and they are still present when it's cloudy in this country.
But warm, you're still at risk

Mark:
so they can get through the clouds of the UV rays?

Louise:
Uh, yeah.

Mark:
Right. Okay. That's interesting. I, sort of knew that anyway, but I think there's a lot of people out there who think if it's cloudy, I don't have to wear any sunscreen or anything like that.

Louise:
Yeah, you get that a lot, particularly at the beach where it's more likely to be a bit more overcast, a little bit windy. That wind can actually be quite dangerous.

Mark:
It could, it calls you down, but you're still burning underneath.

Louise:
Exactly. Yeah, it's true. Same in the water.

Mark:
Okay, so tell us all about, you know, the hidden danger. Explain that whole thing to us.

Sunburn, Dehydration, Heat Exhaustion and Heat Stroke Risks

Louise:
Well. The main risks are sunburn. People don't tend to think of sunburn as a burn.
It is a burn the same as any other. And when we do the, the podcast about dry burns, scalds, freeze burns, etc, they are burns like any other, and they run the same risks, and the same treatment in some cases, depending on how severe.
Sunburn, dehydration, heat exhaustion, severe cases, heat stroke, that is a medical emergency and there is a difference between heat exhaustion and heat stroke, which not everybody realises.

Mark:
Okay. Which you're gonna explain to us in a little bit.

What Is Heat Exhaustion?

Louise:
Yes. So what is heat exhaustion first?
Generally it happens when, your body overheats. It can't cool it itself down effectively, and can be caused by spending too long in the sun. We've all been there, we've all done it, exercising in hot weather.
That's one of my biggest things I must admit when I go abroad, especially when it's nice in the first thing in the morning. I like to go for a run, and actually I've put myself at risk a few times doing that. I should know better, but. It's, it's something that you do when you're on holiday.

Mark:
Well, to be honest, it's something you probably don't think about.
Michael Mosley, that's how he died, wasn't it? By he went out and he's, he's a medical man. He went out Yeah. And didn't realize how hot it was or whatever the reason was. You know, it was very unfortunate what happened to him. And that was, that was for the hot weather, wasn't he in Greece? I think.

Louise:
Utterly tragic. Utterly tragic. But yeah, it just goes to show that absolutely anybody can fall foul of hot weather and cold weather. Extremes. You know, it does happen. Not drinking enough fluids in particular can cause heat exhaustion. The main thing with heat exhaustion and the way to think about it is prevention is always better than cure.
We don't want to get ourselves heat exhausted. We don't want to get ourselves sunburnt, we want to do something about it before it happens. Like everything in first aid, yes, we need to learn what to do. After something's happened, but let's not have it happen in the first place.

Mark:
So what are our main preventative measures for that?

Preventing Heat Exhaustion: Hydration and Clothing

Louise:
Stay hydrated drink. Lots of water. Even if you're not thirsty. If you are thirsty, you are already dehydrated. It's the first stage of dehydration. So really you should be drinking adequately throughout the day, not waiting till you're thirsty and then having a drink. because that means you are already in the first stage of dehydration by the fact that you're thirsty.
So. Keep fluids on board, wear loose, light coloured clothing. Especially in this country, you have people walking around in much darker colours. It's usually a colder country, a wetter country, et cetera. Not everybody has got light clothes. For the five days that we have decent weather, um, use sunscreen, SPF 30 or higher.
We will recommend SPF 50.

Mark:
To be honest, I tend to. I do festivals, open air festivals quite a lot. Yeah. I always wear 50. Always.
Yeah. I find, you know, from a long time ago when I got quite badly burnt, um, when I was in Cornwall once, and someone said to me, you just need to make sure that you're always wearing a, a high SBF level sunscreen.

Louise:
Absolutely. And because it says 30 or 50 or whatever on the, the tin doesn't necessarily mean it's working at that factor when it's on your body. Um, that's the other thing to remember. So if you're getting a 30, it may be working at 20. Um, personally, I don't take that risk. I start at 50.
Um, so highly recommend 50 and reapplying it. No point putting it on in the morning and then not putting any more on and going to bed, you know. It doesn't work like that. You need to reapply roughly every two hours.

Mark:
Yeah. And if, and if you go in the pool or you're go in the sea, same thing again, isn't it?

