Triple-digit temperatures across Central Texas are driving a sharp rise in heat-related 911 calls, and the patients arriving with them can deteriorate fast.

KVUE reported that Austin-Travis County EMS had responded to 132 heat-related incidents in July as of the outlet's report. The spike arrived as extreme heat settled over the Austin area, raising risk for outdoor workers, athletes, older adults, first responders and anyone without reliable access to air conditioning.

The City of Austin issued an extreme-heat advisory on July 22, 2026, when the temperature at Camp Mabry was projected to reach 103°F with a heat index as high as 115°F.

For EMTs and paramedics, a spike like this is a reminder of how quickly heat illness moves. The clinical work is recognizing early symptoms, treating altered mental status as the alarm bell it is, and starting cooling without waiting for certainty.

Heat Illness Is Not Just a Vulnerable-Patient Problem

Certain patients carry higher baseline risk:

  • Infants and young children
  • Older adults
  • Pregnant patients
  • Patients with chronic medical conditions
  • Patients on medications that affect hydration or thermoregulation
  • Outdoor workers
  • Athletes
  • People without air conditioning
  • Anyone in heavy clothing or protective equipment

That list is a starting point, not a filter. Young, healthy, athletic patients develop severe exertional heat illness every summer, especially when they are not acclimatized to the conditions.

Firefighters, EMTs and paramedics are on the risk list too. Vehicle collisions on hot pavement, working fires, outdoor events and long extrications all stack heat load on the people running the call.

The Heat Illness Spectrum

Heat-related illness runs from painful cramping to life-threatening heat stroke. The categories are useful for teaching, but they are not fixed compartments. A patient can slide from one to the next while exposure continues or while treatment is delayed.

Heat Cramps

Heat cramps typically show up during strenuous activity in hot conditions, associated with heavy sweating and loss of water and electrolytes.

Findings may include:

  • Painful muscle spasms
  • Heavy sweating
  • Thirst
  • Fatigue
  • Recent exertion in a hot environment

Stop the activity and move the patient somewhere cooler. Oral fluids may be appropriate for an alert patient who can safely drink and is not nauseated or vomiting.

Cramps that persist, or that come with new symptoms, should raise suspicion for something further along the spectrum.

Heat Exhaustion

Heat exhaustion reflects a body still compensating, but losing ground against heat exposure and fluid loss.

Common findings:

  • Heavy sweating
  • Weakness
  • Dizziness
  • Headache
  • Nausea or vomiting
  • Muscle cramps
  • Pale, cool or clammy skin
  • Tachycardia
  • Syncope or near-syncope

Get the patient out of the hot environment, loosen or remove excess clothing as appropriate and start cooling. An alert patient who is not vomiting may be able to sip cool water. Do not push oral fluids on a patient with altered mental status or an impaired ability to protect their airway.

Heat exhaustion can progress to heat stroke when exposure continues or treatment is delayed.

Heat Stroke

Heat stroke is a time-sensitive emergency defined by severe heat illness with central nervous system dysfunction.

Warning signs:

  • Confusion
  • Agitation
  • Unusual behavior
  • Loss of coordination
  • Seizures
  • Syncope
  • Unresponsiveness
  • Markedly elevated body temperature
  • Tachycardia
  • Hypotension

Watch this one. Hot, dry skin is the classic teaching point, but plenty of heat stroke patients are still sweating, particularly in exertional heat stroke. Diaphoresis does not rule it out.

Altered Mental Status Is the Dividing Line

Mental status is the single most useful finding separating heat stroke from milder heat illness.

A patient who is weak, sweaty and nauseated may be experiencing heat exhaustion. A patient with meaningful heat exposure who is confused, combative, ataxic, seizing or unresponsive should be treated as heat stroke until proven otherwise.

Keep a real differential open. Other causes of altered mental status include:

  • Hypoglycemia
  • Stroke
  • Sepsis
  • Head trauma
  • Hyponatremia
  • Seizure disorder
  • Alcohol or drug use
  • Medication effects
  • Toxicologic emergencies

Broad assessment matters, but suspected heat stroke does not wait. Cooling should not be delayed while every alternative diagnosis gets ruled out one at a time.

Prehospital Priorities for Suspected Heat Stroke

Care always follows your scope of practice, local protocol and medical direction. Within those limits, the priorities look like this.

1Remove the Patient From the Hot Environment

Move the patient into shade, an air-conditioned ambulance or another cooler space. Strip clothing and equipment that traps heat. For athletes, firefighters and outdoor workers that may mean helmets, pads, turnout gear or impermeable protective clothing.

