FORT CAMPBELL, Ky. -- As summer temperatures rise into the 90s on a regular basis, heat is becoming a serious risk factor with any outdoor activities.
According to Capt. Rachel Butler, environmental health, Blanchfield Army Community Hospital, the best way to prevent heat-related injuries is by abiding by a work-rest cycle.
"What you want to do is essentially take into account how hard you're working," she said.
OSHA examples of hard work include push mowing, laying concrete, using a wheel barrow to garden or even simply climbing ladders or stairs. On days when the index reaches category five every day, like it has for the past few days, workers should rest about 45 minutes for every 15 minutes in the sun.
"Just like thirst -- people say thirst isn't a good indicator for drinking. You shouldn't wait until you're thirsty to rehydrate," Butler said. "You shouldn't wait until you're miserable to rest. Especially if you're going to be doing a prolonged activity, whether it's at work or at home."
Butler emphasized that rest only means moving out of direct sunlight as opposed to a complete loss of productivity.
"Rest doesn't mean you have to go back in the shade and sip pina coladas or water and kick your heels up," she said. "You can still -- whether it's at work or at home -- you can still be productive. At home, you could be in the shade reading, or if you're gardening, sitting down. Doing something restful essentially."
Several work examples she gave included attending meetings, catching up on paperwork or doing training on computers indoors. Butler said anyone unsure of what constitutes different levels of activity is welcome to call her office for the guidelines.
She said there are several work-rest cycle guidelines available, one designed for military members and two others for civilians that can be found on the OSHA and American College of Government Industrial Hygienists websites.
"If you Google work-rest cycle [the military one] is going to pop up, that's the easiest to find," Butler said. "But keep in mind that that's geared toward military, so you'd want to err on the side of caution. Generally when you find civilian guidelines, they tend to be more gentle on you."
Every set of work-rest cycles are predicated on the Wet Bulb Globe Temperature Index, a measure of the heat stress in direct sunlight which takes into account: temperature, humidity, wind speed, sun angle and radiant temperature. This differs from the heat index, which takes into consideration only temperature and humidity and is calculated for shady areas.
"When you're listening to the weather forecast, you definitely want to take humidity into account, and also the sun exposure you're getting," Butler said. "When it's humid and sunny, your [WBGT] reading is going to be much higher."
Butler said Environmental Health has a WBGT monitor outside their office, since it's a relatively central location on post, and they have an audio recording updated hourly during business hours, 7:30 a.m. until 4 p.m., to keep Soldiers and Families informed. On weekends and days of no scheduled activities, or simply outside of business hours, Butler said they could also go online at www.srh.noaa.gov/tsa. Simply input the city and state or the zip code and the National Weather Service Weather Forecast Office webpage will provide the information for the area you are currently.
Butler also pointed out that heat is cumulative in the body, so even if the day isn't excessively hot, people who regularly work outdoors are still at risk of heat exhaustion or stroke.
"Let's say you're going to work Tuesday, and it's early in the morning and it's not even that hot out yet. You have to keep in mind you could still experience a heat injury because of what you were doing the days prior. Say you went out to the beach where you were out in the sun Saturday and Sunday you were playing flag football with the Family -- or even just laying in the pool with your kids. Then you go to work on Monday and you're active out in the sun. Come Tuesday, you're going to be a lot more susceptible."
Rather than give up Family fun on weekends, Butler suggested that people make sure they stay hydrated and remember to rest regularly, not just when fatigue sets in, both on the job and off.
"Just protecting yourself," she said.
She suggested that anyone choosing to exercise outdoors not do so alone on the chance that heat causes them to pass out. If exercising with a buddy isn't an option, she suggested sharing your schedule with another person and staying in public places where the odds of being seen or found shortly after passing out are greater.
"Don't go for a run in the woods by yourself when it's hot," Butler said. "Or even if it's not hot at that time if we're talking about cumulative stress."
She said the best option for summer exercise is swimming because it provides a good cardio workout while still keeping the swimmer's body temperature low.
Butler added that sunburn, in addition to the immediate pain and long-term links to cancer, was something that could increase the risk of heat injuries.
"It makes you susceptible to a rise in core body temperatures as well because it's a stressor on your body, and depending on how severe and how much of your body it's covering, it's drying out your skin, you're going to be losing more moisture while you have that sunburn and your body is working hard to recover," Butler said. "So it increases your risk of a more serious injury such as heat stroke."
She suggested applying sunscreen at least every two hours, making sure to cover sensitive spots such as lips and hair parts. Depending on how fair skinned a person is and the type of clothes they're wearing, she suggested applying it under clothes as well.
She said there are a variety of individual risk factors that vary from person to person, including acclimatization, illness, stress, fatigue, inadequate caloric intake and medications, such as antihistamines. She said many of the heat incidents they see at the hospital are the result of a combination of the risk factors.
"If you're managing new people you may not realize all this is going on with them," Butler said. "It's hard enough to know about yourself and your best friend, let alone your coworkers."
Even the cleanliness of clothes can contribute to heat related injuries. Butler said in the military especially, it's common for Soldier to wash their undershirts regularly, but to wear ACU jackets repeatedly between cleanings. As the grim builds up, the material breaths less, and more ambient heat is trapped against the Soldier's skin.
Although heat exhaustion can be dealt with through breaks and water to cool down the sufferer, Butler said that any signs of heat stroke should be dealt with by immediately calling for emergency medical services.
"There's a very understandable perception that with heat stroke someone passes out cause it's just there in the name, but you can have a heat stroke on your hands and that person is still conscious," she said. "The medical indicator is a body temperature of over 100 degrees Fahrenheit. If you go into a medical office and you've been doing any sort of physical activity to increase your core temperature, if it's over 100 degrees Fahrenheit, you're a heat stroke."
Butler said while waiting for medical assistance for heat stroke, it's imperative to lower the body temperature of the victim as quickly as possible. She said to move the person into the shade or into air conditioning if it's an option. Remove the victim's clothing and apply cold water to their body. If possible, turn a fan on to them as well and cover them in sheets soaked in ice water. Ice should also be packed into the armpits, groins and along the sides of the torso.
"Not just the cold hitting their body, but as the water evaporates, that'll essentially get the heat away from their body," she said. "The key is really just anything you can do to rapidly lower their body temperature. We're not looking for comfort here -- if they're conscious, they'll be very uncomfortable."
She added that if the victim is unconscious or vomiting, they should not be forced to drink water because that will only make the situation worse. Only an alert victim should be given cold water.
Butler said the best way to avoid heat incidents is to be prepared before ever going out into the sun and the heat.
"The biggest mistake is just not having a plan in place -- essentially being reactive rather than proactive," she said. "Proactivity can be hard, because it's essential that you have to know your people, known risk factor and have those practices … to not wait for signs of heat stress."
She said Families should plan rests ahead of time when going on outings, or even just playing in their own yards. She also suggested parents enforce children resting and rehydrating every 30 to 45 minutes during the summer depending on their age and how they're playing.
"With children, they're not able to keep aware of everything, so it's on you as that parent or guardian to essentially monitor it for them," Butler said.
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