Heat Injury Prevention

1. During OIF1, six Soldiers died from heat injury. 28 suffered a heat stroke. Most heat injuries actually occur at CAT 0. Education and awareness are all that is needed to drastically reduce incidence. On deployment, the risks of heat injury are increased due to body armor, carrying a full combat load, working in desert environments, adrenaline, and not always having approved water sources available. The medical brigade in theater can tell when a new unit rotates in because of the spike in heat injuries. The camps’ medical facilities typically begin seeing heat casualties within the first week of a unit’s arrival. One unit that rotated through in summer 2004 evacuated as many as 10 percent of its Soldiers to the local Level II facility in a single day. During OIF1, six Soldiers died from heat injury. 28 suffered a heat stroke. Most heat injuries actually occur at CAT 0. Education and awareness are all that is needed to drastically reduce incidence. On deployment, the risks of heat injury are increased due to body armor, carrying a full combat load, working in desert environments, adrenaline, and not always having approved water sources available. The medical brigade in theater can tell when a new unit rotates in because of the spike in heat injuries. The camps’ medical facilities typically begin seeing heat casualties within the first week of a unit’s arrival. One unit that rotated through in summer 2004 evacuated as many as 10 percent of its Soldiers to the local Level II facility in a single day.

2. Heat Injury Hazards are Cumulative H- Heat category past 3 days E- Exertion level past 3 days A- Acclimation/ other individual risk factors T- Temperature/rest overnight Cluster of heat injuries on prior days= HIGH RISK

3. Poor fitness ( 2 mi run > 16 min) Large body mass Minor illness Drugs (cold and allergy, blood pressure) Highly motivated Individual Risk Factors

4. Individual Risk Factors Supplements- ephedra Recent alcohol use Prior heat injury Skin problems- rash, sunburn, poison ivy Age>40

5. Risk MitigationAvoid Heat Loading Modify schedule- time of day, rest Clothing- Loose layers Formations: Wide spacing Shade soldiers Cumulative- avoid strenuous back-to-back events

6. Risk MitigationDump Heat Load Cool overnight temp Cold showers

7. Develop Controls Track Wet Bulb Globe Temp (WBGT) Track hydration of Soldiers Fluid replacement/ work/ rest guidelines Keep urine lemonade color (light yellow) All unit leaders must be familiar with heat injury prevention and recognition Know the Soldiers who are high risk Ensure water points accessible/ utilized

8. Symptoms of Mild Injury Dizziness Headache Nausea Unsteady walk Weakness Muscle cramps These folks need rest, water, evaluation These are your “canaries in the mine”

9. Mild Heat Injury Management Rest Soldier in shade Loosen uniform/ remove head gear Have Soldier drink 2 quarts of water over 1 hour Evacuate if no improvement in 30 min, or if Soldier’s condition worsens

10. Heat Stroke Abnormal brain function- elevated body temperature Examples: Confused Combative Passed out Sudden death

11. Heat Stroke When a soldier’s brain isn’t working correctly- COOL and CALL Treat any soldier who develops abnormal brain function during warm weather activity as a heat stroke victim The sooner a victim with heat stroke is cooled, the less damage will be done to his brain and organs

12. Pre-Hospital Care Cooling is first priority- can reduce mortality from 50% to 5% Drench with water Fan Iced sheets Massage large muscles while cooling Stop if shivering occurs

13. May not be able to follow recommendations exactly due to mission requirements, however it is a guideline. Remember most injuries occur in Cat 0, this is because it is usually in the morning before we have had a chance to hydrate. May not be able to follow recommendations exactly due to mission requirements, however it is a guideline. Remember most injuries occur in Cat 0, this is because it is usually in the morning before we have had a chance to hydrate.

14. HEAT INJURY PREVENTION Hydration is the most important element in a plan to prevent heat casualties. Full hydration is critical to the prevention of heat casualties because it is essential to maintain both blood volume for thermoregulatory blood flow and sweating. Both are reduced by dehydration. Consequently, the dehydrated soldier has less ability to maintain body temperature in the heat. Water requirements are not reduced by any form of training or acclimatization. Exercises to teach soldiers to work or fight with less water are fruitless and dangerous. Units which have soldiers who do not drink because they do not have opportunities to urinate have a leadership problem. Unit leaders must reinforce of hydration by planning for all aspects of adequate hydration: elimination as well as consumption. In hot environments, water losses can reach 15 liters per day per soldier. Complete replacement requires realistic estimates of potable water requirements, an adequate water logistic system and soldiers who understand and act on their water requirement. Water for hygiene will be needed in addition to water for drinking. There is no advantage to carbohydrate/electrolyte beverages beyond their palatability which may encourage drinking. They should not be the sole source of water as they can be mildly hypertonic. DO no consume more than 12 quarts in one day.Hydration is the most important element in a plan to prevent heat casualties. Full hydration is critical to the prevention of heat casualties because it is essential to maintain both blood volume for thermoregulatory blood flow and sweating. Both are reduced by dehydration. Consequently, the dehydrated soldier has less ability to maintain body temperature in the heat. Water requirements are not reduced by any form of training or acclimatization. Exercises to teach soldiers to work or fight with less water are fruitless and dangerous. Units which have soldiers who do not drink because they do not have opportunities to urinate have a leadership problem. Unit leaders must reinforce of hydration by planning for all aspects of adequate hydration: elimination as well as consumption. In hot environments, water losses can reach 15 liters per day per soldier. Complete replacement requires realistic estimates of potable water requirements, an adequate water logistic system and soldiers who understand and act on their water requirement. Water for hygiene will be needed in addition to water for drinking. There is no advantage to carbohydrate/electrolyte beverages beyond their palatability which may encourage drinking. They should not be the sole source of water as they can be mildly hypertonic. DO no consume more than 12 quarts in one day.

15. Drugs that Interfere with Heat Regulation Antihistamines (benadryl, atarax, ctm) Decongestants (sudafed) High Blood Pressure (diuretics, beta blockers) Psychiatric Drugs (tricyclic antidepressants, antipsychotics)

16. ScenarioAwake Victim- Muscle Cramps/Headache Move to shade/ or air conditioning Remove outer layer of clothing/ headgear 2 canteens of water over 1 hour

17. ScenarioAwake Victim- Abnormal Behavior Move to shade Remove outer layer of clothing Call for evacuation Begin rapid cooling- iced sheets CLS qualified individuals may administer an IV after evacuation and cooling started

18. Water Intoxication Do not “Force Hydration” Mental status changes Vomiting History of large volume of water consumed Poor food intake Abdomen distended/bloated Copious clear urine One last thought– Keep Water Intoxication in mind if a person appears to have followed the heat/rest and hydration recommendations, but shows the symptoms listed. One last thought– Keep Water Intoxication in mind if a person appears to have followed the heat/rest and hydration recommendations, but shows the symptoms listed.