The brief
This brief is constructed for the sample. No scoping conversation took place and no subject matter expert was consulted. It shows the shape a real brief takes and what it commits to before production starts. The clinical review it names has not happened, and that is restated at the end of the page.
- Learner and context
- Undergraduate public health students in the term before field placement. Likely to be present at outdoor events, worksites and athletic settings as observers or staff, without clinical credentials
- Observable problem
- Students apply the heuristic they were taught in general first aid: hot, dry skin means heat stroke. In exertional cases, which is what they will actually encounter, the person is usually still sweating. The rule tells them it is not heat stroke at the moment it is
- Outcomes
-
- Discriminate heat exhaustion from suspected heat stroke using mental status as the primary criterion
- Initiate the correct response and escalation for each
- Identify skin condition as a cue that should not drive the decision
- Format
- Self-paced web module, roughly 15 minutes, plus a printable field card
- Out of scope
- Clinical management after EMS arrival; rectal thermometry technique; pediatric and geriatric variation; medication-related heat risk; heat cramps and heat syncope
- Expert supplies
- Verification of thresholds, alignment with current guidance, sign-off
- Designer supplies
- Sequence, outcomes, item construction, format, accessibility, production
Why it is built this way
This is a discrimination problem, not a knowledge problem
The brief assumes a specific learner problem, and for a real build that assumption is what the scoping conversation would test. The assumption here is that students can define both conditions but struggle to separate them in front of a person, quickly, when the visible signs contradict the rule they were taught.
If that is right, the design follows from it. A knowledge problem is addressed with clear exposition and a recall check. A discrimination problem needs contrasting cases side by side, an explicit account of which cue to trust and which to discard, and practice concentrated on the confusable boundary.
So there is no section listing the features of heat exhaustion followed by a section listing the features of heat stroke. Everything is presented comparatively, and all three practice items sit on the boundary.
The lesson
One question decides the response
Both conditions arise from the same process and sit on the same continuum. The line between them is not a matter of degree in how unwell the person looks. It is whether the central nervous system is affected.
| Finding | Heat exhaustion | Suspected heat stroke |
|---|---|---|
| Mental status | Intact. Oriented, answers questions coherently, follows instructions | Altered. Confusion, slurred speech, unusual aggression, ataxia, seizure, collapse |
| Core temperature | Elevated, typically below 40 °C (104 °F) | Typically above 40 °C (104 °F), though not always |
| Skin | Usually cool, pale, clammy, heavy sweating | May be hot and dry, or wet with sweat. Not a reliable discriminator |
| What it requires | Active cooling, rest, fluids, monitoring | Emergency response. Call for help and begin cooling immediately |
The shaded row is the one that decides. The question to ask is whether they are thinking clearly, not how hot they feel or how much they are sweating.
The cue that misleads
General first aid training commonly teaches that heat stroke presents with hot, dry skin. That description fits classic heat stroke, which typically affects older adults and people with chronic illness during sustained heat events, where the sweating response has failed.
It does not fit exertional heat stroke, which occurs in people who are physically active in the heat. There, absence of sweating is an uncommon finding, and prolonged sweating often continues after activity stops. A young worker or athlete in the middle of exertional heat stroke is frequently drenched.
As a student on placement at an outdoor event, a construction site or a training ground, the exertional case is the one you are most likely to meet. Applying the dry-skin rule there will tell you the person is fine at the moment they are most in danger.
What to do
Mental status intact
- Move them out of the heat, into shade or air conditioning
- Loosen or remove excess clothing and equipment
- Cool actively: wet cloths, fanning, cool packs to neck, armpits and groin
- Give water or an electrolyte drink if they are fully alert and able to swallow
- Stay with them and keep watching mental status
- In a workplace setting, arrange medical evaluation. NIOSH directs that a worker with heat exhaustion be taken to a clinic or emergency room, and that you call 911 if medical care is not available
- Escalate immediately if their thinking changes at any point, if they cannot keep fluids down, or if there is no improvement within about 30 minutes
Mental status altered
- Call emergency services immediately. Do this first
- Begin cooling at once. Do not wait for transport to start it
- Cold or ice water immersion is the most effective method where it is available and someone is trained to use it
- If immersion is unavailable: soak them, fan continuously, apply ice packs to neck, armpits and groin
- Do not give fluids by mouth to anyone who is confused or not fully alert
- Keep cooling until help arrives and takes over
Current guidance for exertional heat stroke is to cool first and transport second where trained staff and equipment are on site, because the interval spent waiting for and riding in an ambulance is time at a dangerous core temperature. Your role as a student is not to run that protocol. It is to recognize the emergency, summon help without hesitating, and start cooling with whatever is at hand.
