- Devi Prasad Ahirwar, a 54-year-old migrant worker posted as a security guard, is one among hundreds exposed to the extreme heat in Delhi. He is also one of the few to survive a near-fatal heat stroke.
- Unlike heat stress or other heat-related illnesses, heat strokes are life-threatening and time-sensitive conditions. When the body’s thermoregulation levels breach, it can cause the central nervous system to dysfunction and organs to fail.
- A number of factors contributed to Devi Prasad’s vulnerability, including lack of access to health benefits, a liveable wage, and job security.
- Heat Action Plans need to do more than identify vulnerable groups based on broad categories like gender, and engage with institutional groups to improve awareness and resilience, say experts.
In the grips of a prolonged heatwave this summer season, Delhi’s hospitals were faced with a harsh reality: when a patient suffering from severe heat stroke was rushed into the emergency, the prognosis was poor. Most patients tended to be male, with mortality rates spiking to more than 70% on some days. It was touch-and-go for Devi Prasad Ahirwar, who spent six days unconscious and on a ventilator before what his family said was a miracle. He woke up and survived the worst.
Maximum temperatures were higher than usual across most parts of India this summer. The national capital endured its longest heat spell in 13 years, according to the India Meteorological Department. Labourers and outdoor workers from low-income groups, like Devi Prasad, were the worst hit. Hospitals were inundated with emergency heat stroke cases by mid-June, with the crisis abating after the weather turned on June 20.
The unusual heat and high heat stroke deaths reported in the national capital have prompted conversation on the need for effective heat action plans (HAPs) to mitigate impacts. But 54-year-old Devi Prasad’s story demonstrates that vulnerability to heat stress is woven by a complex web of factors that go beyond just central planning, and that survival for the poorest is driven, in part, by sheer luck.
It was on June 18, when maximum temperatures reached 44 degrees Celsius after two weeks of unrelenting heat, that Devi Prasad collapsed while on guard duty. He was posted in the posh neighbourhood of Noida Sector 50 and was rushed to Neo Super Specialty Hospital nearby at approximately 3:30 in the afternoon.
Gasping and unconscious with a fever of 106 degrees Celsius, the hospital announced a “code blue” according to his prescription – a medical emergency usually caused by cardiac or respiratory arrest. He was administered a cold saline drip, sponged to cool his body, intubated, and then sent to the Intensive Care Unit. “I don’t really remember falling unconscious, or anything from that day,” Devi Prasad said.

What heat stress does to the body
Unlike heat stress or other heat-related illnesses, heat strokes are life-threatening and time-sensitive conditions. Heat stroke can set in when exhaustion from heat is not treated, and the body’s thermoregulation limits are breached without any way to shed the excess heat. It can cause the central nervous system to dysfunction and organs to fail.
Devi Prasad reached the hospital in critical time, but others weren’t so lucky. “We saw four other people who were admitted due to heatstroke die within an hour of arriving,” said Vinod Kumar, Devi Prasad’s son-in-law. “We were so scared our father would die too.”
The primary treatment is to rapidly cool the body down without delay. Some hospitals in Delhi adapted by creating specialised heat stroke units to deal with the influx of patients. At Ram Manohar Lohia Hospital, a heat unit with two cement immersion tubs and a large ice dispenser had been set up under the leadership of Dr. Ajay Chauhan, a heat specialist who contributed to the national guidelines on emergency cooling for heat-related illness. “Early cooling can save lives, but when patients arrive after a delay, there’s very little that can be done. Despite our best efforts, we saw a mortality of 60 to 70 percent,” he said. “When someone collapses from heat stroke, the most important thing to do is to splash water on their bodies from the neck down.”
Bystanders who noticed Devi Prasad collapse had the presence of mind to splash water on him and grew alarmed when he didn’t respond. This small measure could have contributed to his survival, doctors where he was admitted said.