Exertional Heat Injury: Field Management

1. Exertional Heat Injury: Field Management American College of Sports Medicine Annual Meeting New Orleans, LA May 31, 2007

2. Speakers • Steve Blivin • 3rd Marine Logistics Group • Okinawa, Japan • Yuval Heled • Heller Institute • Ramat Gan, Israel

3. Learning Objectives 1. Understand that EHI is fairly common in hot training environments. 2. Understand the basic principles of clinical assessment and immediate management of EHI. 3. Review Field Preparation and Management of EHI 4. Review follow up and Return to Training Recommendations

4. Exertional Heat Illnesses • Exercise Associated Muscle Cramps – Skeletal Muscle • Heat Exhaustion – Orthostatic signs and symptoms without mental status or laboratory abnormalities • Heat Stroke – Orthostatic signs and symptoms with associated mental status and laboratory abnormalities

5. Risk Factors for EHI • Level of Exertion • Low Physical Fitness Level • Lack of Acclimatization • Overweight • Dehydration • Accumulative Affects of Heat • Previous Heat Related Injury • Other Factors - Sickle trait. Illness, Meds, EtOH

6. Non-EHI Injuries • Parade Syncope • Dehydration not due to exertion • Vasovagal reactions • Heat edema

7. Prevention of Heat Illness • Train when it is cool • Adjust pace and level of exertion • Adjust gear and uniform to weather • Maintain good hydration and dietary status • Eliminate unnecessary, severe exercises • Provide shade and rest periods • Consider accumulative effects of heat exposure

8. Clinical Features of Exertional Heat Illness • Non-specific symptoms: • thirst hyperventilation • weakness poor concentration • fatigue impaired judgement • myalgia anxiety • cramps hysteria • headache nausea • Perfuse sweating/dry skin

9. Differential Diagnosis • Exhaustion • Fever • Post-Exercise Positional Hypotension • Dehydration • Seizure Disorder • Attention Seeking