What actually governs a sweat lodge ceremony among the nations that hold it is a body of protocol that has almost nothing to do with the amount of heat involved, which is exactly what the imitations that have caused documented deaths get wrong. Among the Lakota, the inipi is conducted by a leader trained over years, often in an apprenticeship lasting a decade or more, who is responsible for the fire, the number and heating of the stones, the pacing of the rounds, the words spoken, and critically, an unbroken rule that anyone in the lodge may ask for the door to be opened and leave at any point without shame or refusal, a safety valve built into the ceremony's own structure rather than an accommodation added afterward.
Distinct nations, Dine, Anishinaabe, Cree, Blackfoot among others, maintain their own versions with their own leadership requirements, their own songs and their own understanding of what the ceremony does, and Indigenous commentators have specifically objected to treating these as one interchangeable practice, since that flattening is part of what makes an unqualified imitation dangerous: a leader who has not learned the actual protocol from an actual tradition does not know what makes the ceremony safe, only what it looks like from outside. That distinction is not abstract. Fatal incidents run by people without standing to lead the ceremony have occurred in commercial retreat settings, and Native leaders and organisations have been explicit in response that these events were not sweat lodge ceremonies conducted wrongly but an appropriation of the form entirely detached from the tradition and the training that make it what it is.