Louise:
Absolutely. Always reapply. Even if it says it's waterproof.

Mark:
Yeah. Okay.

Louise:
Yes. End of regardless, uh, waterproof. But there's no such thing as fully waterproof. Um, unless you're using lard or something like that and swim in the channel, that's a bit different, but no. Definitely reapply. Um, preferably every two hours. Certainly avoid the midday sun, but that really means from 11 till three, and I don’t know about you, but certainly in the last few years I've noticed three o'clock in the afternoon can sometimes be hotter.

Mark:
The midday. Oh, definitely, definitely. It, it's, it's, uh, I mean, I suppose the thing is, is just be sensible and, and be observant about what's happening and what's around you and Yeah. And how you feel. If you're feeling really hot, the chances are, you know, the sun is really, is, is really getting to you.

Louise:
Yeah, absolutely.
Take breaks, get into the shade, go indoors working or exercising outside. Head indoors for a little while, cool yourself down and then go back and, and continue.

Sun Protection Tips: Hats, SPF and Individual Tolerance

Mark:
But as a man, make sure you take regular breaks. As a man who is follicly challenged as well, I always wear a hat in the summer when I'm out in the gardening or anything.

Louise:
Because you don't realize you're burning the top of your head.
Yeah. I actually use spray on my husband. He'll probably kill me for this, but I, I spray the top of his head if it's particularly hot.

Mark:
Yeah.

Louise:
And then he wears a hat that's got SPF 'cause. Again, same thing. You know, as he's, he's always had it actually, not follicly challenged, but he's always, um, he's always suffered with the heat and because of that, I've always just sprayed the top of his head and then he always wears a hat regardless.

Mark:
Right. Okay.

Louise:
And even then, he can sometimes get bad effects from the sun, you know, everybody's different. How much they can tolerate with sun and cold.

Mark:
Absolutely, absolutely.. I'm not a big fan of hot weather personally.

Louise:
He is much happier heading off to Norway in the winter than he is heading off to Africa in the summer. Put it that way.
Yeah. And having a, a little boy who is exceptionally ginger hair and having the full complexion of somebody with ginger hair, then, you know, we are exceptionally careful.

Mark:
Yeah, there's another layer of risk on top of that altogether, isn't there?

Louise:
Yeah, well, he's now 11 and now he will take himself inside. He'll just say, mommy, I'm too hot. I'm in. And he will take himself in. He feels uncomfortable. Simple as that, the same as Paul does, whereas my other son and I really like it and we'll head out and have to remind ourselves to head back in again.
Yeah, it's, it's more dangerous for people like me who think actually it's fine. It's not, you still need to take yourself in.

Mark:
It's almost that too much of a good thing, isn't it?

Louise:
Yeah, yeah. I mean we, you know, we don't get the sun that, I lived in the south of France for three years. It was great. I used to wear white scrubs. I'd go into the hospital, you put your token in, you receive your white scrubs. If they get dirty, you're given another token. You're going get more white scrubs. Absolutely fantastic. But my shifts were eight till 12 and then four to eight. So between 12 and four. That was like the midnight hour I would be off to go and have my snooze.

Mark:
But places and countries like that though are geared for this.
Spain and south of France and Italy and places like that.

Louise:
Yeah. We are not prepared for it when it happens maybe three or four weeks of the year and it's those times when we're at most at risk.

Recognising Heat Exhaustion: Early Warning Signs

Mark:
Yeah, absolutely. So we talked about prevention of, of heat exhaustion.
What do we need to look out for? That means we're beginning to fall into that situation.

Louise:
So when it comes to. Heat exhaustion. Anybody who's had prolonged exposure to the heat, physical activity, and hot water dehydration. Main symptoms to look for; Dizziness, confusion, complaining of headaches, feeling nauseous or vomiting. Pale clammy. I've mentioned that. Sort of tacky feel on the skin, anything like that. Excessive sweating, muscle cramps as well. If you start getting cramps in your lower legs, in particular, fast breathing, where you're really, it's called technique breathing very rapidly, um, and shallow. And heartbeat as well.
If you start, your heart starts beating really quickly.

Mark:
Is this, you're body just trying to work really hard to absolutely counter what's happening today?

