HEAT

HEAT INJURIES
INJURIES
 Types
Types of
of Heat
Heat Injury
Injury
 Heat Cramps

 Heat Exhaustion

 Heat Stroke
 Heat
Heat Cramps
Cramps
 Painful cramping of the larger muscle groups
 legs, arms, abdomen
 Due to excessive loss of salt through heavy sweating plus
several hours of sustained exertion
 acclimatization decreases risk
 Treatment
 shaded area
 massage arms/legs to increase circulation
 0.1% salt solution orally (1/2 tsp salt in 1-qt. Water), sports
drink, or salted food (MRE) plus fluid
 Heat
Heat Exhaustion
Exhaustion
 Symptoms:
 heavy sweating, headache, light-headed, nausea/vomiting, tingling sensations
 Temperature 99-104 F
 Cause:
 dehydration plus excessive salt depletion
 Treatment:
 shaded environment; loosen clothing
 If suspect early heat stroke, treat as such
 oral fluids if can drink
 cold water, 0.1% salt solution, or 6% carbohydrate beverage
 1-2 liters over 2-4 hours
 EVAC
 Heat
Heat Stroke
Stroke
 Symptoms:
 elevated temperature plus central nervous system
disturbance
 absence of sweating is a late finding
 Can begin as heat exhaustion and progress
 End-organ damage:
 brain damage, kidney failure, liver failure, blood
clotting abnormalities
 related to duration of elevated temperature
 Treatment
Treatment of
of Heat
Heat Stroke
Stroke
 ABC
 Unconscious patient may vomit and aspirate
 IV: no more than 2L unless circulatory collapse
 Lower the body temperature as fast as possible!
 All clothes off
 Cool water with fanning...increase evaporation
 Ice packs under groin or axilla
 EVAC...open doors/windows in helicopter/vehicle
 keep cooling to temp 101-102 F.
 Ice-water immersion: controversial
 USASOC and TB MED do not recommend
 Wilderness Medicine, 3rd ed. supports
 Risk
Risk Factors
Factors for
for Heat
Heat Stroke
Stroke
 Dehydration
 Respiratory and GI illnesses most common
 Alcohol use
 Laxatives and diuretics
 Medications
 Increase heat production and/or decrease heat loss
 pseudoephedrine, thyroid hormone, cocaine
 Decrease sweating
 antihistamines (Benadryl), anti-nausea (meclazine, phenergan)
 Supplements
 Ephedrine (MaHuang), caffeine
 Control
Control Measures
Measures
 Water and sports drinks

 Salt

 Acclimatization
 OTSG
OTSG Guidance
Guidance for
for the
the Field
Field
Use
Use of
of Sports
Sports Drinks
Drinks
 Cool water is usually the best rehydration fluid
 Prolonged training and operational scenarios
 carbohydrates and electrolytes are also required for optimal
physical and mental performance
 meals and snacks plus water are best
 When sports drinks are appropriate:
 duration > 6 hours, hot weather, if snacks/meals not consumed
 duration > 3 hours, strenuous exercise, if snacks, meals not
consumed
 duration > 6 hours strenuous exercise, if total food intake is
significantly limited
 Sports
Sports Drink
Drink
Recommendations
Recommendations
INGREDIENT Amount per 8 ounces (as served)
Sodium 55-160 mg
Potassium 20-55 mg
Carbohydrate 11-19 gm
 Acclimatization
Acclimatization
 Physiologic adaptation that occurs in response to heat exposure in
a natural environment
 5 days for most
 14 days required for 95% of population to have complete acclimatization.
 Can deacclimatize as quickly
 Results:
 sweat at lower temperature
 increased volume of sweat
 decrease in amount to salt secreted in sweat
 increased heat dissipation = lower core body temperature
 End result: Decreased risk for heat injury!
 Fluid
Fluid Replacement
Replacement Guidelines
Guidelines for
for
Warm
Warm Weather
Weather Training
Training
(Average Acclimated Soldier Wearing BDU, Hot Weather)

WBGT Easy Work Moderate Work Hard Work

Heat Index, °F
Category
Work Water Work Water Work Water
/Rest Intake,Qt/ /Rest Intake, /Rest Intake,
h Qt/h Qt/h
1 78-81.9 NL ½ NL ¾ 40/20 min ¾
2 82-84.9 NL ½ 50/10 min ¾ 30/30 min 1
(Green)
3 85-87.9 NL ¾ 40/20 min ¾ 30/30 min 1
(Yellow
4 88-89.9 NL ¾ 30/30 min ¾ 20/40 min 1
(Red)
5 > 90 50/10 min 1 20/40 min 1 10/50 min 1
(Black)

 The work/rest times and fluid replacement volumes will sustain performance and hydration for at least 4
hours of work in the specified heat category. Individual water needs will vary ± ¼ quart/hour.
 NL = no limit to work time per hour.
 Rest means minimal physical activity (sitting or standing) and should be accomplished in shade if possible.
 Caution: Hourly fluid intake should not exceed 1½ quarts.
 Daily fluid intake should not exceed 12 quarts.
 Wearing body armor add 5°F to WBGT Index.
 Wearing MOPP overgarment add 10°F to WBGT Index.
 An acclimitized soldier is one who has worked in the given heat conditions for 10-14 days
 Examples:
Easy Work Moderate Work Hard Work
• Weapon Maintenance • Walking Loose Sand at 2.5 mph, No Load • Walking Hard Surface at 3.5 mph,
• Walking Hard Surface at 2.5 • Walking Hard Surface at 3.5 mph, <40 lb >40 lb Load
mph, <30 lb Load Load
• Manual of Arms • Calisthenics • Walking Loose Sand at 2.5 mph
• Marksmanship Training • Patrolling with Load
• Drill and Ceremony • Individual Movement Techniques, i.e. low
crawl, high crawl
• Defensive Position Construction
• Field Assaults
Questions?