Heatstroke (classical or exertional) can be isolated or endemic, with the duration of heat exposure after collapse probably the most critical factor in determining mortality. Heatstroke occurring during military basic training involves short exposure time and rapid treatment ( A§h..,a.Dd Kashmeery 19.9.5), whereas under other conditions (e.g. military exercises, Mexican aliens locked in trucks, mine accidents, prisons, and stockades) exposure is severe and prolonged. Urban cases are usually sporadic but can be endemic during heat waves.

Examples of isolated cases of heatstroke include the following: occupational exertion, children in locked cars, exposure associated with mental illness or retardation, drug abuse (amphetamines, LSD, cocaine), alcohol abuse, injury, athletic training and competition, neuroleptic medication (haloperidol), and malignant hyperthermia (anesthesia).

Moderately high internal temperatures (42-43 °C) for very brief periods (5-10 min) produce little damage and probably only require removal of the heat source

(Sminia..§131, 1994). The heat syncope seen in Denver, Colorado, during the papal visit in 1993 resulted in 18 000 symptomatic victims with no mortality since immediate relief was available. However, heat waves in Chicago, Illinois, in 1995 and Adelaide, South Australia, in February 1993, with prolonged exposure, resulted in the full-blown picture of multisystem damage. The delayed discovery of comatose elderly victims was responsible for the increased mortality ( Ash and Kashmeery 1995).

Air-conditioned ambulances are available at the Mecca pilgrimage (Hajj) but their arrival at the scene is often delayed due to severe traffic congestion. Owing to lack of shade and evaporative cooling, there is little relief from prolonged environmental exposure to heat, and so heatstroke is a serious problem.

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