Louise:
Yeah, exactly. And feeling very thirsty. I mean, any thirst means that you are dehydrated anyway, but you'll be feeling excessively thirsty with heat exhaustion. That's the difference.
Any of these symptoms you must treat quickly. If somebody doesn't recover within the first 30 minutes with any of these symptoms, you know, they've had exposed, prolonged exposure to heat, then you're heading into heat stroke territory. So although it's not a medical emergency at this moment, it's getting that way.

When Heat Exhaustion Becomes Heat Stroke

Mark:
Once we realise that there is a heat exhaustion situation, what do we do next? So we've not been able to prevent it. We know it's happening. What's your next step?

Louise:
If it's not improving within the first 30 minutes? Um, then. You have to think this could well be heat stroke. Heat stroke is the next stage on from heat exhaustion, so far more serious.
It is a blue light emergency. It's as simple as that. It usually occurs when the body's temperature rises to dangerous levels, generally above 40. And anybody with a temperature above 40. Quite often they can't cool themselves down by this point. The body goes into hyperdrive and generally they've already been through the heat exhaustion stage and now they're into heat stroke.
So it could be that they've got hot, dry skin. It stops sweating and it becomes dry. That's a big clue. Very high body temperature, sorry. Confusion disorientation rather than just a little confused, we're talking full disorientation here. It can lead to seizures. People with, particularly with a temperature above 40, are very prone of getting febrile convulsions, seizures, loss of consciousness, very fast breathing rate, rapid and shallow.
And the same with the heart rate as well. It's 9, 9, 9. Immediate action. Simple as that. It's time critical at this point. Somebody's got heat stroke.

First Aid for Heat Exhaustion and Heat Stroke

Mark:
Is there anything that we can do while we're waiting for the ambulance or waiting for the medical staff to turn up? Or do we just keep the person calm.

Louise:
yeah, you certainly can. For heat exhaustion, I'll start there. Move them into a cool place, preferably indoors or certainly into the shade. Lie them down and raise the legs slightly. You know when I say, when the face is pale, raise the tail. Yeah, same thing. Lie them down, lift the legs up, remove excessive clothing, and you are trying to cool them down, but you're cooling the atmosphere, not them. That's the difference.
Anybody who's got a high temperature, you don't cool the body down. So you're not throwing cold things onto that person. You want to cool around the area.

Mark:
So putting them in an ice bath and things like that is just going to put them in to shock.

Louise:
Please don't, yeah, no, you don't want to do that. You can use cool water spray, you can use a fan, you can use damp cloths, but not, we're not talking ice and things to rapidly cool somebody. We're talking about cooling their immediate area. Um, particularly with kids, you could have cool things around them, not touching them. For example.

Mark:
Right. Okay.

Louise:
Anything that's going to cool that area around them. Fans are brilliant for that. You're not putting a fan directly on a person anyway. You need to put it into the area that you're, you're trying to cool down, okay? Give them fluids. With heat exhaustion, they do need fluids, and it's okay to give fluids in that situation.
It might be a rehydration drink that you can get hold of and stay with them and see if anything happens within those 30 minutes. Watch for them to improve. If they're not improving 111, get advice from them first.
If it's that they're not improving and they're deteriorating, then it's 999. Anyway. And they will advise

Mark:
And it becomes a medical emergency at that point.

Louise:
Start with 111 unless you believe it is definitely heat stroke, in which case it's 999.
When it is a medical emergency, again, you're still moving them into a cool place, cooling them more rapidly because it's time critical at this point. Uh, you can use cold packs under the armpits and neck, sponge them with cold water rather than tepid putting fans on them. Anything that's going to. Rapidly cool them.
However, don't give them any fluids. Particularly if they're unconscious or confused at this point, they need X amount of fluids into their arm via a vein. Ambulance will be on its way, get them into the recovery position. If they lose consciousness, again, you are back to, because this is a very serious medical emergency, so you're dealing with possibly an unresponsive patient, in which case you treat as an unresponsive patient.
Go back to your doctor. A, B, C, always go back to doctor A, B, C. Which is danger response, airway breathing, if it's not breathing, CPR, if it is breathing recovery position.

Mark:
Right. Okay. And that's something we should all think about all the time. Yes. If we're dealing with any kind of medical situation.
Absolutely. When you were working in a and e, did you get many people coming in with heat stroke?

