Heat Stroke and Heat Exhaustion Treatment in Johor Bahru

Heat exhaustion and heat stroke are often written about together as though they sit on a gentle gradient. They do not. One is an unpleasant afternoon; the other kills or leaves permanent brain injury, and the line between them is sharper than most people realise. **Heat exhaustion**: heavy sweating, cold clammy skin, weakness, dizziness, headache, nausea, muscle cramps, a fast weak pulse. The person is uncomfortable, possibly frightened, but **mentally normal**. They know where they are. They answer sensibly. **Heat stroke**: body temperature climbing past about 40°C, and — the decisive feature — **altered mental state**. Confusion, agitation, slurred speech, irrational behaviour, seizure or unconsciousness. The skin may be hot and dry because sweating has failed, but it can also still be wet, particularly in exertional heat stroke in a young worker. **Do not use dry skin as your test.** Use the mind. The rule to carry away: **if the person is not thinking clearly, treat it as heat stroke and call 999 immediately.** Heat stroke is a medical emergency on the level of a heart attack. The organs begin to fail as core temperature rises, and every minute at that temperature adds injury. Death and permanent disability are both realistic outcomes without emergency treatment. While waiting for the ambulance: move them into shade or air conditioning. Remove excess clothing. Cool them aggressively — cold water over the whole body, wet cloths with fanning, ice packs to the neck, armpits and groin. If they are fully alert and can swallow safely, give cool water; if they are confused or drowsy, **give nothing by mouth**. Do not leave them alone. Do not put them in a car to "cool down on the way" without calling first. For heat exhaustion: stop the activity, get into shade or air conditioning, lie down with legs raised, loosen clothing, cool the skin, and take fluids with electrolytes rather than plain water alone. If there is no clear improvement within about 30 minutes, or if confusion appears at any point, it is now an emergency.

Malaysia is hot and humid year-round, and the humidity is what makes it dangerous rather than merely uncomfortable. Sweat cools you by evaporating. When the air is already close to saturated, evaporation slows and the body's main cooling mechanism becomes progressively less effective — which is why 33°C in Johor is more physiologically demanding than 33°C in a dry climate. That is the everyday background. Then there is work. Around Masai and Pasir Gudang, a large share of the workforce is exposed to heat as a condition of the job: petrochemical plants, port and yard operations, fabrication and welding, foundries, boiler rooms, warehouses without air conditioning, construction, and outdoor maintenance. Add protective clothing — which is necessary and which also blocks evaporation — and the exposure rises further. Malaysian occupational safety law treats this as a recognised hazard. DOSH issued **Guidelines on Heat Stress Management at the Workplace in 2016**, and the accepted measurement is the **Wet Bulb Globe Temperature (WBGT)**, which combines air temperature, humidity, radiant heat and air movement into a single index — precisely because plain air temperature understates the risk in a humid environment. Workplaces are categorised by risk. **Low risk** carries minimal likelihood of excessive exposure. **Medium risk** requires general control measures including provision of drinking water and **pre-placement medical screening**. **High risk** requires further analysis and more substantial controls. That pre-placement screening duty matters to employers reading this. It is occupational health work — the same category as the FOMEMA examinations, audiometry and medical surveillance the clinic already provides for industrial employers in this district. If your workforce is heat-exposed and you have not addressed it, that is a gap in your obligations as well as a risk to your staff. The workers most at risk are not usually the careless ones. They are the newly arrived, who have not yet acclimatised; those returning after leave or illness, whose acclimatisation has been lost in as little as a week; those on medication that impairs heat tolerance; and the ones who will not stop because the shift is not finished.

Some people tolerate heat far less well than others, and several of the reasons are treatable or at least foreseeable. **Age at both ends.** Older adults sweat less, feel thirst less reliably, and more often take medication that impairs heat regulation. Infants and small children have a high surface area relative to body mass and cannot remove their own clothing or move themselves to shade. **Chronic illness.** Heart disease, chronic lung disease, kidney disease, obesity, and uncontrolled diabetes all reduce heat tolerance. Diabetes with nerve involvement can impair sweating directly. **Medications**, which are the part patients are almost never warned about: - Diuretics — increase fluid loss. - Beta blockers — blunt the heart's ability to increase output and redirect blood to the skin. - Anticholinergics, many antihistamines, some antidepressants and antipsychotics — reduce sweating. - ACE inhibitors and ARBs — affect fluid balance and thirst. If you work in heat and take any of these, that is worth a conversation rather than a discovery on a hot afternoon. The answer is rarely to stop the medication; it is usually to plan around it. **Alcohol the night before** is a substantially underestimated contributor — it dehydrates, and a worker starting a hot shift already depleted has less margin. **Acclimatisation** is real, protective and quickly lost. It develops over roughly one to two weeks of graded exposure and fades within about a week away. This is why heat illness clusters in the first days back after Raya, after annual leave, or in a new hire's first week. Employers who ease people back in are not being soft; they are managing a known risk window. **Dehydration** compounds everything. Thirst is a late signal — by the time you feel thirsty you are already behind. Urine colour is the practical guide: pale is adequate, dark means catching up. In prolonged heavy sweating, plain water alone is not enough, because sodium is lost as well; electrolyte replacement matters, and drinking large volumes of plain water while sweating heavily can dilute blood sodium dangerously.

Advice that ignores how work is done gets ignored. These are the measures that survive contact with a real shift. **Drink to a schedule, not to thirst.** Roughly a cup every 15 to 20 minutes during heavy work in heat, rather than a large volume at break. Employers should place water where the work is; water in a room ten minutes' walk away does not get drunk. **Use electrolytes for prolonged sweating.** Oral rehydration salts, or an electrolyte drink, rather than water alone across a long hot shift. **Schedule the heaviest work for the coolest part of the day**, and build in rest breaks in shade or air conditioning. Rest in a cool place restores far more than rest in the heat. **Acclimatise new and returning workers over one to two weeks**, with graded exposure rather than full duties on day one. **Use the buddy system.** The defining feature of heat stroke is confusion, and a confused person cannot assess themselves. Colleagues notice it first — and everyone on a heat-exposed site should know that a worker who becomes irritable, stops making sense, or seems drunk needs cooling and an ambulance, not a telling-off. **Train supervisors to recognise it**, and make it genuinely acceptable to stop. Most heat stroke happens in someone who kept going. For everyone else: avoid strenuous outdoor activity in the hottest hours, wear light loose clothing, never leave a child or an older person in a parked car even briefly, and check on elderly relatives living alone during hot spells. Come to the clinic if you have had heat exhaustion and feel unwell afterwards, if you get heat symptoms repeatedly, or if you work in heat and take any of the medications above and want a proper review. For employers: pre-placement and periodic medical screening for heat-exposed workers is part of the occupational health service here, alongside FOMEMA, audiometry and pre-employment medicals. We are at No. 62, Jalan Kiambang, Taman Bunga Raya, 81700 Masai, Johor — close to the Pasir Gudang industrial area — open Monday to Thursday and Saturday 9AM to 9PM, Friday and Sunday 9AM to 3PM. Call +60 7-251 1162 and ask for occupational health. **And once more, because it is the whole page: confusion means heat stroke, and heat stroke means 999.**