FORT LEE, Va. -- Despite well documented and effective techniques for preventing heat illnesses, they continue to be a threat to Soldiers in training and combat.
Even mild heat illness and dehydration can significantly degrade performance. The best solution is prevention
All cadre must receive heat illness prevention training to improve their ability to recognize signs and symptoms of heat illness for themselves, fellow cadre and trainees and improve communication of heat illness.
Everyone needs to monitor heat conditions, not just the temperature but the wet bulb globe temperature, or what it feels like due to humidity. Cadre needs to assess the availability and serviceability of WBGTs, arm immersion cooling systems), ice sheets, and availability of potable water prior to training starting.
Leaders must identify and assess the hazards, know the WBGT, and the risk factors for exertional heat illness, i.e., the environment, training activity, and individual risk characteristics; and apply these steps in the risk management process.
It’s important to develop and implement controls, supervise, and evaluate. Cadre must provide iced sheets at training sites in hot weather conditions; consider ice usage (e.g., AICS, iced sheets) in planning factors for their heat mitigation plan; identify high-risk personnel; utilize the buddy system; ensure Soldiers are hydrated prior to, during, and after an event; implement work/rest and continuous work cycles; use heat risk mitigation methods (e.g., uniform modification, time of day consideration); ensure use of sunscreen; and modify training, as appropriate.
It’s important to consider previous two days of heat exposure and the heat category for that day when determining what types of training is going to be conducted. Cadre must consider the type of training events (distance, pace, breaks and work/rest cycle as well as modifying the required uniform and training, if necessary
Proper nutrition measures assist in mitigating and/or reducing heat illnesses and hyponatremia. A proper nutrition plan is essential for eating and hydrating before, during, and after physical training. Some dietary and performance supplements contain stimulants that may result in adverse effects such as nervousness, headache, irregular heartbeat, and high blood pressure. These effects may increase the risk of dehydration and heat illness.
It's vital to remember the conditions associated with heat illnesses:
(1) Heat exhaustion – A milder form of heat illness that may include acute dehydration, symptoms include dizziness, headache, nausea, weakness, unsteady walk, and muscle cramps. Mental status is normal, and individuals may have core temperature elevation between 100.5 degrees and 104 degrees. Any alteration of mental status is mild and resolves quickly with rest and cooling measures.
(2) Heat stroke – This condition is the most severe heat illness and is a life-threatening medical emergency. Heat stroke can cause damage to the brain and other essential organs and has a high fatality rate if not appropriately identified and promptly treated. Heat stroke victims have altered mental status and typically an elevated core temperature greater than 104 degrees. Immediate cooling with iced sheets (or other local protocol) is lifesaving and rapid evacuation once cooling has been initiated is critical to improving the chance of survival.
(3) Rhabdomyolysis– A severe exercise-induced injury of muscle fibers that involves the release of muscle proteins into the bloodstream resulting in acute kidney injury. Rhabdo can occur any time of year and without regard to ambient temperature. Individuals may experience severe muscle symptoms (pain, weakness, and swelling) in the muscles affected. Individuals often report very dark 'Coca-Cola colored’ urine. Without medical treatment, kidney failure may result.
(4) Hyponatremia – Also called water intoxication. A condition that occurs when the level of sodium (salt) in the blood is abnormally low due to insufficient sodium intake from food or too much water intake. In the training environment, exertional hyponatremia typically occurs as a result of excessive water intake combined with little to no sodium intake, particularly when sodium is being lost via sweating. Hyponatremia may appear similar to heat stroke as both conditions are characterized by altered mental status. To distinguish from heat stroke, it is imperative that leaders question the individual about his or her fluid intake over the previous 24 hours as additional fluids could worsen hyponatremia and obtain a core body temperature as soon as possible. If the casualty is unable to respond or it is otherwise difficult to make determination, heat stroke should be assumed,
and cooling techniques should be initiated.
Soldiers who collapse should immediately be directed to rest in the shade, loosen their clothing, and remove head gear to help rid their body of any excess heat. Be prepared to treat all personnel who collapse as a heat casualty with immediate cooling techniques (e.g., ice water immersion, if available, or iced sheets). For casualties with suspected heat stroke, apply an ice sheet and call 911. Do not self-transport. Timely activation of emergency medical services and application of iced sheets significantly improves survivability.
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