FORT BENNING, Ga. (March 20, 2018) -- A team of doctors at the Martin Army Community Hospital at Fort Benning, Georgia, are working hard on ways to prevent heat-related deaths across the Department of Defense by establishing a heat center on post.
Maj. (Dr.) Meghan Galer, the assistant director of the MACH's Department of Emergency Medical Services, has been one of the biggest driving forces behind the establishment and creation of the center, and according to her, prevention must first start with the way people approach heat-related injuries and illnesses.
"In an effort to prevent heat stroke, we have this culture of drink water, drink water, drink water. But if you drink too much water, you basically dilute the electrolytes in your body, specifically the sodium," said Galer. "When that happens, fluid shifts in your body, specifically in your brain, and your brain swells, and because of your skull, it has nowhere to go."
This condition is known has hyponatremia and can be caused by someone over-hydrating.
Although Fort Benning did not see any deaths in 2017 from hyponatremia or other heat-related illnesses, Galer said the numbers were still alarmingly high at 300 cases, with approximately 60 of those being related to heat stroke.
"When we looked at the numbers last year, I was like, 'God, this is a ton of freaking heat strokes.' There's nowhere else that sees this volume of heat strokes," Galer said.
Thus the idea came about of establishing a heat center geared toward perfecting a triad, or three-pronged approach to heat illnesses and injuries, which involves management, prevention and education, and research.
"We're rocking the management part, because we know what we're doing in the ER, but we also have protocols that go all the way forward to the point of injury," Galer said. "Last year was the first year we protocoled all the way to the point of injury. There's protocols for the drill sergeants. There's protocols for the 68Ws (combat medics). There's protocols for EMS, and protocols for when they get to the emergency room."
With these protocols, everyone plays a role in the patient's care from the time he or she shows signs of a heat injury or illness. More importantly, the focus is to manage the patient in order to prevent him or her from going into hyponatremia, which can be a catch-22, according to Galer, since most people equate heat prevention and treatment to drinking a lot of fluids.
"Our medics, or anyone at the scene, are not allowed to give more than one liter of ice-cold fluid until they know what the patient's sodium is," Galer said.
This determination is made by Fort Benning EMS personnel, who arrive to the scene equipped with an iStat machine, which provides a real-time measurement of the patient's sodium levels.
Nonetheless, medics at the scene, per their protocol, are instructed to remove the patient's clothing, perform ice sheeting measures and retrieve a rectal temperature while waiting for EMS personnel to arrive with the iStat.
"There isn't anywhere else that I know of that pushes these machines out to the ambulances," Galer said. "Following these protocols has made a huge difference."
The second principle of the triad, prevention and education, is where the focus will be on making sure everyone is informed and trained at the lowest level. The hospital is scheduled to host its second Heat Forum March 21 and 22, where leaders on both the training and medical sides will come together to discuss each other's obstacles and successes.
"It's important to get the medical leaders and the non-medical leaders on the same page," said Galer. "We've got to discuss each other's challenges, what works, what doesn't work, because we all have the same goal, and that's no more deaths from heat hyponatremia."
Medics at the scene also have begun to fill out heat cards starting with the point of injury.
"These patients come in with little pink cards that tell us what they were doing when they went down, what their initial temperature was, and what their iStat was, and we track that," Galer said. "We are looking for trends. What are our high-risk events? What are the factors that put these kids at higher risk for heat stroke? This is all part of the prevention. "
The third and final principle of the triad, research, is something Galer said they absolutely have an obligation to do.
"We've partnered with other research organizations for two big research studies coming up," Galer said.
One study will focus on all individualized risk factors such as genetics, which can determine whether a person is more susceptible to heat injuries. Through this type of research, it can be determined whether or not a trainee should do basic training at certain locations during the summer months. The other study will focus on non-invasive core temperature measurements.
Whether looking at short-term treatment or long-term research, the goal is to save lives.
"We think we have a good model that we can push out to the rest of the Army's hot-climate training posts, and the rest of the Department of the Defense in the hopes of saving some lives," said Galer.