Knowledge check
Three items, each placed on the boundary between the two conditions. The reasoning behind each set of wrong answers is available under every item, closed until you want it.
Item 1 of 3
You are assisting at an outdoor summer festival. A 19-year-old volunteer sits down heavily and cannot tell you what city he is in. His shirt is soaked through and his skin is wet. What do you do?
Designer’s notes on this item
A is the item’s purpose. It rewards the dry-skin heuristic, and a learner who has not unlearned that rule will take it. The feedback names the rule instead of only marking the answer wrong.
B tests a different failure, deferring action for a measurement. It appeals to careful students, which is what makes it useful here.
D is a contraindication check. Oral fluids with altered mental status carry an aspiration risk, and the option looks plausible because giving fluids is correct in the other condition.
Item 2 of 3
A groundskeeper on a worksite tells you he is dizzy and nauseated. He is sweating heavily, his skin is cool and clammy, and he answers every question you ask clearly and correctly. What is the priority?
Designer’s notes on this item
B checks over-reading. His mental status is intact, so the presentation does not fit heat stroke, and a module that only ever rewards the emergency response produces students who cannot triage.
C is the realistic workplace pressure and what often happens on sites. Naming it in an item is more useful than pretending it is absent.
D is the option that catches careful students, and it is why the scenario sits on a worksite. Cooling and fluids are correct as far as they go, but NIOSH directs medical evaluation for an occupational case. Feeling better is not a discharge criterion.
Item 3 of 3
You are assessing someone who has been working in high heat. Which single finding should most change what you do next?
Designer’s notes on this item
A and C are the same error stated two ways. Splitting it across two options means a learner who still holds the skin heuristic has two chances to reveal it, which a single option would let a lucky guess conceal.
B is a real symptom of both conditions, which makes it the honest distractor: accurate information with no discriminating power.
A single wrong answer here would not establish that the misconception survived. It could be misreading, guessing, or a different confusion. The signal worth watching is the pattern across a cohort.
The field card
The card is what a student carries into the field, and it is organized around the deciding question instead of around the two conditions. It is designed to support recall at the moment of use, when the module itself will not be to hand.
Ask first: are they thinking clearly?
Confused, slurred, unsteady, unusually aggressive, or not fully awake all count as no.YES, thinking clearly
Treat as heat exhaustion
- Out of the heat
- Loosen clothing and gear
- Cool actively, neck, armpits, groin
- Fluids if fully alert
- Stay and keep watching
- At work: medical evaluation. 911 if care unavailable
- Thinking changes, or no better in 30 min, escalate
NO, or unsure
Treat as heat stroke until proven otherwise
- Call for help first
- Start cooling immediately
- Immersion if available, otherwise soak, fan, ice packs
- Nothing by mouth
- Keep cooling until help takes over
Skin condition is absent from the card on purpose. A job aid that lists an unreliable cue invites the learner to use it, and this one is designed to make that cue unavailable at the moment of decision.
What this measures, and what it does not
No learners have taken this check, so there are no results to report. What it is designed to assess is discrimination in a written scenario, under no time pressure, with four options visible and nothing else competing for attention. Performance on it would sit at Kirkpatrick Level 2, and would speak to whether the misconception has weakened in a classroom setting.
The outcome anyone actually cares about is whether a student recognizes the emergency in a field, at an event, with a supervisor nearby and social pressure not to overreact. Measuring that requires observation during placement or a structured preceptor report, designed before the module launches instead of added afterward. Performance on these items would not on its own establish transfer to field practice.
Item three is the one to watch across a cohort. If learners keep selecting the two skin-condition options after working through the comparison and the flagged section, that pattern would suggest the instruction is not correcting the heuristic and the module needs rebuilding.
The clinical thresholds on this page are drawn from published guidance and would require subject matter expert verification and a dated citation before any real deployment. That review is the expert's round one, and it is the step this sample deliberately shows rather than hides.
The field problem named above, recognizing the emergency with a supervisor nearby and pressure not to overreact, is what the companion scenario puts on screen. The Second Day takes the same judgment onto a worksite, with a new worker who says he is fine and a supervisor who wants the job finished.
Instructional design sample. Not clinical guidance and not a substitute for accredited first aid training.
Clinical content drawn from: Heat Stroke, StatPearls (NCBI Bookshelf) for diagnostic criteria and the anhidrosis finding in exertional presentation; CDC/NIOSH heat stress guidance for occupational first aid and the medical evaluation requirement; exertional heat stroke guidance on cool first, transport second for the cooling sequence; Cleveland Clinic for general comparison.