Real-Life Experience: Heat Stroke Cases in Central London

Louise:
Yes.

Mark:
And this was Central London as well, wasn't it?

Louise:
Absolutely. There was one week, I remember we were in ITUI was working in ITU at the time, at UCLH, university College London Hospital, now called NHS Foundation Trust. Bit of a mouthful and it was hitting a hundred degrees during the day for a week. I was on nights, we were doing rotations of a full week of nights, 12 and a half hour shifts, uh, seven nights on and myself and our team, because we work in teams. So there were 25 of us, I think. All of us. In fact, none of us slept for a week because we were then going home and sleeping in a hundred degree temperatures. Then going into work and working the night when it wasn't getting that cold, it was still very warm in the evenings.
That, yeah, that, that went down in the annals of history. I have to say, it's still mentioned at times as soon as the weather goes barmy, so to speak, unfortunately, so do we because we don't see it that often. And as a result, people do end up in a and e way too often and, and when it's hot everywhere else, in London, it seems to be even hotter.

Mark:
There's very little air movement. Oh yes. I used, I worked in London for 13 years and it was luckily in an air conditioned taxi. Yeah. But some, I, I know that, you know, it certainly got very hot and if you were out in the park or something, yeah it was always always so hot.

Louise:
The one thing I was grateful for doing nights is that I was able to drive in because I was doing nights, I was going in one direction. The rest of the world goes in the other direction. So I was heading into London and it meant I could put the air conditioning. Just for the half an hour when I was driving in, um, and I could leave my car near the hospital at that time.

Hospital Treatment for Heat Stroke: Cooling and IV Fluids

Mark:
So if someone comes in with heat stroke, what's the first thing that, that you, that you would do as a res first responder?

Louise:
We need to start cooling them down. We need to get fluids into them.

Mark:
And that's IV fluids?

Louise:
Yes, absolutely. Intravenous fluids. And we treat the symptoms. Basically in a nutshell, it depends on the symptoms that they're coming in with.
Obviously if they're in the middle of having a seizure, then we will be treating that seizure and lowering that temperature as fast, but as safely as we can as well.

Mark:
So as ever you put in all your notes and everything, and I know one of the things you have there is the current up to date information from the NHS regarding heat stroke and heat exhaustion. So, do you want to go through those so we know exactly what the current advice from the nhs?

NHS Guidance: Preventing Heat Exhaustion and Heat Stroke

Louise:
Certainly. So preventing heat, stroke and heat exhaustion, high risk of heat exhaustion or heat stroke during hot weather or exercise. In order to prevent, you need to drink more cold drinks, especially if you're active or exercising.
Wear light coloured loose clothing. Avoid the sun. 11 till three in particular, avoid excessive alcohol. Avoid extreme exercise more than your body is used to in particular. If you're inside in a very hot day, close the curtains, close the windows if it's hotter outside than your house, and turn off all electrical equipment within reason and lights that may get hot because they will conduct heat. They will warn the house itself. Anything that you can do to cool things down, certainly keeping those curtains closed. Because it cools down at night. You've got your curtains closed anyway in the dark. Leaving them closed throughout the day means that the sun isn't getting into your house and heating up your house.

Mark:
Yeah, I think people don't realise like your furniture and your carpets and everything, they're like massive storage heaters, aren't they?

Louise:
Absolutely. And they will store all that heat and then everything is still really warm at nine o'clock at night or whatever out. Well that's why my house in France, when I was living there.
We would have floorboards, we would have, rugs, we wouldn't have, there's no fitted carpets there at all. Half the time there isn't radiators tends to be little storage heaters purely for the winter. Because the winter's much shorter. And we had blinds and we had a. Shutters. Yeah, so we would use the shutters.
The shutters would be closed throughout the day and just open a crack to allow some air in, and that's it.

Mark:
It's a reason why they have shutters in hot countries.

Louise:
Yes, exactly. Is to keep the sun out of the house basically. We don't need it for the five days that we get nice weather here. In this country.
We don't need to go to that extreme, but we've got to think like people in hot countries when we do get that sort of weather, so using your curtains just to keep things cooler. Don't open them during the day, but not just when the weather's really hot, do it first thing in the morning. Just don't open them in the morning basically.
Because otherwise it'll heat up in the morning and then closing them at that point. There's not a lot of point.