2Support Airway, Breathing and Circulation

Assess airway, respiratory effort, oxygenation, perfusion and neurologic status. Provide oxygen or ventilatory support when clinically indicated. Check a blood glucose. Consider cardiac monitoring and vascular access based on patient condition and local protocol. Reassess vitals and mental status frequently, because these patients change quickly.

3Begin Active Cooling

When heat stroke is suspected, cooling starts as soon as it is practical. Options may include:

  • Cold-water immersion when appropriate and operationally feasible
  • Evaporative cooling with misted water and airflow
  • Wet sheets with fans
  • Cold packs at major vessels
  • Removal of excess clothing
  • Air-conditioned transport

Cold packs alone are usually not enough for severe heat stroke. Pick the method that actually lowers core temperature without compromising airway management, resuscitation or safe transport. Cold-water immersion is particularly effective in exertional heat stroke when it can be performed safely and in line with local protocol.

4Keep Cooling During Transport

Cooling and transport are not competing priorities. A critically ill patient should not experience an unnecessary transport delay, but active cooling can usually continue during packaging and transport. Notify the receiving facility early when severe heat stroke is suspected.

Your Crew Is Exposed Too

The same weather generating the call volume is working on the people answering it.

Exposure adds up while:

  • Working on hot pavement
  • Carrying patients and equipment
  • Wearing protective clothing
  • Standing by at outdoor events
  • Working fires
  • Managing prolonged extrications
  • Running back-to-back calls without recovery time

Heat stress degrades concentration, coordination and decision-making before most providers notice their own symptoms. Partners should watch each other for unusual fatigue, confusion, headache, nausea, weakness or behavior changes.

Water, Rest and Shade

OSHA's heat guidance centers on three basics: water, rest and shade.

Crews need regular access to cool drinking water and should not use thirst as the trigger to drink. Over longer exposures, electrolyte-containing fluids may also be appropriate. Rest breaks should get more frequent as heat stress climbs, and should happen somewhere shaded, cooled or air conditioned. Remember that PPE itself increases heat stress by limiting the body's ability to shed heat.

Acclimatization Matters

Acclimatization is the gradual adaptation that lets the body work in heat. New employees, personnel returning after an extended absence and anyone hit with a sudden jump in temperature may not be acclimatized.

OSHA recommends increasing heat exposure gradually, building in more frequent breaks and monitoring workers closely during that period. EMS and fire agencies should apply the same thinking to new hires, academy students and personnel returning from leave.

Agency Preparation for Extreme Heat

Worth reviewing before the next stretch of triple digits:

  • Ambulance air-conditioning systems
  • Drinking water stock
  • Cooling supplies
  • Exertional heat stroke protocols
  • Training on recognizing mental-status changes
  • Incident rehabilitation procedures
  • Crew rotation during prolonged incidents
  • Heat index or wet-bulb globe temperature monitoring
  • Buddy system during high-heat operations
  • Receiving facilities equipped to treat severe hyperthermia

Documentation matters as well. Encourage personnel to record estimated duration of heat exposure, environmental conditions, mental status, temperature when obtainable and every cooling intervention performed.

Community Prevention Reduces Call Volume

Public education prevents heat illness and heads off avoidable 911 calls. Encourage community members to:

  • Drink water throughout the day
  • Avoid strenuous activity during peak heat
  • Take frequent cooling breaks
  • Wear lightweight, loose-fitting clothing
  • Check on older adults and vulnerable neighbors
  • Never leave children or pets in parked vehicles
  • Know the symptoms of heat exhaustion and heat stroke
  • Call 911 for confusion, seizures, unconsciousness or other signs of severe heat illness

Living in Texas for twenty years does not make anyone heat-proof. Acclimatization and experience reduce risk. They do not eliminate it.

What the Austin Numbers Mean for EMS

The rise in heat-related incidents in Austin-Travis County shows how fast extreme temperatures can strain an EMS system. Heat emergencies drive call volume, tax field personnel and produce patients who deteriorate on scene.

The skills that matter are recognizing progression along the heat illness spectrum, catching CNS changes early and starting effective cooling as quickly as conditions allow. The other half of the job is protecting your own clinicians through hydration, rehab, crew rotation and heat-safety training.

Get CE Credit for Heat-Related Emergencies

CE Solutions offers heat-related emergency education within its online EMS course library. Eligible courses may be available through Full and Core NREMT recertification packages based on provider level and package enrollment.

Browse Recertification Packages

Clinical treatment should always follow your scope of practice, local protocols and medical direction. This article is provided for educational purposes and does not replace agency protocol or online medical control.

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