HEAT INJURIES

Types of Heat Injury

Heat Cramps Heat Exhaustion Heat Stroke

Heat 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 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

Treatment

Heat Exhaustion

Symptoms:

heavy sweating, headache, light-headed, nausea/vomiting, tingling sensations Temperature 99-104 F dehydration plus excessive salt depletion shaded environment; loosen clothing If suspect early heat stroke, treat as such oral fluids if can drink

Cause:

Treatment:

cold water, 0.1% salt solution, or 6% carbohydrate beverage 1-2 liters over 2-4 hours EVAC

Heat 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 of Heat Stroke

ABC

Unconscious patient may vomit and aspirate IV: no more than 2L unless circulatory collapse 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. USASOC and TB MED do not recommend Wilderness Medicine, 3rd ed. supports

Lower the body temperature as fast as possible!

Ice-water immersion: controversial

Risk Factors for Heat 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 antihistamines (Benadryl), anti-nausea (meclazine, phenergan)

Decrease sweating

Supplements

Ephedrine (MaHuang), caffeine

Control Measures

Water and sports drinks Salt

Acclimatization

OTSG Guidance for the Field Use of Sports 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 Drink Recommendations

INGREDIENT Amount per 8 ounces (as served)

Sodium Potassium Carbohydrate

55-160 mg 20-55 mg 11-19 gm

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 sweat at lower temperature increased volume of sweat decrease in amount to salt secreted in sweat increased heat dissipation = lower core body temperature

Results:

End result: Decreased risk for heat injury!

Fluid Replacement Guidelines for Warm Weather Training

(Average Acclimated Soldier Wearing BDU, Hot Weather)
Heat Category WBGT Index, F Easy Work Moderate Work Hard Work Work /Rest 1 2 (Green) 3 (Yellow 4 (Red) 5 (Black) 78-81.9 82-84.9 85-87.9 88-89.9 > 90 NL NL NL NL 50/10 min Water Intake,Qt/ h 1 Work /Rest NL 50/10 min 40/20 min 30/30 min 20/40 min Water Intake, Qt/h 1 Work /Rest 40/20 min 30/30 min 30/30 min 20/40 min 10/50 min Water Intake, Qt/h 1 1 1 1

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 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 1 quarts. Daily fluid intake should not exceed 12 quarts.
Wearing body armor add 5F to WBGT Index. Wearing MOPP overgarment add 10F 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?