Mark:
And of course at night often you close your curtains anyway.

Louise:
You throw the shutters open at night as the heat cools down, in France, you know that's when the shutters go open and then they close again just as you're getting up when the sun's rising. Yeah, absolutely.

Mark:
So again, and NHS advice. At what point do we call 999?

When to Call 999 for Heat Stroke: Red Flag Symptoms

Louise:
Okay. So always phone 999 if somebody is still unwell after 30 minutes of resting in a cool place, being cooled and drinking fluids, if they have a very high temperature, anywhere over 40 is an absolute, but generally, if they start going 37, 38 and it's going in that trend, then I would certainly start calling at least 111.
But if it's over 40, forget it. Just. 999. Hot skin that's not sweating anymore. So they will start perspiring to begin with and they'll get that sort of tacky. Sweaty. If that suddenly stops, they are in heat stroke, that's the big red flag. It might look red doesn't always, it's more difficult to see as well with anybody who has black or brown skin or darker skin. It can be harder to, to recognize, look at people's, uh, the palms of their hands. Look at their nail beds as well. That'll give you a better indication of paleness.
A fast heartbeat if you can feel their heartbeat on their wrist and you find that it's going really quickly. Should be going roughly one a second, say 60 to 90 beats a minute. If it's going really quickly, that is very bad news. That means you need to be fighting. 999 Fast breath or shortness of breath, confusion, lack of coordination, appearing drunk when you know that they haven't had anything to drink. For example, if they're having a seizure or fit clearly, or loss of consciousness.
Again, you're down to doctor. A, B, C. You're phoning 999 It is a medical emergency.

Hydration, Pets and Children in Hot Weather

Mark:
Tell me if I'm wrong, but the thing I get from this is the main thing is. Keep drinking hydration.

Louise:
Yes, absolutely. If you are thirsty, you are already starting to get dehydrated. You're in the first stage of dehydration. Nobody should get to the stage of being thirsty, which is why you always see me walking around with my drink.

Mark:
I've got my drink in my back actually down there.
Again, when I'm at festivals and stuff and I know it's hot, I will have a flask thing, you know, that keeps the Yeah. Water relatively cool. I'll have it with me all day and I'll just keep filling it up all day.

Louise:
Well, that's the other thing trying to keep your drinks cool as well. It's great these days you didn't use to get them, but now you can have thermal carriers and things that will deliberately keep things cold. I use those all the time. We go down to Aberdovey very often we've got a static caravan down there and we get tricked a few times when we think it's not as hot as actually it is. One thing that we always have are loads of fluids, particularly as we're in seawater as well, salty water. We need those fluids both for us and for our dogs because the dogs go and drink out of the sea.
They become excessively thirsty really quickly. And again, think about your pets. Put your hand on that ground and see how hot that ground is before your dogs paws go on it. If you can't keep your hand down for at least five seconds. Your dog should not be walking on it. I'm not in any way an expert with animals that much. That's as much as I know.
But I take a lot of fluids from my dogs as well if I'm going down to the beach.

Mark:
We always have drinks for the dog with us.
Just very quickly with children. T-shirts, hats?

Louise:
Yes. Always keep them covered all the time. I always have. I always recommend that people do keep their children covered. To be honest. I recommend that everybody keeps themselves covered.

Mark:
Right? Okay.

Louise:
As much as possible, it is a barrier to the sun and of really, and I do as much as possible. And I can really enjoy the sun. I can't sit still long enough. You know me well. I cannot sit still long enough to actually get burnt on any occasion. Five minutes, I'm done. I'm walking up a hill. Thanks very much.
And my husband's exactly the same. Thankfully both the kids are so we are not some worshipers like that where we will sit outside.

How to Contact Louise and Learn More About Heat Exhaustion and Heat Stroke

Mark:
Right Louise. That is fantastic. Hopefully people will, will know what they need to do in this hot weather if they're on holiday or even if just in their own back garden, or walking in the street. Just, you need to know these things because this sort of thing can creep up on you without you realising what's happening, uh, as Louise is already.
As already mentioned, if people want get in contact with you, what's the best way to contact you?

Louise:
Uh, you can contact me through email, which is enquiries@madeleysfirstaplus.co.uk

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